Test Id : BLYM
B-Cell Lymphoma, FISH, Tissue
Useful For
Suggests clinical disorders or settings where the test may be helpful
Detecting, at diagnosis, recurrent common chromosome abnormalities associated with various B-cell lymphomas in paraffin-embedded tissue specimens
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 |
---|---|---|---|
_PRAA | Probe, Each Additional (BLYM) | 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. No analysis charges will be incurred if an insufficient number of representative cells are available for analysis.
This FISH test allows different combinations of probes to be utilized based on the suspected lymphoma subtype, patient's age, and clinical question. See the Common Chromosome Abnormalities in B-cell Lymphomas table in Clinical Information for specific gene locations associated with these B-cell lymphoma subtypes.
Both the break-apart MYC and the MYC/IGH dual-fusion FISH probes are analyzed simultaneously when MYC is requested. The BCL2/IGH FISH probe set will only be performed, at the laboratory's discretion, to resolve or confirm unbalanced BCL2 rearrangement concerns.
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, the following algorithms are available:
-Aggressive B-cell Lymphoma Diagnostic 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
Aliases
Lists additional common names for a test, as an aid in searching
Burkitt lymphoma (BL)
Blastoid mantle cell lymphoma
Diffuse large cell lymphoma/"Double Hit"
Triple hit lymphoma
Burkitt-like lymphoma
High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements
(DLBCL/HGBL-MYC/BCL2)
Diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS)
Diffuse large B-cell lymphoma with follicular lymphoma (FLBL)
High grade B-cell lymphoma (HGBL NOS)
Large BCL with IRF4 rearranged
Follicular lymphoma (FL)
Classic follicular lymphoma (cFL)
Mantle Cell Lymphoma (MCL)
Mantle Cell Lymphoma, Blastoid variant
Cyclin D1-negative MCL subtype
Splenic marginal zone lymphoma (SMZL)
SMZL with 7q32 deletion
MALT lymphoma
Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (EMZL)
Gastric EMZL
Pulmonary EMZL
1p36 deletion or TNFRSF14 deletion
BCL6 (3q27) rearrangement
IRF4 (6p25.3) rearrangement
7q32 deletion
MYC (8q24.21) rearrangement
t(2;8)(p11;q24.21)-IGK::MYC or IGK/MYC
t(8;14) (q24.21;q32)-IGH::MYC or MYC/IGH
t(8;22) (q24.21;q11.2)-IGL::MYC or MYC/IGL
MYC/Kappa or MYC/Lambda
JAK2 (9p24.1) rearrangement
t(11;14) (q13;q32)-IGH::CCND1 or CCND1/IGH
CCND1 (11q13) rearrangement
CCND2 (12p13.32) rearrangement
t(14;18)(q32;q21)-IGH::BCL2 or IGH/BCL2
17p- (17p deletion) or TP53
MALT1 (18q21) rearrangement
BCL2 (18q21) rearrangement
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. No analysis charges will be incurred if an insufficient number of representative cells are available for analysis.
This FISH test allows different combinations of probes to be utilized based on the suspected lymphoma subtype, patient's age, and clinical question. See the Common Chromosome Abnormalities in B-cell Lymphomas table in Clinical Information for specific gene locations associated with these B-cell lymphoma subtypes.
Both the break-apart MYC and the MYC/IGH dual-fusion FISH probes are analyzed simultaneously when MYC is requested. The BCL2/IGH FISH probe set will only be performed, at the laboratory's discretion, to resolve or confirm unbalanced BCL2 rearrangement concerns.
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, the following algorithms are available:
-Aggressive B-cell Lymphoma Diagnostic Algorithm
Specimen Type
Describes the specimen type validated for testing
Tissue
Ordering Guidance
This test does not include a pathology consultation. If a pathology consultation is requested, order PATHC / Pathology Consultation, and appropriate testing will be added at the discretion of the pathologist and performed at an additional charge.
Mayo Clinic Hematopathology consultants are involved in both the pre-analytic (tissue adequacy and probe selection, when applicable) and post-analytic (interpretation of fluorescence in situ hybridization [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 non-paraffin embedded bone marrow or blood sample is received for this test, 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.
For patients with T-cell lymphoma, order TLYM / T-Cell Lymphoma, FISH, Tissue.
Shipping Instructions
Advise Express Mail or equivalent if not on courier service.
Necessary Information
1. A pathology report is required for testing to be performed. If not provided, appropriate testing and/or interpretation may be compromised or delayed. Acceptable pathology reports include working drafts, preliminary pathology, or surgical pathology reports.
2. The following information must be included in the report provided:
-Patient name
-Block number - must be on all blocks, slides, and paperwork
-Date of collection
-Tissue source
3. 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.
4. A list of probes is required if select probes are necessary or if the patient is being tracked for known abnormalities. See Table in Clinical Information.
ORDER QUESTIONS AND ANSWERS
Question ID | Description | Answers |
---|---|---|
GC026 | Reason for Referral |
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: Tissue block
Collection Instructions:
1. Submit a formalin-fixed, paraffin-embedded tumor tissue block. Blocks prepared with alternative fixation methods will be attempted but are less favorable for successful results.
