Genomic structural variations (SVs) are genetic alterations that result in duplications, insertions, deletions, inversions, and translocations of segments of DNA covering 50 or more base pairs. By changing the organization of DNA, SVs can contribute to phenotypic variation or cause pathological consequences as neurobehavioral disorders, autoimmune diseases, obesity, and cancers. SVs were first examined using classic cytogenetic methods, revealing changes down to 3 Mb. Later techniques for SV detection were based on array comparative genome hybridization (aCGH) and single-nucleotide polymorphism (SNP) arrays. Next-generation sequencing (NGS) approaches enabled precise characterization of breakpoints of SVs of various types and sizes at a genome-wide scale. Dissecting SVs from NGS presents substantial challenge due to the relatively short sequence reads and the large volume of the data. Benign variants and reference errors in the genome present another dimension of problem complexity. Even though a wide range of tools is available, the usage of SV callers in routine molecular diagnostic is still limited. SV detection algorithms relay on different properties of the underlying data and vary in accuracy and sensitivity; therefore, SV detection process usually utilizes multiple variant callers. This chapter summarizes strengths and limitations of different tools in effective NGS SV calling
