Test Catalog

Test ID: LCMS    
Leukemia/Lymphoma Immunophenotyping by Flow Cytometry

Useful For Suggests clinical disorders or settings where the test may be helpful

Evaluating lymphocytoses of undetermined etiology

 

Identifying B- and T-cell lymphoproliferative disorders involving blood and bone marrow

 

Distinguishing acute lymphoblastic leukemia (ALL) from acute myeloid leukemia (AML)

 

Immunologic subtyping of ALL

 

Distinguishing reactive lymphocytes and lymphoid hyperplasia from malignant lymphoma

 

Distinguishing between malignant lymphoma and acute leukemia

 

Phenotypic subclassification of B- and T-cell chronic lymphoproliferative disorders, including chronic lymphocytic leukemia, mantle cell lymphoma, and hairy cell leukemia

 

Recognizing AML with minimal morphologic or cytochemical evidence of differentiation

 

Recognizing monoclonal plasma cells

Reflex Tests Lists tests that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial tests.

Test IDReporting NameAvailable SeparatelyAlways Performed
VBETATCR V-BETANo, (Bill Only)No
FCINTFlow Cytometry Interp, 2-8 MarkersNo, (Bill Only)No
FCIMSFlow Cytometry Interp, 9-15 MarkersNo, (Bill Only)No
FCINSFlow Cytometry Interp,16 or greaterNo, (Bill Only)No
AMLFAML, FISHYesNo

Additional Tests Lists tests that are always performed, at an additional charge, with the initial tests.

Test IDReporting NameAvailable SeparatelyAlways Performed
FIRSTFlow Cytometry, Cell Surface, FirstNo, (Bill Only)Yes
ADD1Flow Cytometry, Cell Surface, AddlNo, (Bill Only)Yes

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

The testing process begins with a screening panel. The screening panel will be charged based on the number of markers tested (FIRST for first marker, ADD1 for each additional marker). The interpretation will be based on markers tested in increments of 2 to 8, 9 to 15, or 16 and greater. In addition, reflex testing may occur to fully characterize a disease state or clarify any abnormalities from the screening test. Reflex tests will be performed at an additional charge for each marker tested (FIRST if applicable, ADD1 if applicable).

 

In addition to reflexing flow cytometric panels, AML FISH testing for PML-RARA translocation t(15;17) may be added by the Mayo Clinic pathologist  to exclude acute promyelocytic leukemia if there is morphologic suspicion or if blasts and promyelocytes are CD34-negative and HLA-DR-negative.

 

The triage panel is initially performed to evaluate for monotypic B cells by kappa and lambda light chain expression, increased numbers of blast cells by CD34 and CD45 expression along with side scatter gating, and increased plasma cells by CD45 expression and side scatter gating. The triage panel also includes antibodies to assess the number of CD3-positive T cells and CD16-positive/CD3-negative natural killer (NK) cells present. This triage panel also determines if there is an increase in the number of T cells that aberrantly coexpress CD16, an immunophenotypic feature of T-cell granular lymphocytic leukemia.

 

This panel, together with the provided clinical history and morphologic review, is used to determine what, if any, additional testing is needed for disease diagnosis or classification. If additional testing is required, it will be added per the algorithm to fully characterize a disease state with a charge per unique antibody tested.

 

If no abnormalities are detected by the initial panel, no further flow cytometric assessment will be performed unless otherwise indicated by specific features of the clinical presentation or prior laboratory results.

 

Additional FISH or molecular testing may be recommended by the Mayo pathologist to facilitate diagnosis. The referring physician or pathologist will be contacted to confirm the addition of any of these tests. Cytogenetic FISH Studies:

-CCND1/IGH translocation t(11;14), to exclude mantle cell lymphoma in cases of CD5+CD23- B-cell lymphoproliferative disorder.

-TCL-1 break-apart at 14q32, to exclude T-cell prolymphocytic leukemia in cases with CD4-positive T-cell lymphoproliferative disorder (phenotypic aberrancy or very tight CD4+ population with high CD4:CD8 ratio).

-MYC break-apart at 8q24, with or without IGH-BCL2 t(14;18) and BCL6 break-apart at 3q27, for suspected high grade B-cell lymphomas, based on morphologic assessment and immunophenotype (usually CD10-positive).

 

Molecular Genetic Studies:

-T-cell receptor gene rearrangement to examine clonality of T cells in cases showing phenotypically aberrant T-cell population.

 

Cytochemical Stains:

-Confirmatory cytochemical stains as needed.

 

The following algorithms are available in Special Instructions:

-Bone Marrow Staging for Known or Suspected Malignant Lymphoma Algorithm

-Acute Promyelocytic Leukemia: Guideline to Diagnosis and Follow-up

Special Instructions Library of PDFs including pertinent information and forms related to the test

Method Name A short description of the method used to perform the test

Immunophenotyping

NY State Available Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name Lists a shorter or abbreviated version of the Published Name for a test

Leukemia/Lymphoma, Phenotype

Aliases Lists additional common names for a test, as an aid in searching

Acute Leukemia -- Immunophenotyping, Flow Cytometry
B cell antigen
B cells, hematologic
B-cell clonality
Bone Marrow Consultation
Chronic Lymphocytic Leukemia, Immunophenotyping, Flow Cytometry
Flow Cytometry, Leukemia Immunophenotyping
Flow Cytometry, Lymphoma Immunophenotyping
Leukemia Immunophenotyping
Lymphocytoflow
Lymphoma Immunophenotyping by Flow Cytometry
Plasma cell clonality
T-cell clonality
T-cell receptor (TCR) flow cytometry
Vbeta T-cell clonality
Anti-kappa
Anti-lambda
GLL Panel - Leukemia Immunophenotyping (ALWAYS order LCMS)
Granular Lymphocytic Leukemia (ALWAYS order LCMS)
KIR Panel - Leukemia Immunophenotyping (ALWAYS order LCMS)
LGL Panel - Leukemia Immunophenotyping (ALWAYS order LCMS)
NK Panel - Leukemia Immunophenotyping (ALWAYS order LCMS)
B-cell ALL minimal residual disease (MRD) detection
Mast Cell
Leukemia Lymphoma