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Next-Generation Sequencing: From Basic Research to Diagnostics ...

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<strong>Next</strong>-<strong>Generation</strong> <strong>Sequencing</strong>ReviewsFig. 4. Pseudocolor image from the Illumina flow cell.Each fluorescence signal originates from a clonally amplified template cluster. Top panel illustrates 4 emission wavelengths offluorescent labels depicted in red, green, blue, and yellow. Images are processed <strong>to</strong> identify individual clusters and <strong>to</strong> removenoise or interference. The lower panel is a composite image of the 4 fluorescence channels.Sanger sequencing reflects not only the maturity of thechemistry but also the fact that a Sanger trace peakrepresents highly redundant, multiple terminated extensionreactions. Accuracy in NGS is achieved by sequencinga given region multiple times, enabled by themassively parallel process, with each sequence contributing<strong>to</strong> “coverage” depth. Through this process, a“consensus” sequence is derived. To assemble, align,and analyze NGS data requires an adequate number ofoverlapping reads, or coverage. In practice, coverageacross a sequenced region is variable, and fac<strong>to</strong>rs otherthan the Poisson-like randomness of library preparationthat may contribute <strong>to</strong> this variability include differentialligation of adapters <strong>to</strong> template sequences anddifferential amplification during clonal template generation(11, 70). Beyond sequence errors, inadequatecoverage can cause failure <strong>to</strong> detect actual nucleotidevariation, leading <strong>to</strong> false-negative results for heterozygotes(3, 11). Studies have shown that coverages of lessthan 20- <strong>to</strong> 30-fold begin <strong>to</strong> reduce the accuracy ofsingle-nucleotide polymorphism calls in data on the454 platform (65). For the Illumina system, higherClinical Chemistry 55:4 (2009) 651

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