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Test ID BLYM B-Cell Lymphoma, FISH, Tissue


Ordering Guidance


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

 

This assay detects chromosome abnormalities observed in paraffin-embedded tissue samples of patients with B-cell lymphoma. If a blood or bone marrow specimen is submitted, the test will be canceled and BLPMF / B-Cell Lymphoma, Specified FISH, Varies will be added and performed as the appropriate test.

 

If either the break-apart MYC or the MYC/IGH D-FISH probe sets are requested in isolation, both probe sets will be performed concurrently to optimize the detection of MYC rearrangements.



Shipping Instructions


Advise Express Mail or equivalent if not on courier service.



Necessary Information


1. A reason for testing and pathology report are required for testing to be performed. Send information with specimen. Acceptable pathology reports include working drafts, preliminary pathology or surgical pathology reports. The laboratory will not reject testing if a reason for testing is not provided; however, appropriate testing and interpretation may be compromised or delayed. If not provided, an appropriate indication for testing may be entered by Mayo Clinic Laboratories.

2. If the patient is being tracked for known abnormalities, an indication of which probes should be used is required for testing to be performed. See Table in Clinical Information.



Specimen Required


Submit only 1 of the following specimens:

 

Specimen Type: Tissue

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.

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: Tissue slides

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


Forms

If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.

Secondary ID

65878

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 lymphomas

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
_PRAA Probe, Each Additional (BLYM) No, (Bill Only) No

Testing Algorithm

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.

 

A charge and CPT code is applied for each probe set hybridized, analyzed, and reported.

 

If, based on testing algorithms, results of the initial probe sets require reflex testing, complete results will be available within 10 days.

 

The following algorithms are available:

-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, Tissue

Specimen Type

Tissue

Specimen Minimum Volume

See Specimen Required

Specimen Stability Information

Specimen Type Temperature Time
Tissue Ambient (preferred)
  Refrigerated 

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). Fluorescence in situ hybridization (FISH) permits the detection of recurrent gene rearrangements associated with various chromosome translocations and inversions in B-cell lymphoma. FISH is available for the specific B-cell lymphoma subtypes; see Table.

 

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, "double-hit"

8q24.1 rearrangement

5'/3' MYC

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

MYC/IGH

----Reflex: t(8;22)(q24.1;q11.2)

MYC/IGL

----Reflex: t(2;8)(p12;q24.1)

IGK/MYC

----Reflex: 3q27 rearrangement

3'/5' BCL6

----Reflex: 18q21 rearrangement

3'/5' BCL2

Large BCL IRF4 rearranged

6p24.3 rearrangement

5’/3' IRF4

18q21 rearrangement

3'/5' BCL2

3q27 rearrangement

3'/5' BCL6

Follicular

18q21 rearrangement

3'/5' BCL2

3q27 rearrangement

3'/5' BCL6

Predominantly diffuse subtype only: deletion of 1p36

TNFRSF14/1q22

Mantle cell

t(11;14)(q13;q32)

CCND1/IGH

11q13 rearrangement

5'/3' CCND1

Blastoid subtype only: deletion of 17p

TP53/D17Z1

Blastoid subtype only: 8q24.1 rearrangement

5'/3' MYC

Cyclin D1-negative subtype only: 12p13.32 rearrangement

5'/3' CCND2

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.

Cautions

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

 

Fixatives other than formalin (eg, Prefer, Bouin) may not be successful for fluorescence in situ hybridization assays.

 

Bone specimens that have been decalcified will be attempted for testing, but the success rate is approximately 50%.

Day(s) Performed

Monday through Friday

Report Available

4 to 10 days

Performing Laboratory

Mayo Clinic 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 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)

NY State Approved

Yes