Test Id : BLPMF
B-Cell Lymphoma, Specified FISH, Varies
Useful For
Suggests clinical disorders or settings where the test may be helpful
Detecting, at diagnosis, common chromosome abnormalities associated with specific B-cell lymphoma subtypes using client specified FISH probes
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 Id | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| BLPMB | Probe, Each Additional (BLPMF) | No, (Bill Only) | No |
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
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.
This is not intended as a panel test and the desired probes or suspected B-cell lymphoma subtype must be specified upon order. If the patient is being evaluated for known abnormalities, individual probes must be listed in the probe request field. This test is only appropriate for the following known subtypes of B-cell lymphoma:
Pediatric Burkitt lymphoma testing (aged 18 years or younger):
-Recommended probe request = 5'/3' MYC, MYC/IGH, MYC/IGK, MYC/IGL, 3'/5' BCL2, 3'/5' BCL6
Diffuse large B-cell, "double-hit", "triple hit" lymphoma testing:
-Recommended probe request = 5'/3' MYC, MYC/IGH, reflex with 3'/5' BCL2, 3'/5' BCL6
*If reflex is included in the probe request, break-apart BCL2 and BCL6 reflex testing would occur when a MYC disruption is observed
Follicular lymphoma testing:
-Recommended probe request = 3'/5' BCL2, 3'/5' BCL6
Mantle cell lymphoma (MCL) testing:
-Recommended probe request = CCND1/IGH, 5'/3' CCND1 as reflex
*If reflex is included in the probe request, break-apart CCND1 reflex testing would occur when an additional CCND1 FISH signal is detected to rule out a CCND1 gene disruption
Blastoid Mantle cell lymphoma testing:
-Recommended probe request = CCND1/IGH, TP53, 5'/3' MYC, MYC/IGH, 5'/3' CCND1 as reflex
*If reflex is included in the probe request, break-apart CCND1 reflex testing would occur when an additional CCND1 FISH signal is detected to rule out a CCND1 gene disruption
Splenic marginal zone lymphoma testing:
-Recommended probe request = D7Z1/7q32, TP53/D17Z1
See Common Chromosome Abnormalities in B-cell Lymphomas in Clinical Information for specific gene locations associated with these B-cell lymphoma subtypes.
If the laboratory is not provided a specific probe request or an appropriate B-cell lymphoma subtype, the following probes will be performed.
t(3q27;var) rearrangement, BCL6 break-apart
7q-, D7Z1/7q32
8q24.1 rearrangement, MYC break-apart
t(8;14)(q24.1;q32), MYC/IGH fusion
t(11;14)(q13;q32), CCND1/IGH fusion
-17/17p-, TP53/D17Z1
t(18q21;var) rearrangement, BCL2 break-apart
When this test and flow cytometry testing for leukemia/lymphoma are ordered concurrently, the flow cytometry result will be utilized to determine if sufficient clonal B-cells are available for FISH testing. If the result does not identify a sufficient clonal B-cell population, this FISH test order will be canceled, and no charges will be incurred. The B-cell lymphoma subtype will be used by the laboratory to determine appropriate FISH probes, if determined and applicable.
Appropriate ancillary probes may be performed at consultant discretion to render comprehensive assessment. Any additional probes will have the results included within the final report and will be performed at an additional charge.
For more information see Bone Marrow Staging for Known or Suspected Malignant Lymphoma Algorithm.
Method Name
A short description of the method used to perform the test
Fluorescence In Situ Hybridization (FISH)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
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.
