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To the Editor: Dr Smith-Bindman and colleagues ¹ have summarized a large amount of potentially useful data but, I believe, have misinterpreted or ignored data that support the use of ultrasonographic markers of Down syndrome. The results of their meta-analysis show that most ultrasonographic markers as isolated findings are statistically associated with an increased risk for fetal Down syndrome (2.8- to 17-fold greater). Furthermore, the combination of anomalies and markers were identified in 69% of fetuses with trisomy 21 (Table 3). This is consistent with other centers reporting detection rates of 59% to 82% ⁴ when markers are combined with structural anomalies (observed in less than 20% of affected fetuses before 20 weeks at most centers).^2-3 Even using outdated assumptions, the authors found a benefit for all markers except choroid plexus cyst among high-risk patients (defined as a relatively low risk of 1 in 300).

In addition, the authors assume a prevalence . . . [Full Text of this Article]

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RELATED ARTICLE

Second-Trimester Ultrasound to Detect Fetuses With Down Syndrome: A Meta-analysis
Rebecca Smith-Bindman, Wylie Hosmer, Vickie A. Feldstein, Jonathan J. Deeks, and James D. Goldberg
JAMA. 2001;285(8):1044-1055.
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