Abstract
Nucleic acid-based technologies have opened new perspectives in diagnosis, prognosis, and treatment in clinical medicine. To maintain patient confidence in this rapidly expanding field and to provide the highest standard of analysis, strict laboratory quality assurance procedures must be followed. While impressive break-through are taking place in this field, the need for an appropriate and suitable quality assurance (QA) plan for nucleic acid-based diagnostic laboratories must be a top priority. In this study, we developed a systematic QA plan for this kind of diagnostic laboratories that would enable us to assure the highest quality standards of their services. We focus on those labs that would like to start introducing a quality system for the first time and discuss the most appropriate ways to pave the way to implement a QA plan from the beginning. This QA plan is suitable for any nucleic acid-based techniques laboratory regardless of the field or services provided.
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References
Cowan TM, Strovel ET (2008) Management and quality assurance in the biochemical genetics laboratory. Curr Protoc Hum Genet 17:Unit 17.7
Neumaier M, Braun A, Wagener C (1998) Fundamentals of quality assessment of molecular amplification methods in clinical diagnostics. Clin Chem 44:12–26
Orlando C, Verderio P, Maatman R, Danneberg J, Ramsden S, Neumaier M, Taruscio D, Falbo V, Jansen R, Casini-Raggi C, Malentacchi F, Marubini E, Pizzamiglio S, Vernelen K, Libeer JC, Palicka V, Pazzagly M (2007) EQUAL-qual: a European program for external quality assessment of genomic DNA extraction and PCR amplification. Clin Chem 53:1349–1357
Libeer JC (2001) Role of external quality assurance schemes in assessing and improving quality in medical laboratories. Clin Chim Acta 20:173–177
Ramsden SC, Daly S, Geilenkeuser WJ, Duncan G, Hermitte F, Marubini E, Neumaier M, Orlando C, Palicka V, Paradiso A, Pazzagli M, Pizzamiglio S, Verderio P (2006) EQUAL-quant: an international external quality assessment scheme for real-time PCR. Clin Chem 52:1584–1591
Chen B, O’Connell CD, Boone DJ, Amos JA, Beck JC, Chan MM, Farkas DH, Lebo RV, Richards CS, Roa BB, Silverman LM, Barton DE, Pejjani BA, Belloni DR, Bernacki SH, Caggana M, Charache P, Dequeker E, Ferreira-Gonzalez A, Friedman KJ, Greene CK, Grody WW, Highsmith WE, Hinkel CS, Kalman LV, Lubin IM, Lyon E, Payne DA, Pratt VM, Rohlfs E, Rundell CA, Schneider E, Willey AM, Williams LO, Willey JC, Winn-Deen ES, Wolff DJ (2005) Developing a sustainable process to provide quality control material for genetic testing. Genet Med 7:534–549
Seabrook JM, Hubbard RA (2003) Achieving quality reproducible results and maintaining compliance in molecular diagnostic testing of human papillomavirus. Arch Pathol Lab Med 127:978–983
Stenhouse SAR, Middleton-Price H (1996) Molecular diagnosis of genetic diseases. Springer, Berlin
McGovern MM, Elles R, Beretta I, Somerville MJ, Hoefler G, Keinanen M, Barton D, Carson N, Dequeker E, Brdicka R, Blazkova A, Avme S, Schnieders B, Muller CR, Dalen V, Martines AA, Kristoffersson U, Ozguc M, Mueller H, Boone J, Lubin IM, Sequeiros J, Taruscio D, Williamson B, Mainland L, Yoshikura H, Ronchi E (2007) Report of an international survey of molecular genetic testing laboratories. Community Genet 10:123–131
Casini Raggi C, Pinzani P, Paradiso A, Pazzagli M, Orlando C (2003) External quality assurance program for PCR amplification of genomic DNA: an Italian experience. Clin Chem 49:782–791
Burkardt HJ (2000) Standardization and quality control of PCR analyses. Clin Chem Lab Med 38:87–91
Losekoot M, Bakker B, Laccone F, Stenhouse S, Elles R (1999) A European pilot quality assessment scheme for molecular diagnosis of Huntington’s disease. Eur J Hum Genet 7:217–222
Preston FE, Kitchen S, Jennings I, Woods TA (1999) A UK National External Quality Assessment scheme (UK NEQAS) for molecular genetic testing for the diagnosis of familial thrombophilia. Thromb Haemost 82:1556–1557
Lutz CT, Foster PA, Noll WW, Voelkerding KV, Press RD, McGlennen RC, Kirschbaum NE (1998) Multicenter evaluation of PCR methods for the detection of factor V Leiden (R506Q) genotypes. Clin Chem 44:1356–1358
Simoni M (2001) Molecular diagnosis of Y chromosome microdeletions in Europe: state-of-the-art and quality control. Hum Reprod 16:402–409
Valentine-Thon E, van Loon AM, Schirm J, Reid J, Klapper PE, Cleator GM (2001) European proficiency testing program for molecular detection and quantitation of hepatitis B virus DNA. J Clin Microbiol 39:4407–4412
Robertson JS (1998) International standardization of gene amplification technology. Biologicals 26:111–113
Lefrere JJ, Lerable J, Mariotti M, Bogard M, Thibault V, Frangeul L, Loiseau P, Bouchardeau F, Laperche S, Pawlotsky JM, Cantaloube JF, Biagini P, de Lamballerie X, Izopet J, Defer C, Lepot I, Poveda JD, Dussaix E, Gerolami V, Hafton P, Buffet-Janvresse C, Ferec C, Mercier B, Marcellin P, Martinot-Peignoux M, Gassain M (2000) Lessons from a multicentre study of the detectability of viral genomes based on a two-round quality control of GB virus C (GBV-C)/hepatitis G virus (HGV) polymerase chain reaction examination. J Virol Methods 85:117–124
