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HelpTest Code BLBLF B-Cell Lymphoblastic Leukemia/Lymphoma, FISH, 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 the pre-analytic phase (tissue adequacy and probe selection, when applicable).
This test is not appropriate for testing blood and bone marrow from patients with B-lymphoblastic leukemia/lymphoma. If a non-paraffin embedded bone marrow or blood sample is received for this test, the test will be canceled and automatically reordered by the laboratory as BALAF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Adult, Varies or BALFP / Pediatric B-Lymphoblastic Leukemia/Lymphoma Panel, FISH, Varies depending on the age of the patient.
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.
Specimen Required
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. If individual probe sets are chosen: For each probe set ordered, submit 2 consecutive, unstained, 5 micron-thick sections placed on positively charged slides.
3. If a complete B-lymphoblastic leukemia/lymphoma (BLBL) panel is ordered: Submit 20 consecutive, unstained, 5 micron-thick sections placed on positively charged slides.
Forms
If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:
Useful For
Detecting, at diagnosis, recurrent common chromosome abnormalities associated with B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/LBL) and Philadelphia chromosome-like acute lymphoblastic leukemia (Ph-like ALL) in paraffin-embedded specimens
Monitoring response to therapy by tracking known chromosome abnormalities in patients with B-ALL/LBL
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| _IL25 | Interphases, <25 | No, (Bill Only) | No |
| _I099 | Interphases, 25-99 | No, (Bill Only) | No |
| _I300 | Interphases, >=100 | No, (Bill Only) | No |
| _PADD | Probe, +1 | No, (Bill Only) | No |
| _PB02 | Probe, +2 | No, (Bill Only) | No |
| _PB03 | Probe, +3 | No, (Bill Only) | No |
| _PBCT | Probe, +2 | No, (Bill Only) | No |
Testing Algorithm
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. Analysis charges will be incurred based on the number of cells analyzed per probe set. If no cells are available for analysis, no analysis charges will be incurred.
This test may be ordered in 2 distinct ways allowing different combinations of probes to be analyzed based on the clinical question.
1. Standard (diagnostic) B-lymphoblastic leukemia/lymphoma (BLBL) FISH panel
2. Individual BLBL FISH probes chosen, per client request, from probes listed below
If individual BLBL FISH probes are wanted, the specific probes requested must be noted on the request form or in the reason for referral. If no FISH probes are indicated, the standard (diagnostic) panel will be performed.
The standard (diagnostic) panel for patients aged 30 years or younger includes testing for the following abnormalities, using the FISH probes listed:
t(1;19)(q23;p13) or TCF3::PBX1 fusion, request probe PBX1/TCF3
Hyperdiploidy or +4,+10,+17, request probe D4Z1/D10Z1/D17Z1
t(8;14)(q24.21;q32) or IGH::MYC fusion, request probe MYC/IGH
t(8q24.21;var) or MYC rearrangement, request probe MYC break-apart
t(9;22)(q34;q11.2) or BCR::ABL1 fusion, request probe ABL1/BCR
t(11q23;var) or KMT2A rearrangement, request probe KMT2A break-apart
t(12;21)(p13;q22), ETV6::RUNX1 fusion and iAMP21, request probe ETV6/RUNX1
t(14q32;var) or IGH rearrangement, request probe IGH break-apart
If results for the initial panel are negative or demonstrate nonclassical abnormalities, the Philadelphia chromosome-like acute lymphoblastic leukemia (Ph-like ALL) panel will be performed as a secondary panel. The Ph-like ALL panel includes testing for the following kinase activating chromosome abnormalities, using the FISH probes listed below:
t(1q25;var) or ABL2 rearrangement, request probe ABL2 break-apart
t(5q32;var) or PDGFRB rearrangement, request probe PDGFRB break-apart
t(9p24.1;var) or JAK2 rearrangement, request probe JAK2 break-apart
t(9q34;var) or ABL1 rearrangement, request probe ABL1 break-apart
The FISH initial (diagnostic) panel for patients aged 31 years or older includes testing with the following FISH probe: t(9;22)(q34;q11.2), BCR/ABL1
If BCR::ABL1 fusion is not observed, the following probe sets will be performed as a secondary panel:
t(1;19)(q23;p13) or TCF3::PBX1 fusion, request probe PBX1/TCF3
t(1q25;var) or ABL2 rearrangement, request probe ABL2 break-apart
Hyperdiploidy or +4,+10,+17, request probe D4Z1/D10Z1/D17Z1
t(5q32;var) or PDGFRB rearrangement, request probe PDGFRB break-apart
t(8;14)(q24.21;q32) or IGH::MYC fusion, request probe MYC/IGH
t(8q24.21;var) or MYC rearrangement, request probe MYC break-apart
t(9p24.1;var) or JAK2 rearrangement, request probe JAK2 break-apart
t(9q34;var) or ABL1 rearrangement, request probe ABL1 break-apart
t(11q23;var) or KMT2A rearrangement, request probe KMT2A break-apart
t(12;21)(p13;q22), ETV6::RUNX1 fusion and iAMP21, request probe ETV6/RUNX1
t(14q32;var) or IGH rearrangement, request probe IGH break-apart
Appropriate ancillary probes may be performed at consultant discretion to render comprehensive assessment. Any additional probes used will have the results included within the final report and will be performed at an additional charge. In the following situations, additional (reflex) testing may be performed at the laboratory's discretion and may be influenced by available karyotype results or other FISH testing.
