Back-to-Back Comparison of Third-Generation Sequencing and Next-Generation Sequencing in Carrier of Thalassemia

center dot Context.-Recently, new technologies, such as nextgeneration sequencing and third -generation sequencing, have been used in carrier screening of thalassemia. However, there is no direct comparison between the 2 methods in carrier screening of thalassemia. Objective.-To compare the clinical performance of third -generation sequencing with next -generation sequencing in carrier screening of thalassemia. Design.-Next-generation sequencing and third -generation sequencing were simultaneously conducted for 1122 individuals in Hainan Province. Results.-Among 1122 genetic results, 1105 (98.48%) were concordant and 17 (1.52%) were discordant between the 2 methods. Among the 17 discordant results, 4 were common thalassemia variants, 9 were rare thalassemia variants, and 4 were variations with unknown pathogenicity. Sanger sequencing and polymerase chain reaction for discordant samples confirmed all the results of thirdgeneration sequencing. Among the 685 individuals with common and rare thalassemia variants detected by third generation sequencing, 512 (74.74%) were carriers of athalassemia, 110 (16.06%) were carriers of b-thalassemia, and 63 (9.20%) had coinheritance of a-thalassemia and bthalassemia. Three thalassemia variants were reported for the first time in Hainan Province, including -THAI, -a2.4, and aaaaanti3.7. Eleven variants with potential pathogenicity were identified in 36 patients with positive hemoglobin test results. Among 52 individuals with negative hemoglobin test results, 17 were identified with thalassemia variants. In total, third -generation sequencing and nextgeneration sequencing correctly detected 763 and 746 individuals with variants, respectively. Third -generation sequencing yielded a 2.28% (17 of 746) increment compared with next -generation sequencing. Conclusions.-Third-generation sequencing was demonstrated to be a more accurate and reliable approach in carrier screening of thalassemia compared with nextgeneration sequencing. (Arch Pathol Lab Med. 2024;148:797-804; doi: 10.5858/ arpa.2022-0168-OA)