Weber T, Klapper PE, Cleator GM, Bodemer M, Luke W, Knowles W, Cinque P, Van Loon AM, Grandien M, Hammarin AL, Ciardi M, Bogdanovic G (1997) Polymerase chain reaction for detection of JC virus DNA in cerebrospinal fluid: a quality control study. European Union Concerted Action on Viral Meningitis and Encephalitis. J Virol Methods 69:231–237
Hirsch HH, Bossart W (1999) Two-centre study comparing DNA preparation and PCR amplification protocols for herpes simplex virus detection in cerebrospinal fluids of patients with suspected herpes simplex encephalitis. J Med Virol 57:31–35
van Loon AM, Cleator GC, Ras A (1999) External quality assessment of enterovirus detection and typing. European Union concerted action on virus meningitis and encephalitis. Bull World Health Organ 77:217–223
Grundy JE, Ehrnst A, Einsele H, Emery VC, Hebart H, Prentice HG, Ljungman P (1996) A three-center European external quality control study of PCR for detection of cytomegalovirus DNA in blood. J Clin Microbiol 34:1166–1170
Nowicki MJ, Benning L, Bremer JW, Meyer WA III, Hanson C, Brambilla D, Silver S, Kovacs A (2001) Longitudinal variability of human immunodeficiency virus type 1 RNA viral load measurements by nucleic acid sequence-based amplification and NucliSens examinations in a large multicenter study. J Clin Microbiol 39:3760–3763
Pelloux H, Guy E, Angelici MC, Aspock H, Bessieres MH, Blatz R, Del Pezzo M, Girault V, Gratzl R, Holberg-Petersen M, Johnson J, Kruger D, Lappalainen M, Naessens A, Olsson M (1998) A second European collaborative study on polymerase chain reaction for Toxoplasma gondii, involving 15 teams. FEMS Microbiol Lett 165:231–237
Noordhoek GT, van Embden JD, Kolk AH (1996) Reliability of nucleic acid amplification for detection of Mycobacterium tuberculosis: an international collaborative quality control study among 30 laboratories. J Clin Microbiol 34:2522–2525
Bolufer P, Lo Coco F, Grimwade D, Barragan E, Diverio D, Cassinat B, Chomienne C, Gonzalez M, Colomer D, Gomez MT, Marugan I, Roman J, Delgado MD, Garcia-Marco JA, Bornstein R, Vizmanos JL, Martinez B, Jansen J, Villegas A, de Blas JM, Cabello P, Sanz MA (2001) Variability in the levels of PML-RAR α fusion transcripts detected by the laboratories participating in an external quality control program using several reverse transcription polymerase chain reaction protocols. Haematologica 86:570–576
Chevillard S, Vielh P, Validire P, Marie JP, Faussat AM, Barbu V, Bayle C, Benard J, Bonnal C, Boutonnat J, Calvo F, Charrier J, Clary A, Colosetti P, Danel-Moore L, Decremoux P, Delvincourt C, Finat-Duclos F, Genne P, Kataki A, Kouyoumdjian JC, Lacave R, Maugard C, Merlin JL, Robert J (1997) French multicentric evaluation of mdr1 gene expression by RT–PCR in leukemia and solid tumours. Standardization of RT–PCR and preliminary comparisons between RT–PCR and immunohistochemistry in solid tumours. French Network of the Drug Resistance Intergroup, and Drug Resistance Network of Assistance Publique-Hopitaux de Paris. Leukemia 11:1095–1106
Jannes G, De Vos D (2006) A review of current and future molecular diagnostic tests for use in the microbiology laboratory. Methods Mol Biol 345:1–21
Liu YT (2008) A technological update of molecular diagnostics for infectious diseases. Infect Disord Drug Targets 8:183–188
Richmond TD (2008) The current status and future potential of personalized diagnostics: Streamlining a customized process. Biotechnol Annu Rev 14:411–422
Clinical Laboratory Standard Institute (2008) GP29-A2. Assessment of laboratory tests when proficiency testing is not available. Approved guideline—CLSI, Wayne, PA
Carraro P, Plebani M (2007) Errors in a Stat Laboratory: types and frequencies 10 years later. Clin Chem 53:1338–1342
Ricos C, Garcia-Victoria M, de la Fuente B (2004) Quality indicators and specifications for the extra-analytical phases in clinical laboratory management. Clin Chem Lab Med 42:578–582
Acknowledgments
We acknowledge support by the International Atomic Energy Agency, through Consultant Meeting “Establish Guidelines of a Quality Assurance and Quality Control Network for Molecular Diagnosis and Genotype Identification of Insect-borne Diseases” and ARCAL LXXXII and RAS 6034 programs. We acknowledge anonymous reviewers of this manuscript for invaluable help in improving the quality of this work.
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Oliveira, D., Yap, S.F., Wongwanich, S. et al. Establishing a quality assurance plan for nucleic acid-based diagnostic laboratories: from planning to implementation. Accred Qual Assur 15, 89–97 (2010). https://doi.org/10.1007/s00769-009-0598-4
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DOI: https://doi.org/10.1007/s00769-009-0598-4