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Test ID LLTOF Leukemia and Lymphoma Phenotyping, Technical Only, Varies

Useful For

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 (AML)

 

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

Method Name

Immunophenotyping

Reporting Name

Leukemia/Lymphoma; Tech Only Flow

Specimen Type

Varies


Advisory Information


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) should be ordered as 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; however, 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.



Shipping Instructions


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.



Necessary Information


1. The following information is required:

a. Pertinent clinical history including reason for referral 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.



Specimen Required


Submit only 1 of the following specimens:

 

Specimen Type: Blood

Container/Tube:

Preferred: Yellow top (ACD solution A or B)

Acceptable: Sodium heparin, EDTA

Specimen Volume: 10 mL

Slides: Include 5 to 10 unstained blood smears, if possible.

Collection Instructions:

1. Do not transfer blood to other containers.

2. Label specimen as blood.

Specimen Stability Information: Ambient <96 hours/Refrigerated ≤96 hours

 

Specimen Type: Bone marrow

Container/Tube:

Preferred: Yellow top (ACD solution A or B)

Acceptable: Sodium heparin, 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.

Additional Information: If cytogenetic tests are also desired when drawing LCMS / Leukemia/Lymphoma Immunophenotyping by Flow Cytometry, an additional specimen should be submitted. It is important that the specimen be obtained, processed, and transported according to instructions for the other required test.

Specimen Stability Information: Ambient <96 hours/Refrigerated ≤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 ≤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 ≤48 hours

 

Supplies: Hank's Solution (T132)

Specimen Type: Tissue

Container/Tube: Sterile container with 15 mL of tissue culture medium (eg, Hank's balanced salt solution [T132], RPMI, or equivalent)

Specimen Volume: 5 mm(3) or larger biopsy

Specimen Stability Information: Ambient <96 hours/Refrigerated ≤96 hours

Collection Instructions:

1. Send intact specimen (do not mince).

2. Specimen cannot be fixed.


Specimen Minimum Volume

Blood: 3 mL
Bone Marrow, Spinal Fluid: 1 mL
Fluid from Serous Effusions: 5 mL
Tissue: 1 mm(3) or larger biopsy

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Varies

Reference Values

Not applicable

Day(s) and Time(s) Performed

Specimens are processed and reported Monday through Saturday

Performing Laboratory

Mayo Clinic Laboratories in Rochester

CPT Code Information

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)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
LLTOF Leukemia/Lymphoma; Tech Only Flow In Process

 

Result ID Test Result Name Result LOINC Value
CK071 Flow Cytometry 69052-9
CK072 Final Diagnosis 22637-3
CK073 Microscopic Description 22635-7
CK074 Special Studies 30954-2

Test Classification

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 U.S. Food and Drug Administration.

Testing Algorithm

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 or V-beta 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

NY State Approved

Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
VBETA TCR V-BETA No No
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

Additional Tests

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

Forms

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.