This is not intended as a panel test and the desired probes or suspected B-cell lymphoma subtype must be specified upon order. If the patient is being evaluated for known abnormalities, individual probes must be listed in the probe request field. This test is only appropriate for the following known subtypes of B-cell lymphoma:
Pediatric Burkitt lymphoma testing (aged 18 years or younger):
-Recommended probe request = 5'/3' MYC, MYC/IGH, MYC/IGK, MYC/IGL, 3'/5' BCL2, 3'/5' BCL6
Diffuse large B-cell, "double-hit", "triple hit" lymphoma testing:
-Recommended probe request = 5'/3' MYC, MYC/IGH, reflex with 3'/5' BCL2, 3'/5' BCL6
*If reflex is included in the probe request, break-apart BCL2 and BCL6 reflex testing would occur when a MYC disruption is observed
Follicular lymphoma testing:
-Recommended probe request = 3'/5' BCL2, 3'/5' BCL6
Mantle cell lymphoma (MCL) testing:
-Recommended probe request = CCND1/IGH, 5'/3' CCND1 as reflex
*If reflex is included in the probe request, break-apart CCND1 reflex testing would occur when an additional CCND1 FISH signal is detected to rule out a CCND1 gene disruption
Blastoid Mantle cell lymphoma testing:
-Recommended probe request = CCND1/IGH, TP53, 5'/3' MYC, MYC/IGH, 5'/3' CCND1 as reflex
*If reflex is included in the probe request, break-apart CCND1 reflex testing would occur when an additional CCND1 FISH signal is detected to rule out a CCND1 gene disruption
Splenic marginal zone lymphoma testing:
-Recommended probe request = D7Z1/7q32, TP53/D17Z1
See Common Chromosome Abnormalities in B-cell Lymphomas in Clinical Information for specific gene locations associated with these B-cell lymphoma subtypes.
If the laboratory is not provided a specific probe request or an appropriate B-cell lymphoma subtype, the following probes will be performed.
t(3q27;var) rearrangement, BCL6 break-apart
7q-, D7Z1/7q32
8q24.1 rearrangement, MYC break-apart
t(8;14)(q24.1;q32), MYC/IGH fusion
t(11;14)(q13;q32), CCND1/IGH fusion
-17/17p-, TP53/D17Z1
t(18q21;var) rearrangement, BCL2 break-apart
When this test and flow cytometry testing for leukemia/lymphoma are ordered concurrently, the flow cytometry result will be utilized to determine if sufficient clonal B-cells are available for FISH testing. If the result does not identify a sufficient clonal B-cell population, this FISH test order will be canceled, and no charges will be incurred. The B-cell lymphoma subtype will be used by the laboratory to determine appropriate FISH probes, if determined and applicable.
Appropriate ancillary probes may be performed at consultant discretion to render comprehensive assessment. Any additional probes will have the results included within the final report and will be performed at an additional charge.
For more information see Bone Marrow Staging for Known or Suspected Malignant Lymphoma Algorithm.
Specimen Type
Describes the specimen type validated for testing
Varies
Ordering Guidance
This test should only be ordered if the sample is known to have a sufficient clonal B-cell population. If a flow cytometry result is available and does not identify a sufficient clonal B-cell population, this test order will be canceled, and no charges will be incurred.
If either the break-apart MYC or the MYC/IGH D-FISH probe set is requested in isolation, both probe sets will be performed concurrently to optimize the detection of MYC rearrangements.
This test should NOT be used to screen for residual B-cell lymphoma.
This assay detects chromosome abnormalities observed in blood or bone marrow samples of patients with B-cell lymphoma. If a paraffin-embedded tissue specimen is submitted, the test will be canceled and BLYM / B-Cell Lymphoma, FISH, Tissue will be added and performed as the appropriate test.
For patients with B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/LBL), order either BALAF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Adult, Varies or BALPF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Pediatric, FISH, Varies, depending on the age of the patient.
For testing paraffin-embedded tissue samples from patients with B-cell lymphoblastic Lymphoma, see BLBLF / B-Cell Lymphoblastic Leukemia/Lymphoma, FISH, Tissue.
Additional Testing Requirements
Microarray testing for Burkitt-like lymphoma with 11q aberration is available, order CMAH / Chromosomal Microarray, Hematologic Disorders, Varies.
Shipping Instructions
Advise Express Mail or equivalent if not on courier service.
Necessary Information
1. A list of probes requested for analysis is required. Probes available for this test are listed in the Testing Algorithm section.
2. 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.
3. A flow cytometry and/or a bone marrow pathology report should be submitted 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.
