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Test Code LCMS Leukemia/Lymphoma Immunophenotyping by Flow Cytometry

Additional Codes

MLAB: YL1

Powerchart: Lymphoid Cytoflow

Epic: order via LIS

MA Cerner: Leukemia/Lymphoma Immunophenotyping by Flow Cytometry.

Reporting Name

Leukemia/Lymphoma, Phenotype

Useful For

Evaluating lymphocytoses of undetermined etiology

 

Identifying B- and T-cell lymphoproliferative disorders involving blood and bone marrow

 

Distinguishing acute lymphoblastic leukemia (ALL) from acute myeloid leukemia (AML)

 

Immunologic subtyping of ALL

 

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

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
VBETA TCR V-BETA No, (Bill Only) 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

Testing Algorithm

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). The interpretation will be based on markers tested in increments of 2 to 8, 9 to 15, or 16 and greater. 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 (FIRST if applicable, ADD1 if applicable).

 

The triage panel is initially performed to evaluate for monotypic B cells by kappa and lambda light chain expression, increased numbers of blast cells by CD34 and CD45 expression along with side scatter gating, and increased plasma cells by CD45 expression and 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.

 

This panel, together with the provided clinical history and morphologic review, is used to determine what, if any, additional 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.

 

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.

 

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, not this test.

 

In addition to reflexing flow cytometric panels, FISH or molecular testing may be recommended by the Mayo pathologist to facilitate diagnosis. They will contact the referring physician or pathologist to confirm the addition of these tests.

 

These include:

Cytogenetic FISH Studies:

-CCND1/IGH translocation t(11;14), to exclude mantle cell lymphoma in cases of CD5+CD23- B-cell lymphoproliferative disorder.

-PML-RARA translocation t(15;17), to exclude acute promyelocytic leukemia if there is morphologic suspicion and/or blasts and promyelocytes are CD34 and HLA-DR-negative.

-TCL-1 break-apart at 14q32, to exclude T-cell prolymphocytic leukemia in cases with CD4-positive T-cell lymphoproliferative disorder (phenotypic aberrancy or very tight CD4+ population with high CD4:CD8 ratio).

-MYC break-apart at 8q24, with or without IGH-BCL2 t(14;18) and BCL6 break-apart at 3q27, for suspected high grade B-cell lymphomas, based on morphologic assessment and immunophenotype (usually CD10-positive).

 

Molecular Genetic Studies:

-T-cell receptor gene rearrangement to examine clonality of T cells in cases showing phenotypically aberrant T-cell population.

 

Cytochemical Stains:

-Confirmatory cytochemical stains as needed.

The following algorithms are available in Special Instructions:

-Malignant Lymphoma, Guideline for Bone Marrow Staging Studies

-Acute Promyelocytic Leukemia: Guideline to Diagnosis and Follow-up

Performing Laboratory

Mayo Medical Laboratories in Rochester

Specimen Type

Varies


Advisory Information


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.



Shipping Instructions


Specimen must arrive within 48 hours of collection for spinal fluid, 72 hours for fluids, or 96 hours for peripheral blood and bone marrow.



Necessary Information


The following information is required:

1. Pertinent clinical history including reason for referral or clinical indication

2. Clinical or morphologic suspicion

3. Specimen source

4. Date and time of collection



Specimen Required


Submit only 1 of the following specimens:

 

Specimen Type: Blood

Container/Tube:

Preferred: Yellow top (ACD)

Acceptable: 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)

Acceptable: ACD, 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

Container/Tube: Body fluid container

Specimen Volume: 20 mL

Collection Instructions:

1. If possible, the 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.

Additional Information: Spinal fluid cell and differential counts are required.

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


Specimen Minimum Volume

Blood: 3 mL; Bone Marrow, Spinal Fluid: 1 mL; Fluid from Serous Effusions: 5 mL

Specimen Stability Information

Specimen Type Temperature Time
Varies Varies

Reference Values

An interpretive report will be provided.

This test will be processed as a laboratory consultation. An interpretation of the immunophenotypic findings and correlation with the morphologic features will be provided by a hematopathologist for every case.

Day(s) and Time(s) Performed

Specimens are processed and reported Monday through Saturday

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.

CPT Code Information

88184-Flow cytometry; first cell surface, cytoplasmic or nuclear marker x 1

88185-Flow cytometry; additional cell surface, cytoplasmic or nuclear marker (each)

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
LCMS Leukemia/Lymphoma, Phenotype In Process

 

Result ID Test Result Name Result LOINC Value
18245 Accession Number 57723-9
18246 Referring Pathologist/Physician 46608-6
18247 Ref. Path Address 74221-3
18248 Material In Process
18528 Specimen: 31208-2
18249 Bone Marrow Differential 47286-0
18250 Peripheral Blood: No LOINC Needed
18251 Aspirate: No LOINC Needed
18252 Biopsy 52121-1
18253 Microscopic Description 22635-7
18254 Special Studies: 30954-2
18255 Final Diagnosis: 34574-4
18256 Comment: 48767-8
18257 Revision Description: In Process
18258 Signing Pathologist 19139-5
18259 Special Procedures 30954-2
18260 SP Signing Pathologist 19139-5
18261 *Previous Report Follows* No LOINC Needed
18262 Addendum 35265-8
19191 Addendum Comment: 22638-1
18263 Addendum Pathologist: 19139-5

Reject Due To

Hemolysis

Mild OK; Gross reject

Lipemia

NA

Icterus

NA

Other

Specimens received frozen

 

Method Name

Immunophenotyping

Secondary ID

3287

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 1 of the following forms with the specimen:

Hematopathology/Cytogenetics Test Request Form (T726) (http://www.mayomedicallaboratories.com/it-mmfiles/hematopathology-request-form.pdf)

Benign Hematology Test Request Form (T755) (http://www.mayomedicallaboratories.com/it-mmfiles/benign-hematology-test-request-form.pdf)