Evaluating lymphocytoses of undetermined etiology
Identifying B- and T-cell lymphoproliferative disorders involving blood and bone marrow
Distinguishing acute lymphoblastic leukemia from acute myeloid leukemia
Immunologic subtyping of acute leukemias
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
Test Id | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
FCINT | Flow Cytometry Interp, 2-8 Markers | No, (Bill Only) | No |
FCIMS | Flow Cytometry Interp, 9-15 Markers | No, (Bill Only) | No |
FCINS | Flow Cytometry Interp,16 or greater | No, (Bill Only) | No |
Test Id | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
FIRST | Flow Cytometry, Cell Surface, First | No, (Bill Only) | Yes |
ADD1 | Flow Cytometry, Cell Surface, Addl | No, (Bill Only) | Yes |
Note: This test is only available to clients who have MayoAccess or MayoLink.
The client is responsible for the interpretation and billing of the professional component; Mayo Clinic will bill the technical component only.
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). 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 (ADD1 if applicable).
The triage panel is initially performed on peripheral blood, bone marrow, and fluid samples to evaluate for monotypic B cells by kappa and lambda light chain expression, increased numbers of blasts by CD34 and CD45 expression along with side scatter gating, and increased plasma cells by CD45 expression with 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.
The tissue panel is initially performed to evaluate for monotypic B-cells by kappa and lambda light chain expression, increased numbers of blasts, and plasma cells by CD45 expression along with side scatter gating. The panel can also evaluate T cells with CD3, CD5, and CD7. Additionally, viability is assessed on all tissue specimens using 7-AAD exclusion.
These panels, together with the provided clinical history and morphologic review, are used to determine what, if any, further testing is needed for disease diagnosis or classification. If additional testing is required, it will be added per algorithm to fully characterize a disease state with a charge per unique antibody tested.
Cases requiring the granular lymphocytic leukemia flow panel will have an interpretation added and performed by a Mayo Clinic pathologist.
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.
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
Immunophenotyping
Tech Flow
Technical Only Flow
Tech Only Immunophenotyping
Technical Only Immunophenotyping
Virtual Flow
Leukemia Lymphoma
Note: This test is only available to clients who have MayoAccess or MayoLink.
The client is responsible for the interpretation and billing of the professional component; Mayo Clinic will bill the technical component only.
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). 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 (ADD1 if applicable).
The triage panel is initially performed on peripheral blood, bone marrow, and fluid samples to evaluate for monotypic B cells by kappa and lambda light chain expression, increased numbers of blasts by CD34 and CD45 expression along with side scatter gating, and increased plasma cells by CD45 expression with 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.
The tissue panel is initially performed to evaluate for monotypic B-cells by kappa and lambda light chain expression, increased numbers of blasts, and plasma cells by CD45 expression along with side scatter gating. The panel can also evaluate T cells with CD3, CD5, and CD7. Additionally, viability is assessed on all tissue specimens using 7-AAD exclusion.
These panels, together with the provided clinical history and morphologic review, are used to determine what, if any, further testing is needed for disease diagnosis or classification. If additional testing is required, it will be added per algorithm to fully characterize a disease state with a charge per unique antibody tested.
Cases requiring the granular lymphocytic leukemia flow panel will have an interpretation added and performed by a Mayo Clinic pathologist.
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.
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
Varies
For bone marrow specimens being evaluated for possible involvement by a myelodysplastic syndrome (MDS) or a myelodysplastic/myeloproliferative neoplasm (MDS/MPN) including chronic myelomonocytic leukemia (CMML), order MYEFL / Myelodysplastic Syndrome by Flow Cytometry, Bone Marrow.
Bronchoalveolar lavage specimens submitted for evaluation for leukemia or lymphoma are appropriate to send for this test.
This test is not appropriate for and cannot support diagnosis of sarcoidosis, hypersensitivity pneumonitis, interstitial lung diseases, or differentiating between pulmonary tuberculosis and sarcoidosis (requests for CD4/CD8 ratios); specimens sent for these purposes will be rejected.
For bone marrow testing, if cytogenetic tests are desired along with this test request, an additional specimen should be submitted. It is important that the specimen be obtained, processed, and transported according to instructions for the other test.
Specimen must arrive within 48 hours of collection for spinal fluid, 72 hours for serous fluids, and 96 hours for peripheral blood, bone marrow, and tissues.
1. The following information is required:
a. Pertinent clinical history including reason for testing or clinical indication
b. Clinical or morphologic suspicion
c. Specimen source
d. Date and time of collection
e. For spinal fluid specimens: spinal fluid cell and differential counts are required.
f. For tissue specimens: tissue type and location are required.
2. A pathology/diagnostic report including the client surgical pathology case number, a brief history, reason for referral or clinical suspicion are required before the specimen will be processed.
Submit only 1 of the following specimens:
Specimen Type: Whole blood
Container/Tube:
Preferred: Yellow top (ACD solution A or B)
Acceptable: Green top (sodium heparin) or lavender top (EDTA)
Specimen Volume: 10 mL
Slides: Include 5 to 10 unstained blood smears, if possible.
