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Test Code BLPF B-Cell Lymphoma, FISH, Blood or Bone Marrow

Useful For

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

 

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

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 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.

 

See Malignant Lymphoma, Guideline for Bone Marrow Staging Studies in Special Instructions.

 

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 no probes (or lymphoma subtype) are specified at the time of order, a panel of the following probe sets will be performed:

-8q24.1 rearrangement, MYC
-18q21 rearrangement, BCL2
-3q27 rearrangement, BCL6
-t(11;14), CCND1/IGH

-17p-, TP53/D17Z1
-18q21 rearrangement, MALT1

 

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

Method Name

Fluorescence In Situ Hybridization (FISH)

Reporting Name

B-cell Lymphoma, FISH, B/BM

Specimen Type

Varies


Specimen Required


Provide a reason for referral 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.

 

Advise Express Mail or equivalent if not on courier service.

 

Submit only 1 of the following specimens:

 

Specimen Type: Blood

Container/Tube: Green top (sodium heparin)

Specimen Volume: 7-10 mL

Collection Instructions:

1. Invert several times to mix blood.

2. Other anticoagulants are not recommended and are harmful to the viability of the cells. 

           

Specimen Type: Bone marrow

Container/Tube: Green top (sodium heparin)

Specimen Volume: 1-2 mL

Collection Instructions:

1. Invert several times to mix bone marrow.

2. Other anticoagulants are not recommended and are harmful to the viability of the cells.

 

Acceptable:

Specimen Type: Touch prep or fresh tissue


Specimen Minimum Volume

Blood: 2 mL; Bone Marrow: 1 mL

Specimen Stability Information

Specimen Type Temperature Time
Varies Ambient (preferred)
  Refrigerated 

Reject Due To

No specimen should be rejected. If specimen not received at appropriate temperature or in wrong anticoagulant, include note to laboratory. Contact the laboratory with questions.

Clinical Information

Lymphoid neoplasms are known to be complex and the prognosis and clinical course of patients with lymphoma is highly variable. Genetic abnormalities have emerged as one of the most reliable criteria for categorizing lymphomas. Several chromosome abnormalities and variants of these abnormalities have been associated with various kinds of 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

    Reflex: t(2;8)(p12;q24.1)

IGK/MYC

    Reflex: t(8;14)(q24.1;q32)

MYC/IGH

    Reflex: t(8;22)(q24.1;q11.2)  

MYC/IGL

    Reflex: 3q27 rearrangement

3’/5’ BCL6

    Reflex: 18q21 rearrangement

3’/5’ BCL2

Follicular

18q21 rearrangement

3’/5’ BCL2

3q27 rearrangement

3’/5’ BCL6

Mantle Cell

t(11;14)(q13;q32)

CCND1/IGH

    Reflex: 11q13 rearrangement

5’/3’ CCND1

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 supports a diagnosis of a B-cell neoplasm; the specific abnormality detected may help subtype the neoplasm

 

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

 

Bone marrow is the preferred sample type for this FISH test. If bone marrow is not available, a blood specimen may be used if there are malignant cells in the blood specimen (as verified by hematopathology).

 

This test is not appropriate for testing paraffin-embedded tissue samples from patients with B-cell lymphoma, see BLYMF / B-Cell Lymphoma, FISH, Tissue.

Supportive Data

Each probe was independently tested on a set of normal bone marrow control samples and bone marrow samples from patients diagnosed with a B-cell lymphoma. Normal cutoffs were calculated based on the results from 25 normal specimens. Each probe set was evaluated to confirm the probe set detected the abnormality it was designed to detect.

Clinical Reference

1. WHO Classification of Tumour of Haematopoietic and Lymphoid Tissues. Edited by SH Swerdlow, E Campo, NL Harris. IARC, Lyon 2008, pp 185-187, 214-217, 220-226, 229-237, 262-278

2. Remstein ED, Kurtin PJ, Buno I, et al: Diagnostic utility of fluorescence in situ hybridization in mantle-cell lymphoma. Br J Haematol 2000 Sep;110(4):856-862

3. Remstein ED, Kurtin PJ, James CD, et al: Mucosa-associated lymphoid tissue lymphomas with t(11;18) (q21;q21) and mucosa-associated lymphoid tissue lymphomas with aneuploidy develop along different pathogenetic pathways. Am J Pathol 2002 Jul;161(1):63-71

4. Remstein ED, Dogan A, Einerson RR, et al: The incidence and anatomic site specificity of chromosomal translocations in primary extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) in North America. Am J Surg Pathol 2006 Dec;30(12):1546-1553

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. For enumeration and BAP strategy probe sets, 200 interphase nuclei are scored; 500 interphase nuclei are scored when D-FISH probes are used. Two technologists analyze each probe set and the results are 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. to 5 p.m. CST.

Analytic Time

7 days

Specimen Retention Time

Four weeks

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
BLPF B-cell Lymphoma, FISH, B/BM In Process

 

Result ID Test Result Name Result LOINC Value
51900 Result Summary 50397-9
51902 Interpretation In Process
51901 Result Table No LOINC Needed
54546 Result No LOINC Needed
CG684 Reason for Referral 42349-1
CG685 Specimen 31208-2
51903 Source 31208-2
51904 Method 49549-9
54455 Additional Information 48767-8
53867 Disclaimer 62364-5
51905 Released by No LOINC Needed