ORDER QUESTIONS AND ANSWERS
| Question ID | Description | Answers |
|---|---|---|
| GC105 | Reason for Referral | |
| GC106 | Probes Requested | |
| GC107 | Specimen |
Whole blood ACD Bone marrow ACD Whole blood Na Hep Bone marrow Na Hep Whole blood EDTA Bone marrow EDTA |
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Submit only 1 of the following specimens:
Preferred
Specimen Type: Bone marrow
Container/Tube:
Preferred: Yellow top (ACD)
Acceptable: Green top (heparin) or lavender top (EDTA)
Specimen Volume: 2 to 3 mL
Collection Instructions:
1. It is preferable to send the first aspirate from the bone marrow collection.
2. Invert several times to mix bone marrow.
3. Send bone marrow in original tube. Do not aliquot.
Acceptable
Specimen Type: Whole blood
Container/Tube:
Preferred: Yellow top (ACD)
Acceptable: Green top (heparin) or lavender top (EDTA)
Specimen Volume: 6 mL
Collection Instructions:
1. Invert several times to mix blood.
2. Send whole blood in original tube. Do not aliquot.
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Forms
If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
Bone marrow: 1 mL; Whole blood: 2 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Ambient (preferred) | ||
| Refrigerated | |||
Useful For
Suggests clinical disorders or settings where the test may be helpful
Detecting, at diagnosis, common chromosome abnormalities associated with specific B-cell lymphoma subtypes using client specified FISH probes
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
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.
This is not intended as a panel test and the desired probes or suspected B-cell lymphoma subtype must be specified upon order. If the patient is being evaluated for known abnormalities, individual probes must be listed in the probe request field. This test is only appropriate for the following known subtypes of B-cell lymphoma:
Pediatric Burkitt lymphoma testing (aged 18 years or younger):
-Recommended probe request = 5'/3' MYC, MYC/IGH, MYC/IGK, MYC/IGL, 3'/5' BCL2, 3'/5' BCL6
Diffuse large B-cell, "double-hit", "triple hit" lymphoma testing:
-Recommended probe request = 5'/3' MYC, MYC/IGH, reflex with 3'/5' BCL2, 3'/5' BCL6
*If reflex is included in the probe request, break-apart BCL2 and BCL6 reflex testing would occur when a MYC disruption is observed
Follicular lymphoma testing:
-Recommended probe request = 3'/5' BCL2, 3'/5' BCL6
Mantle cell lymphoma (MCL) testing:
-Recommended probe request = CCND1/IGH, 5'/3' CCND1 as reflex
*If reflex is included in the probe request, break-apart CCND1 reflex testing would occur when an additional CCND1 FISH signal is detected to rule out a CCND1 gene disruption
Blastoid Mantle cell lymphoma testing:
-Recommended probe request = CCND1/IGH, TP53, 5'/3' MYC, MYC/IGH, 5'/3' CCND1 as reflex
*If reflex is included in the probe request, break-apart CCND1 reflex testing would occur when an additional CCND1 FISH signal is detected to rule out a CCND1 gene disruption
Splenic marginal zone lymphoma testing:
-Recommended probe request = D7Z1/7q32, TP53/D17Z1
See Common Chromosome Abnormalities in B-cell Lymphomas in Clinical Information for specific gene locations associated with these B-cell lymphoma subtypes.
If the laboratory is not provided a specific probe request or an appropriate B-cell lymphoma subtype, the following probes will be performed.
t(3q27;var) rearrangement, BCL6 break-apart
7q-, D7Z1/7q32
8q24.1 rearrangement, MYC break-apart
t(8;14)(q24.1;q32), MYC/IGH fusion
t(11;14)(q13;q32), CCND1/IGH fusion
-17/17p-, TP53/D17Z1
t(18q21;var) rearrangement, BCL2 break-apart
When this test and flow cytometry testing for leukemia/lymphoma are ordered concurrently, the flow cytometry result will be utilized to determine if sufficient clonal B-cells are available for FISH testing. If the result does not identify a sufficient clonal B-cell population, this FISH test order will be canceled, and no charges will be incurred. The B-cell lymphoma subtype will be used by the laboratory to determine appropriate FISH probes, if determined and applicable.