Collection Instructions:
1. Send specimen in original tube. Do not aliquot.
2. Label specimen as blood.
Specimen Stability Information: Ambient <96 hours/Refrigerated < or =96 hours
Specimen Type: Bone marrow
Container/Tube:
Preferred: Yellow top (ACD solution A or B)
Acceptable: Green top (sodium heparin) or lavender top (EDTA)
Specimen Volume: 1-5 mL
Slides: Include 5 to 10 unstained bone marrow aspirate smears, if possible.
Collection Instructions:
1. Submission of bilateral specimens is not required.
2. Label specimen as bone marrow.
Specimen Stability Information: Ambient <96 hours/Refrigerated < or =96 hours
Specimen Type: Fluid
Sources: Serous effusions, pleural, pericardial, or abdominal (peritoneal fluid)
Container/Tube: Body fluid container
Specimen Volume: 20 mL
Collection Instructions:
1. If possible, fluids other than spinal fluid should be anticoagulated with heparin (1 U/mL of fluid).
2. The volume of fluid necessary to phenotype the lymphocytes or blasts in serous effusions depends upon the cell count in the specimen. Usually 20 mL of pleural or peritoneal fluid is sufficient. Smaller volumes can be used if there is a high cell count.
3. Label specimen with fluid type.
Specimen Stability Information: Refrigerated <72 hours/Ambient < or =72 hours
Specimen Type: Spinal fluid
Container/Tube: Sterile vial
Specimen Volume: 1-1.5 mL
Collection Instructions:
1. An original cytospin preparation (preferably unstained) must be included with the spinal fluid specimen so correlative morphologic evaluation can occur.
2. The volume of fluid necessary to phenotype the lymphocytes or blasts in spinal fluid depends upon the cell count in the specimen. A cell count should be determined and submitted with the specimen. Usually 1 to 1.5 mL of spinal fluid is sufficient. Smaller volumes can be used if there is a high cell count. If cell count is <10 cells/mcL, a larger volume of spinal fluid may be required. When cell counts drop below 5 cells/mcL, the immunophenotypic analysis may not be successful.
3. Label specimen as spinal fluid.
Specimen Stability Information: Refrigerated <48 hours/Ambient < or =48 hours
Specimen Type: Tissue
Supplies: Hank's Solution (T132)
Container/Tube: Sterile container with 15 mL of tissue culture medium (eg, Hank's balanced salt solution, RPMI, or equivalent)
Specimen Volume: 5 mm(3) or larger biopsy
Specimen Stability Information: Ambient <96 hours/Refrigerated < or =96 hours
Collection Instructions:
1. Send intact specimen (do not mince).
2. Specimen cannot be fixed.
1. Hematopathology Patient Information (T676) in Special Instructions
2. If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.
Blood: 3 mL
Bone Marrow, Spinal Fluid: 1 mL
Fluid from Serous Effusions: 5 mL
Tissue: 1 mm(3) or larger biopsy
Gross hemolysis | Reject |
Fixed, paraffin-embedded, or minced tissue | Reject |
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Varies | Varies |
Evaluating lymphocytoses of undetermined etiology
Identifying B- and T-cell lymphoproliferative disorders involving blood and bone marrow
Distinguishing acute lymphoblastic leukemia from acute myeloid leukemia
Immunologic subtyping of acute leukemias
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
Note: This test is only available to clients who have MayoAccess or MayoLink.
The client is responsible for the interpretation and billing of the professional component; Mayo Clinic will bill the technical component only.
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). 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 (ADD1 if applicable).
The triage panel is initially performed on peripheral blood, bone marrow, and fluid samples to evaluate for monotypic B cells by kappa and lambda light chain expression, increased numbers of blasts by CD34 and CD45 expression along with side scatter gating, and increased plasma cells by CD45 expression with 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.
The tissue panel is initially performed to evaluate for monotypic B-cells by kappa and lambda light chain expression, increased numbers of blasts, and plasma cells by CD45 expression along with side scatter gating. The panel can also evaluate T cells with CD3, CD5, and CD7. Additionally, viability is assessed on all tissue specimens using 7-AAD exclusion.
These panels, together with the provided clinical history and morphologic review, are used to determine what, if any, further testing is needed for disease diagnosis or classification. If additional testing is required, it will be added per algorithm to fully characterize a disease state with a charge per unique antibody tested.
Cases requiring the granular lymphocytic leukemia flow panel will have an interpretation added and performed by a Mayo Clinic pathologist.
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.
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
Immunophenotyping hematopoietic specimens can help resolve many differential diagnostic problems posed by the clinical or morphologic features.
This is a technical only test and does not include interpretation unless reflex testing is performed. At any point, clients may request to have a Mayo Clinic hematopathologist provide an interpretation at an additional charge.
Not applicable
Report will include a summary of the procedure.
Specimens will be initially screened to determine which, if any, of the immunophenotyping panels should be performed.