2. 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
Specimen Type: Tissue slides
Slides: 1 Hematoxylin and eosin-stained and 2 unstained for each probe set
Collection Instructions:
1. Include 1 hematoxylin and eosin-stained slide for the entire test order.
2. For each probe set ordered, 2 consecutive, unstained, 5 micron-thick sections placed on positively charged slides.
3. If ordering MYC, 4 unstained slides are necessary; the break-apart MYC and the MYC/IGH D-FISH probe sets are performed simultaneously
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.
See Specimen Required
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 |
---|---|---|---|
Tissue | Ambient (preferred) | ||
Refrigerated |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Detecting, at diagnosis, recurrent common chromosome abnormalities associated with various B-cell lymphomas in paraffin-embedded tissue specimens
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. No analysis charges will be incurred if an insufficient number of representative cells are available for analysis.
This FISH test allows different combinations of probes to be utilized based on the suspected lymphoma subtype, patient's age, and clinical question. See the Common Chromosome Abnormalities in B-cell Lymphomas table in Clinical Information for specific gene locations associated with these B-cell lymphoma subtypes.
Both the break-apart MYC and the MYC/IGH dual-fusion FISH probes are analyzed simultaneously when MYC is requested. The BCL2/IGH FISH probe set will only be performed, at the laboratory's discretion, to resolve or confirm unbalanced BCL2 rearrangement concerns.
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, the following algorithms are available:
-Aggressive B-cell Lymphoma Diagnostic 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 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, < or =18 years old) | 8q24.21 rearrangement | 5'/3' MYC |
t(2;8)(p12;q24.21) | IGK/MYC | |
t(8;14)(q24.21;q32) | MYC/IGH | |
t(8;22)(q24.21;q11.2) | MYC/IGL | |
3q27 rearrangement | 3'/5' BCL6 | |
18q21 rearrangement | 3'/5' BCL2 | |
Diffuse large B-cell, "double-hit" | 8q24.21 rearrangement | 5'/3' MYC |
t(8;14)(q24.21;q32) | MYC/IGH | |
----Reflex: t(8;22)(q24.21;q11.2) | MYC/IGL | |
----Reflex: t(2;8)(p12;q24.21) | 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: 8q24.21 rearrangement | 5'/3' MYC | |
Cyclin D1-negative MCL subtype only: 12p13.32 rearrangement | 5'/3' CCND2 | |
Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue | 18q21 rearrangement | 5'/3' MALT1 |
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.
A positive result is supportive of a diagnosis of a B-cell lymphoma. The specific abnormality detected may help determine a B-cell lymphoma subtype and/or contribute to the prognosis.
The absence of an abnormal clone, or Negative result, does not rule out the presence of a neoplastic disorder or change the pathologic diagnosis.
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.
Fixatives other than formalin (eg, Prefer, Bouin's) may not be successful for fluorescence in situ hybridization (FISH) assays. Non-formalin fixed specimens will not be rejected.
Paraffin-embedded tissues that have been decalcified may not be successful for FISH analysis. The success rate of FISH studies on decalcified tissue is approximately 50%.
FISH studies will be attempted if sufficient tumor is present for analysis. The pathologist reviewing the hematoxylin and eosin-stained slide may find it necessary to cancel testing if insufficient tissue/tumor is available for testing.
If no FISH signals or a lack of sufficient tumor tissue 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
Swerdlow SH, Campo E, Harris NL, eds, et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. 4th ed. IARC Press; 2017. WHO Classification of Tumours. Vol 2
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 TNFRSF14 locus from chromosome 1, the 7q32 locus from chromosome 7, and the TP53 locus from chromosome 17 are detected using enumeration strategy probe sets. Rearrangements involving MYC, BCL2, BCL6, IRF4, CCND1, CCND2 or MALT1 are detected using dual-color break-apart (BAP) strategy probe sets. 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).
At the laboratory's discretion, the IGH/BCL2 FISH probe set will be performed, when necessary, to resolve or confirm an unbalanced BCL2 rearrangement. IGH::BCL2 fusion is detected using a dual color, dual fusion probe set.
Paraffin-embedded tissue samples are cut at 5 microns and mounted on positively charged glass slides. The selection of tissue and the identification of target areas on the hematoxylin and eosin (H and E)-stained slide are performed by a pathologist. Using the H and E-stained slide as a reference, target areas are etched with a diamond-tipped engraving tool on the back of the unstained slide to be assayed. Each probe set is hybridized to the appropriate target areas, as indicated on the H and E, and 100 interphase nuclei are scored within the targeted areas. The results are expressed as the percent of 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.
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)
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 |
---|---|---|
BLYM | B-cell Lymphoma, FISH, Tissue | 101651-8 |
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.
|
---|---|---|
603063 | Result Summary | 50397-9 |
603064 | Interpretation | 69965-2 |
603065 | Result Table | 93356-4 |
603066 | Result | 62356-1 |
GC026 | Reason for Referral | 42349-1 |
603067 | Specimen | 31208-2 |
603068 | Source | 85298-8 |
603069 | Tissue ID | 80398-1 |
603070 | Method | 85069-3 |
603071 | Additional Information | 48767-8 |
603072 | Disclaimer | 62364-5 |
603073 | Released By | 18771-6 |