When a KMT2A rearrangement is identified, testing with 1 or more dual-fusion FISH probe sets may be performed in an attempt to identify the translocation partner for the following abnormalities:
t(4;11)(q21;q23) or KMT2A::AFF1 fusion, request probe AFF1/KMT2A
t(6;11)(q27;q23) or KMT2A::AFDN fusion, request probe AFDN/KMT2A
t(9;11)(p22;q23) or KMT2A::MLLT3 fusion, request probe MLLT3/KMT2A
t(10;11)(p12;q23) or KMT2A::MLLT10 fusion, request probe MLLT10/KMT2A
t(11;19)(q23;p13.1) or KMT2A::MLLT1 fusion, request probe KMT2A/ELL
t(11;19)(q23;p13.3) or KMT2A::ELL fusion, request probe KMT2A/MLLT1
In the absence of BCR::ABL1 fusion, when an extra ABL1 signal is identified, testing using the ABL1 break-apart probe set may be performed to evaluate for the presence of a potential variant translocation involving ABL1, t(9;var)(q34;?).
In the absence of ETV6::RUNX1 fusion, when an extra ETV6 signal is identified, testing using the ETV6 break-apart probe set may be performed to evaluate for the presence or absence of a potential variant translocation involving ETV6, t(12;var)(p13;?).
When a MYC rearrangement is identified, both the BCL2 and BCL6 break-apart probe sets will be performed.
If an unbalanced rearrangement of BCL2 is identified, testing using the IGH/BCL2 probe set may be performed to identify a potential t(14;18)(q32;q21) or IGH::BCL2 fusion.
Method Name
Fluorescence In Situ Hybridization (FISH)
Reporting Name
B-Lymphoblastic Leuk/Lymph, FISH,TsSpecimen Type
TissueSpecimen Minimum Volume
See Specimen Required
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Tissue | Ambient (preferred) | |
| Refrigerated | ||
Reject Due To
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.Reference Values
An interpretive report will be provided.
Day(s) Performed
Monday through Friday
Report Available
7 to 10 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
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
88271 x 2, 88291-DNA probe, each (first probe set), interpretation and report
88271 x 2-DNA probe, each; each additional probe set (if appropriate)
88271-DNA probe, each; coverage for sets containing 3 probes (if appropriate)
88271 x 2-DNA probe, each; coverage for sets containing 4 probes (if appropriate)
88271 x 3-DNA probe, each; coverage for sets containing 5 probes (if appropriate)
88274 w/modifier 52-Interphase in situ hybridization, <25 cells, each probe set (if appropriate)
88274-Interphase in situ hybridization, 25 to 99 cells, each probe set (if appropriate)
88275-Interphase in situ hybridization, 100 to 300 cells, each probe set (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| BLBLF | B-Lymphoblastic Leuk/Lymph, FISH,Ts | 102100-5 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 609452 | Result Summary | 50397-9 |
| 609453 | Interpretation | 69965-2 |
| 609454 | Result Table | 93356-4 |
| 609455 | Result | 62356-1 |
| GC057 | Reason for Referral | 42349-1 |
| 609456 | Specimen | 31208-2 |
| 609457 | Source | 31208-2 |
| 609458 | Tissue ID | 80398-1 |
| 609459 | Method | 85069-3 |
| 609460 | Additional Information | 48767-8 |
| 609461 | Disclaimer | 62364-5 |
| 609462 | Released By | 18771-6 |