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Test Code LABBLYMF B-Cell Lymphoma, FISH, Tissue

Additional Codes

Test Name in EPIC EPIC Test Code Mnemonic Mayo Test ID
B-CELL LYMPHOMA, FISH, TISSUE LABBLYMF BLYMF BLYMF

 

Useful For

Detecting a neoplastic clone associated with the common chromosome abnormalities seen in patients with various B-cell lymphomas using tissue specimens

 

Tracking known chromosome abnormalities and response to therapy in patients with B-cell lymphomas

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
_PBCT Probe, +2 No, (Bill Only) No
_PADD Probe, +1 No, (Bill Only) No
_PB02 Probe, +2 No, (Bill Only) No
_PB03 Probe, +3 No, (Bill Only) No
_IL25 Interphases, <25 No, (Bill Only) No
_I099 Interphases, 25-99 No, (Bill Only) No
_I300 Interphases, >=100 No, (Bill Only) No

Testing Algorithm

This test does not include a pathology consultation. If a pathology consultation is desired, PATHC / Pathology Consultation should be ordered and the appropriate FISH test will be ordered and performed at an additional charge. Mayo Hematopathology Consultants are involved in both the preanalytic (tissue adequacy and probe selection, when applicable) and postanalytic (interpretation of FISH results in context of specific case, when applicable) phases.

 

This test includes a charge for application of the first probe set (2 FISH probes) and professional interpretation of results. Additional charges will be incurred for all reflex probes performed. Analysis charges will be incurred based on the number of cells analyzed per probe set. If no cells are available for analysis, no analysis charges will be incurred.

 

Depending on the lymphoma subtype suspected, the most appropriate probes to order are listed in the table: Common Chromosome Abnormalities in B-cell Lymphomas in Clinical Information.

 

If the patient is being tracked for known abnormalities, indicate which probes should be used. If pathology report indicates T-cell lineage and IRF4 probe is requested, this test will be cancelled and IRF4F / Cutaneous Anaplastic Large Cell Lymphoma, 6p25.3 (DUSP22 or IRF4) Rearrangement, FISH, Tissue will be performed as the appropriate test.

 

The following algorithms are available in Special Instructions:

-Aggressive B-cell Lymphoma Diagnostic Algorithm

-Gastric MALT Lymphoma Diagnostic Algorithm

-Gastric MALT Posttherapy Follow-up Algorithm

Method Name

Fluorescence In Situ Hybridization (FISH)

Reporting Name

B-cell Lymphoma, FISH, Ts

Specimen Type

Tissue


Advisory Information


This assay detects chromosome abnormalities observed in paraffin-embedded tissue samples of patients with B-cell lymphoma. For testing the blood and bone marrow from patients with B-cell lymphoma, see BLPF / B-Cell Lymphoma, FISH, Blood or Bone Marrow.

 

If pathology report indicates T-cell lineage and IRF4 probe is requested, testing will automatically be converted to the IRF4F / Cutaneous Anaplastic Large Cell Lymphoma, 6p25.3 (DUSP22 or IRF4) Rearrangement, FISH, Tissue.

 

If requesting this test for FISH testing for anaplastic large cell (ALK) lymphoma, it must be ordered as TLYMF / T-Cell Lymphoma, FISH, Tissue.



Shipping Instructions


Advise Express Mail or equivalent if not on courier service.



Necessary Information


Provide a reason for referral and pathology report with each specimen. The laboratory will not reject testing if this information is not provided, but appropriate testing and interpretation may be compromised or delayed.



Specimen Required


Submit only 1 of the following specimens:

 

Specimen Type: Lymph node

Preferred: Tissue block

Collection Instructions: Submit a formalin-fixed, paraffin-embedded (FFPE) tumor tissue block. Blocks prepared with alternative fixation methods may be acceptable; provide fixation method used.

Acceptable: Slides

Collection Instructions: For each probe set ordered, 2 consecutive, unstained, 5 micron-thick sections placed on positively charged slides, and 1 hematoxylin and eosin-stained slide.

 

Specimen Type: Solid tumor

Preferred: Tissue block

Collection Instructions: Submit a formalin-fixed, paraffin-embedded (FFPE) tumor tissue block. Blocks prepared with alternative fixation methods may be acceptable; provide fixation method used.

Acceptable: Slides

Collection Instructions: For each probe set ordered, 2 consecutive, unstained, 5 micron-thick sections placed on positively charged slides, and 1 hematoxylin and eosin-stained slide.


Specimen Minimum Volume

See Specimen Required.

Specimen Stability Information

Specimen Type Temperature Time
Tissue Ambient (preferred)
  Refrigerated 

Reject Due To

No specimen should be rejected.

Clinical Information

Mature B-cell lymphoma can be low grade, intermediate grade, or high grade, and the prognosis and clinical course are highly variable. Genetic abnormalities have emerged as one of the most important prognostic markers in B-cell lymphomas and can aid in diagnosis. Several chromosome abnormalities and variants of these abnormalities have been associated with various lymphoma subtypes (see table). Conventional chromosome studies cannot be employed on paraffin-embedded tissue, and molecular genetic analyses are often problematic in the study of lymphomas. FISH permits the detection of abnormal gene associated with various chromosome translocations and inversions in B-cell lymphoma (see table).

