e13052 Background: Although multiplex PCR is still the golden standard technology for detecting microsatellite instability (MSI), it has some disadvantages. Firstly, its results are not quantized, and the interpretation of results can be varying for different operators. Secondly, PCR requires extra sample amount and may affect the sample amount for next-generation sequencing (NGS). So we developed a method to detect MSI status from NGS data. Methods: We developed a tool called VisualMSI, which simulates the PCR behaviors to detect the instability level of microsatellite loci. For each microsatellite locus, a pair of PCR primers are simulated by extracting the sequence from reference genome. The read pairs covering this microsatellite locus will be merged first, and then the simulated PCR primers will be mapped to the merged sequences to evaluate the inserted length. For paired tumor/normal samples, VisualMSI evaluates the earth mover's distance (EMD) between the inserted length distributions of tumor and normal. MSI status is determined by the EMD value, and is also visualized on a HTML page for manual validation. As a comparison, the MSI was also evaluated using a multiplex PCR comprising 5 loci (NR27, NR21, NR24, BAT25, and BAT26). Results: To evaluate the concordance of VisualMSI results and PCR-based results, we enrolled a group of 92 patients (39 lung cancers, 33 colorectal cancers and 20 others). For each patient, a tumor tissue sample and a blood sample were collected. White blood cells from the blood samples were also sequenced as normal control. For each patient, the 5 major MSI loci, including BAT-25, BAT-26, NR-21, NR-24 and NR-27 were evaluated by VisualMSI from NGS data, and by PCR. MSI status was categorized as MSI-H or MSI-L for each MSI locus. Finally, for the total 460 MSI loci, the VisualMSI and PCR results were concordant for 425 of them (92.39%), and were not concordant for the rest 35 (7.61%). The sensitivity is 89% (95% CI) and the specificity is 95% (95% CI), indicating that they were highly consistent. Conclusions: We developed a tool for detecting and visualizing MSI status from NGS data. The data shows that results of VisualMSI and PCR are highly concordant. This tool is now open-sourced at: https://github.com/OpenGene/VisualMSI.