Home
HelpTest Code LABSSLFT Small Lymphocytic Lymphoma, FISH, Tissue
Additional Codes
| Test Name in EPIC | EPIC Test Code | Mnemonic | Mayo Test ID |
|---|---|---|---|
| Small Lymphocytic Lymphoma, FISH, Tissue | LABSLLFT | SLL | SLL |
Ordering Guidance
This test does not include a pathology consultation. If a pathology consultation is requested, order PATHC / Pathology Consultation and the appropriate fluorescence in situ hybridization test (FISH) test will be added 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 is not appropriate for testing blood and bone marrow from patients with chronic lymphocytic leukemia. If a non-paraffin embedded bone marrow or blood sample is received for this test, the test will be canceled and automatically reordered by the laboratory as CLLDF / Chronic Lymphocytic Leukemia (CLL), Diagnostic FISH, Varies or CLLMF / Chronic Lymphocytic Leukemia (CLL), Specified FISH, Varies.
Shipping Instructions
Advise Express Mail or equivalent if not on courier service.
Necessary Information
1. A pathology report is required for testing to be performed. If not provided, appropriate testing and/or interpretation may be compromised or delayed. Acceptable pathology reports include working drafts, preliminary pathology, or surgical pathology reports.
2. The following information must be included in the report provided:
-Patient name
-Block number-must be on all blocks, slides, and paperwork
-Date of collection
-Tissue source
3. A reason for testing must be provided. If this information is not provided, an appropriate indication for testing may be entered by Mayo Clinic Laboratories.
4. A list of probes is required if select probes are necessary or if the patient is being tracked for known abnormalities. See Table in Clinical Information.
Specimen Required
Submit only 1 of the following specimens:
Preferred:
Specimen Type: Tissue block
Collection Instructions:
1. Submit a formalin-fixed, paraffin-embedded tumor tissue block. Blocks prepared with alternative fixation methods will be attempted but are less favorable for successful results.
2. Provide fixation method used.
Additional Information:
1. Paraffin embedded specimens can be from any anatomic location (skin, soft tissue, lymph node, etc).
2. Bone specimens that have been decalcified will be attempted for testing, but the success rate is approximately 50%.
Acceptable:
Specimen Type: Tissue slides
Slides: 1 Hematoxylin and eosin stained and 2 unstained for each probe set
Collection Instructions:
1. Include 1 hematoxylin and eosin-stained slide for the entire test order.
2. If individual probe sets are chosen: For each probe set ordered, 2 consecutive, unstained, 5 micron-thick sections placed on positively charged slides.
3. If a complete small lymphocytic lymphoma (SLL) panel is ordered, submit 14 consecutive, unstained, 5 micron-thick sections placed on positively charged slides.
Useful For
Detecting, at diagnosis, recurrent common chromosome abnormalities in patients with small lymphocytic lymphoma (SLL) in paraffin-embedded tissue specimens
Distinguishing patients with 11;14 translocations who have mantle cell lymphoma from patients who have SLL
Detecting patients with atypical SLL with translocations between IGH and BCL3
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| _PRAG | Probe, Each Additional (SLL) | No, (Bill Only) | No |
Testing Algorithm
This test includes a charge for the probe application, analysis, and professional interpretation of results for one probe set (2 individual fluorescence in situ hybridization [FISH] probes). Additional charges will be incurred for all reflex or additional probe sets 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.
This test may be ordered in 2 distinct ways allowing different combinations of probes to be analyzed based on the clinical question.
1. Standard (diagnostic) small lymphocytic lymphoma (SLL) FISH panel
2. Individual SLL FISH probes chosen, per client request, from probes listed below
If individual SLL FISH probes are needed, the specific probes requested must be noted on the request form or in the reason for referral. If no FISH probes are indicated, the standard (diagnostic) panel will be performed.
The standard (diagnostic) SLL FISH panel includes testing for the following abnormalities using the FISH probes listed:
6q-, D6Z1/MYB probe set
11q-, D11Z1/ATM probe set
+12, D12Z3/MDM2 probe set
13q-, D13S319/LAMP1 probe set
17p-, TP53/D17Z1 probe set
t(11;14)(q13;q32) or IGH::CCND1 fusion, CCND1/IGH probe set
Appropriate ancillary probes may be performed at consultant discretion to render comprehensive assessment. Any additional probes used will have the results included within the final report and will be performed at an additional charge. In the following situations, additional (reflex) testing may be performed at the laboratory's discretion and may be influenced by available karyotype results or other FISH testing.
In the absence of IGH::CCND1 fusion, when an extra IGH signal is identified, testing using the IGH/BCL3 probe set may be performed to identify a potential IGH::BCL3 fusion, t(14;19)(q32;q13).