 

Common Chromosome Abnormalities in B-cell Lymphomas

 Lymphoma Type

 Chromosome Abnormality

  FISH Probe

Burkitt (pediatric,

≤18 years old)

8q24.1 rearrangement

5'/3' MYC

t(2;8)(p12;q24.1)

IGK/MYC

t(8;14)(q24.1;q32)

MYC/IGH

t(8;22)(q24.1;q11.2)

MYC/IGL

3q27 rearrangement

3'/5' BCL6

18q21 rearrangement

3'/5' BCL2

Diffuse large B-cell,

Burkitt-like "double-hit"

8q24.1 rearrangement

5'/3' MYC

t(8;14)(q24.1;q32)

MYC/IGH

    Reflex: t(2;8)(p12;q24.1)

IGK/MYC

    Reflex: t(8;22)(q24.1;q11.2)  

MYC/IGL

    Reflex: 3q27 rearrangement

3'/5' BCL6

    Reflex: 18q21 rearrangement

3'/5' BCL2

Large BCL with IRF4 Rearranged

6p24.3 rearrangement

3'/5' IRF4

18q21 rearrangement

3'/5' BCL2

3q27 rearrangement

3'/5' BCL6

Follicular

18q21 rearrangement

3'/5' BCL2

3q27 rearrangement

3'/5' BCL6

Mantle Cell

t(11;14)(q13;q32)

CCND1/IGH

Blastoid subtype only: deletion of 17p

TP53/D17Z1

Blastoid subtype only: 8q24.1 rearrangement

5'/3' MYC

MALT

18q21 rearrangement

5'/3' MALT1

Splenic Marginal Zone

Deletion of 7q

D7Z1/7q32

Deletion of 17p

TP53/D17Z1

Reference Values

An interpretive report will be provided.

Interpretation

A neoplastic clone is detected when the percent of cells with an abnormality exceeds the normal reference range for any given probe.

 

Detection of an abnormal clone is supportive of a diagnosis of a B-cell lymphoma. The specific abnormality detected may help subtype the neoplasm.

 

The absence of an abnormal clone does not rule out the presence of a neoplastic disorder.

Cautions

This test is not approved by the U.S. Food and Drug Administration and it is best used as an adjunct to existing clinical and pathologic information.

 

Fixatives other than formalin (eg, Prefer, Bouin) may not be successful for FISH assays.

 

Paraffin-embedded tissues that have been decalcified are generally unsuccessful for FISH analysis. The pathologist reviewing the hematoxylin and eosin-stained slide may find it necessary to cancel testing.

Supportive Data

Each probe was independently tested on a set of formalin-fixed, paraffin-embedded tissue specimens from patients diagnosed with a B-cell lymphoma and noncancerous lymph node specimens. Normal cutoffs were calculated based on the results from 25 normal specimens. For each probe set, a series of chromosomally abnormal specimens were evaluated to confirm each probe set detected the anomaly it was designed to detect.

Method Description

This test is performed using either commercially available or laboratory-developed probes. Rearrangements involving MYC, BCL2, BCL6, CCND2, or MALT1 are detected using dual-color break-apart (BAP) strategy probes, translocations involving MYC, MALT1, or CCND1/IGH are identified using dual-color, dual-fusion (D-FISH) strategy probes, and deletions (7q32 or TP53) using enumeration strategy probes. Formalin-fixed, paraffin-embedded tissues are cut at 5 microns and mounted on positively charged glass slides. The selection of tissue and the target areas on the hematoxylin and eosin (H and E)-stained slide is performed by a pathologist. Using the H and E-stained slide as a reference, target areas are etched with a diamond-tipped etcher on the back of the unstained slide to be assayed. The probe set is hybridized to the appropriate target areas and 2 technologists each analyze 100 interphase nuclei (200 total) with the results expressed as the percent abnormal nuclei.(Unpublished Mayo method)

Day(s) and Time(s) Performed

Samples processed Monday through Sunday. Results reported Monday through Friday, 8 a.m.-5 p.m.

Analytic Time

4 days

Specimen Retention Time

Slides and H and E used for analysis are retained by the lab indefinitely. Client provided paraffin blocks and extra unstained slides (if provided) will be returned after testing is complete.

Performing Laboratory

Mayo Medical Laboratories in Rochester

Test Classification

This test was developed using an analyte specific reagent. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

88271x2, 88291 – DNA probe, each (first probe set), Interpretation and report

88271x2 – DNA probe, each; each additional probe set (if appropriate)

88271x1 – DNA probe, each; coverage for sets containing 3 probes (if appropriate)

88271x2 – DNA probe, each; coverage for sets containing 4 probes (if appropriate)

88271x3 – DNA probe, each; coverage for sets containing 5 probes (if appropriate)

88274 w/modifier 52 – Interphase in situ hybridization, <25 cells, each probe set (if appropriate)

88274 – Interphase in situ hybridization, 25 to 99 cells, each probe set (if appropriate)     

88275 – Interphase in situ hybridization, 100 to 300 cells, each probe set (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
BLYMF B-cell Lymphoma, FISH, Ts In Process

 

Result ID Test Result Name Result LOINC Value
52058 Result Summary 50397-9
54647 Interpretation 69965-2
54646 Result Table No LOINC Needed
54572 Result In Process
CG727 Reason for Referral 42349-1
CG728 Specimen 31208-2
52059 Source 31208-2
52060 Tissue ID In Process
52061 Method 49549-9
55119 Additional Information 48767-8
53843 Disclaimer 62364-5
52062 Released By 18771-6

Forms

If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request Form (T726) with the specimen (http://www.mayomedicallaboratories.com/it-mmfiles/hematopathology-request-form.pdf)