Appropriate ancillary probes may be performed at consultant discretion to render comprehensive assessment. Any additional probes will have the results included within the final report and will be performed at an additional charge.
For more information see Bone Marrow Staging for Known or Suspected Malignant Lymphoma Algorithm.
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Mature B-cell lymphoma can be low grade, intermediate grade, or high grade, and the prognosis and clinical course are highly variable. Genetic abnormalities can assist diagnosis and have served as important prognostic markers in B-cell lymphomas. Fluorescence in situ hybridization (FISH) permits the detection of recurrent gene rearrangements associated with various chromosomal abnormalities in specific B-cell lymphoma subtypes (see Table).
Table. Common Chromosome Abnormalities in B-cell Lymphomas
| Lymphoma type | Chromosome abnormality | FISH probe |
| Burkitt (pediatric, < or =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 | |
| 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 | |
| Splenic marginal zone | Deletion of 7q | D7Z1/7q32 |
| Deletion of 17p | TP53/D17Z1 |
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
An interpretive report will be provided.
Interpretation
Provides information to assist in interpretation of the test results
A neoplastic clone is detected when the percent of cells with an abnormality exceeds the normal reference range for any given probe set.
Detection of an abnormal clone supports a diagnosis of B-cell lymphoma. The specific abnormality detected may help to determine a specific B-cell lymphoma subtype.
The absence of an abnormal clone does not rule out the presence of lymphoma or another neoplastic disorder.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
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.
Bone marrow is the preferred sample type for this fluorescence in situ hybridization test. If bone marrow is not available, a blood specimen may be used if there are neoplastic cells in the blood specimen (as verified by a hematopathologist).
If no fluorescence in situ hybridization (FISH) signals are observed post-hybridization, the case will be released indicating a lack of FISH results.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Swerdlow SH, Campo E, Harris NL, et al, eds. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. 4th ed. IARC Press; 2017. WHO Classification of Tumours. Vol 2
2. King RL, McPhail ED, Meyer RG, et al. False-negative rates for MYC fluorescence in situ hybridization probes in B-cell neoplasms. Haematologica. 2019;104(6):e248-e251
3. Pophali PA, Marinelli LM, Ketterling RP, et al. High level MYC amplification in B-cell lymphomas: is it a marker of aggressive disease?. Blood Cancer J. 2020;10(1):5
Method Description
Describes how the test is performed and provides a method-specific reference
This test is performed using commercially available and laboratory-developed probes. Deletion of the 7q32 locus from chromosome 7 and the TP53 locus from chromosome 17 are detected using enumeration strategy probes. Rearrangements involving MYC, BCL2, BCL6, or CCND1 are detected using dual-color break-apart (BAP) strategy probes. Dual-color, dual-fusion fluorescence in situ hybridization (D-FISH) strategy probe sets are used to detect t(2;8), t(8;14), t(8;22), and t(11;14). For enumeration and BAP strategy probe sets, 100 interphase nuclei are scored; 200 interphase nuclei are scored when D-FISH probes are used, and results are expressed as the percent abnormal nuclei.(Unpublished Mayo method)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Friday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
- Authorized users can sign in to Test Prices for detailed fee information.
- Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
- Prospective clients should contact their account representative. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
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
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
88271 x 2, 88275, 88291-FISH Probe, Analysis, Interpretation; 1 probe set
88271 x 2, 88275-FISH Probe, Analysis; each additional probe set (if appropriate)
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| BLPMF | B-cell Lymphoma, Specified FISH | 101920-7 |
| 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.
|
|---|---|---|
| 614229 | Result Summary | 50397-9 |
| 614230 | Interpretation | 69965-2 |
| 614231 | Result Table | 93356-4 |
| 614232 | Result | 62356-1 |
| GC105 | Reason for Referral | 42349-1 |
| GC106 | Probes Requested | 78040-3 |
| GC107 | Specimen | 31208-2 |
| 614233 | Source | 31208-2 |
| 614234 | Method | 31208-2 |
| 614235 | Additional Information | 48767-8 |
| 614236 | Disclaimer | 62364-5 |
| 614237 | Released By | 18771-6 |