In the absence of IGH::CCND1 fusion, when an extra or atypical CCND1 signal is identified, testing using the CCND1 break-apart probe set may be performed to identify a potential variant translocation involving CCND1, t(11;var)(q13;?).
Method Name
Fluorescence In Situ Hybridization (FISH)
Reporting Name
SLL, FISH, TissueSpecimen Type
TissueSpecimen Minimum Volume
See Specimen Required.
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Tissue | Ambient (preferred) | |
| Refrigerated | ||
Reject Due To
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.Clinical Information
Small lymphocytic lymphoma (SLL) is the nonleukemic form of chronic lymphocytic leukemia (CLL), one of the most common leukemias in adults. The most frequently seen cytogenetic abnormalities in SLL involve chromosomes 6, 11, 12, 13, and 17. These are detected and quantified using the SLL fluorescence in situ hybridization (FISH) panel.
Cytogenetics has proven to be a reliable predictor of outcome for patients with CLL. It is unknown if SLL has the same prognostic significance when these genetic abnormalities are observed.
This FISH test detects an abnormal clone in approximately 65% of patients with SLL. Patients with t(11;14)(q13;q32) associated with IGH::CCND1 fusion, have mantle cell lymphoma which can be distinguished from SLL and other B-cell lymphomas with this assay. Patients with t(14;19)(q32;q13.3) associated with IGH::BCL3 fusion, may have an atypical form of SLL or another B-cell lymphoma.
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 set.
A positive result is not diagnostic for small lymphocytic lymphoma but may provide relevant prognostic information.
A negative result does not exclude the diagnosis an SLL clone or another neoplastic disorder.
Cautions
This test is not approved by the US Food and Drug Administration and is best used as an adjunct to existing clinical and pathologic information.
Fixatives other than formalin (eg, Prefer, Bouin's) may not be successful for fluorescence in situ hybridization (FISH) assays. Non-formalin fixed specimens will not be rejected.
Paraffin-embedded tissues that have been decalcified will be attempted but may not be successful for FISH analysis. The success rate of FISH studies on decalcified tissue is approximately 50%.
Fluorescent in situ hybridization studies will be attempted if sufficient tumor is present for analysis. The pathologist reviewing the hematoxylin and eosin-stained slide may find it necessary to cancel testing if insufficient tissue/tumor is available for testing.
If no FISH signals are observed post-hybridization, the case will be released indicating a lack of FISH results.
Method Description
This test is performed using commercially available and laboratory-developed probes. Deletion of chromosomes 6q, 11q, 13q, and 17p, and trisomy of chromosome 12 are detected using enumeration strategy probe sets. Rearrangements involving CCND1 are detected using a dual-color break-apart strategy probe set. A dual-color, dual-fusion fluorescence in situ hybridization (D-FISH) strategy probe set is used to detect IGH::CCND1 rearrangements and for reflex testing to identify IGH::BCL3 rearrangements.
Paraffin-embedded tissues are cut at 5 microns and mounted on positively charged glass slides. The selection of tissue and the identification of 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 engraving tool on the back of the unstained slide to be assayed. For each probe set, the probes are hybridized to the appropriate target areas and 2 technologists each analyze 50 interphase nuclei (100 total). All results are expressed as the percent abnormal nuclei.(Unpublished Mayo method)
Day(s) Performed
Report Available
7 to 10 daysSpecimen Retention Time
Slides used for analysis are retained by the laboratory in accordance with regulatory requirements. Client provided paraffin blocks and extra unstained slides (if provided) will be returned after testing is complete.Performing Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
88377-if 1 probe set
88377 x 2-if 2 probe sets
88377 x 3-if 3 probe sets
88377 x 4-if 4 probe sets
88377 x 5-if 5 probe sets
88377 x 6-if 6 probe sets
88377 x 7-if 7 probe sets
88377 x 8-if 8 probe sets
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| SLL | SLL, FISH, Tissue | 103621-9 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 603129 | Result Summary | 50397-9 |
| 603130 | Interpretation | 69965-2 |
| 603131 | Result Table | 93356-4 |
| 603132 | Result | 62356-1 |
| GC038 | Reason for Referral | 42349-1 |
| 603133 | Specimen | 31208-2 |
| 603134 | Source | 31208-2 |
| 603135 | Tissue ID | 80398-1 |
| 603136 | Method | 85069-3 |
| 603137 | Additional Information | 48767-8 |
| 603138 | Disclaimer | 62364-5 |
| 603139 | Released By | 18771-6 |
Forms
If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.