title: Description and pilot results from a novel method for evaluating return of incidental findings from next-generation sequencing technologies.
abstract: OBJECTIVE
  The aim of this study was to develop, operationalize, and pilot test a transparent, reproducible, and evidence-informed method to determine when to report incidental findings from next-generation sequencing technologies.
  
  
  METHODS
  Using evidence-based principles, we proposed a three-stage process. Stage I "rules out" incidental findings below a minimal threshold of evidence and is evaluated using inter-rater agreement and comparison with an expert-based approach. Stage II documents criteria for clinical actionability using a standardized approach to allow experts to consistently consider and recommend whether results should be routinely reported (stage III). We used expert opinion to determine the face validity of stages II and III using three case studies. We evaluated the time and effort for stages I and II.
  
  
  RESULTS
  For stage I, we assessed 99 conditions and found high inter-rater agreement (89%), and strong agreement with a separate expert-based method. Case studies for familial adenomatous polyposis, hereditary hemochromatosis, and α1-antitrypsin deficiency were all recommended for routine reporting as incidental findings. The method requires <3 days per topic.
  
  
  CONCLUSIONS
  We establish an operational definition of clinically actionable incidental findings and provide documentation and pilot testing of a feasible method that is scalable to the whole genome.
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA. Katrina.AB.Goddard@kpchr.org
authors.forename: Katrina A B
authors.initials: KA
authors.lastname: Goddard
authors.forename: Evelyn P
authors.initials: EP
authors.lastname: Whitlock
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Berg
authors.forename: Marc S
authors.initials: MS
authors.lastname: Williams
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Webber
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Webster
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Lin
authors.forename: Kasmintan A
authors.initials: KA
authors.lastname: Schrader
authors.forename: Doug
authors.initials: D
authors.lastname: Campos-Outcalt
authors.forename: Kenneth
authors.initials: K
authors.lastname: Offit
authors.forename: Heather Spencer
authors.initials: HS
authors.lastname: Feigelson
authors.forename: Celine
authors.initials: C
authors.lastname: Hollombe
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000235:genetics; D059472:Exome; D005820:Genetic Testing; D006432:Hemochromatosis / Q000235:genetics; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D033162:Incidental Findings; D010865:Pilot Projects; D015203:Reproducibility of Results; D017422:Sequence Analysis, DNA; D019896:alpha 1-Antitrypsin Deficiency / Q000235:genetics
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