1. Jevremovic D, Dronca RS, Morice WG, et al: CD5+ B-cell lymphoproliferative disorders: Beyond chronic lymphocytic leukemia and mantle cell lymphoma. Leuk Res. 2010;34(9):1235-1238
2. Hanson CA: Acute leukemias and myelodysplastic syndromes. In: McClatchey KD, ed. Clinical Laboratory Medicine. Williams and Wilkins, Inc., 1994:939-969
3. Jevremovic D, Olteanu H: Flow Cytometry Applications in the diagnosis of T/NK-cell lymphoproliferative disorders. Cytometry B Clin Cytom. 2019;96(2):99-115
4. Rosado FG, Morice WG, He R, et al: Immunophenotypic features by multiparameter flow cytometry can help distinguish low grade B-cell lymphomas with plasmacytic differentiation from plasma cell proliferative disorders with an unrelated clonal B-cell process. Br J Haematol. 2015 May;169(3):368-376
5. Shi M, Ternus JA, Ketterling RP, et al: Immunophenotypic and laboratory features of t(11;14)(q13;q32)-positive plasma cell neoplasms. Leuk Lymphoma. 2018;59(8):1913-1919
6. Morice WG, Kimlinger T, Katzmann JA, et al: Flow cytometric assessment of TCR-V-beta expression in the evaluation of peripheral blood involvement by T-cell lymphoproliferative disorders: a comparison with conventional T-cell immunophenotyping and molecular genetic techniques. Am J Clin Pathol. 2004;121(3):373-383
7. Shi M, Jevremovic D, Otteson GE, Timm MM, Olteanu H, Horna P: Single antibody detection of T-cell receptor alpha-beta clonality by flow cytometry rapidly identifies mature T-cell neoplasms and monotypic small CD8-positive subsets of uncertain significance. Cytometry B Clin Cytom. 2020 Jan;98(1):99-107
8. Jevremovic D, Olteanu H: Flow cytometry applications in the diagnosis of T/NK-cell lymphoproliferative disorders. Cytometry B Clin Cytom. 2019;96(2):99-115
Flow cytometric immunophenotyping of peripheral blood, bone marrow, and body fluids is performed using the following antibodies:
Triage Panel: CD3, CD10, CD16, CD19, CD34, CD45, and kappa and lambda light chains.
Flow cytometric immunophenotyping of tissues is performed using the following antibodies:
Tissue Panel: CD3, CD5, CD7, CD10, CD19, CD20, CD23, CD45, 7-AAD, and kappa and lambda light chains.
Possible Additional Panels:
-B-cell Panel: CD5, CD11c, CD19, CD20, CD22, CD23, CD38, CD45, CD103, CD200 and kappa and lambda light chains
-T-cell Panel: CD2, CD3, CD4, CD5, CD7, CD8, CD45, TRBC1, and gamma/delta
-Killer-cell immunoglobulin-like receptor (KIR) Panel: CD3, CD8, CD16, CD56, CD57, CD94, CD158a, CD158b, CD158e (p70), and NKG2a
-Acute Panel: CD2, CD7, CD13, CD15, CD16, CD33, CD34, CD36, CD38, CD45, CD56, CD64, CD117, and HLA-DR
-B-cell ALL, minimal residual disease (MRD) panel: CD10, CD19, CD20, CD22, CD24, CD34, CD38, CD45, CD58, and CD66c
-Myeloperoxidase (MPO)/terminal deoxynucleotidyl transferase (TdT) (MPO/TdT) Panel: cytoplasmic CD3, CD13, cytoplasmic CD22, CD34, CD45, cytoplasmic CD79a, nuclear TdT, and cytoplasmic MPO
-Plasma Cell Panel: CD19, CD38, CD45, CD138, and cytoplasmic kappa and lambda light chains
-Mast Cell Panel: CD2, CD25, CD69, CD117.(Keren P, McCoy JP, Carey J, eds. Flow Cytometry in Clinical Diagnosis. 4th ed. ASCP Press; 2007; Betters DM: Use of flow cytometry in clinical practice. J Adv Pract Oncol. 2015 Sep-Oct;6[5]:435–440)
Monday through Saturday
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.
88184-Flow cytometry; first cell surface, cytoplasmic or nuclear marker
88185-Flow cytometry; additional cell surface, cytoplasmic or nuclear marker (each)
Additional CPTs may be added if consultative help is needed with the case, or algorithm dictates Mayo consultant involvement.
88187-Flow cytometry interpretation, 2 to 8 markers (if appropriate)
88188-Flow cytometry interpretation, 9 to 15 markers (if appropriate)
88189-Flow cytometry interpretation, 16 or more markers (if appropriate)
Test Id | Test Order Name | Order LOINC Value |
---|---|---|
LLTOF | Leukemia/Lymphoma; Tech Only Flow | In Process |
Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
---|---|---|
CK072 | Final Diagnosis | 22637-3 |
CK073 | Microscopic Description | 22635-7 |
CK074 | Special Studies | 30954-2 |
CK071 | Flow Cytometry | 69052-9 |