Epic Code LAB3273 Diffuse Large B-Cell Lymphoma (DLBCL) Probe Panel by FISH
Test Name Alias
DLBCL by FISH | Double Hit Lymphoma by FISH | Triple Hit Lymphoma by FISH | 9223
Interface Order Alias
11604
Clinical Information
This probe panel detects specific structural chromosome abnormalities commonly associated with Diffuse Large B-cell Lymphoma.
Routine chromosome analysis is performed on all diagnostic samples and is recomended on all bone marrow specimens to exclude abnormalities not identified by the specified FISH probe(s).
Mandatory Reflex Information:
1. Immunohistochemical/In situ hybridization staining to include: CD3, CD20, CD5, CD10, BCL-1, Ki-67, EBERish, BCL-2, BCL-6, MUM1, MYC, CD30, and CD45
2. Cytogentic FISH testing to include: BCL-2, BCL-6, and MYC rearrangement testing.
Collection Instructions
Multiple specimen collection types. Submit only one:
Specimen Collection: Bone Marrow
Container(s): Green Top (Sodium Heparin)
Preferred volume to collect: 5.0 mL
Minimum volume to collect: 1.0 mL
Neonate volume to collect: 1.0 mL
Collection Instructions:
- Collect bone marrow and transfer marrow from syringe to plain green top sodium heparin tube.
Specimen Collection: Peripheral blood
Container/Tube: Green Top (Sodium Heparin)
Preferred volume to collect: 8.0 mL
Minimum volume to collect: 0.5 mL
Neonate volume to collect: 0.5 mL
Collection Instructions:
- Peripheral blood may be substituted for Bone Marrow if circulating blasts are present
- Collect peripheral blood into a plain green top sodium heparin tube.
- Keep sample at room temperature and send to the Lab immediately.
Specimen Collection: Formalin-fixed, paraffin-embedded (FFPE) tissue
Container(s): Block
Preferred Volume to Collect: 6 unstained slides cut between 4 and 6 microns thick
Collection Instructions:
- Include an H&E slide scribed by Pathologist and Surgical Specimen Testing order sheet.
- Place specimen in 10% Formalin and order Tissue Pathology in addition to Diffuse Large B-Cell Lymphoma (DLBCL) Probe Panel by FISH order.
Specimen Collection: Fine Needle Aspirate (FNA, such as lymph node)
Collection Instructions: Order FNA Cytology (refer to test code 202 for collection instructions) in addition to Diffuse Large B-Cell Lymphoma (DLBCL) Probe Panel by FISH order.
Specimen Collection: Pleural Fluid
Collection instructions: Place specimen in sterile container and order Medical Cytology in addition to Diffuse Large B-Cell Lymphoma (DLBCL) Probe Panel by FISH order.
Processing Instructions (Laboratory, Outpatient or Off-site collection)
Spin: No
Aliquot: No
Transport Temperature: Ambient
If ambient temperature exceeds 80°F or is below 40°F, please send in an insulated container. All samples should be directed to the laboratory as soon as possible.
Specimen Stability
Ambient: 3 days for fresh (beyond 3 days, specimen viability will be detemined by Cytogenetics Lab)
Laboratory Retention: primary specimens 4 weeks; frozen pellets retained greater than 1 year
Test Frequency
Test Set Up: Monday – Friday 8:00 am – 5:00 pm, Saturday 8:00 am – 3:00 pm.
Technologist on call for Sunday set up.
Final report: 2-3 days. 2-5 days for paraffin embedded specimens.
Reference Range
An interpretative report will be provided.
Performing Department
CYTOGENETICS
Performing Department Laboratory Location
Spectrum Health Advanced Technology Laboratory (ATL), Grand Rapids, MI
Methodology
Performed by fluorescence in situ hybridization (FISH). This test was developed and its performance characteristics determined by Spectrum Health Cytogenetics Laboratory. It has not been cleared or approved by the US FDA. The FDA has determined that such clearance or approval is not necessary. This test is used for clinical purposes.
CPT
88275 x3, 88271 x6
CDM Code
4148275, 4148271
Epic Test ID
1230100614
LOINC
Specimen Type: 66746-9
Indication Provided: 42349-1
Result: in process
Interpretation: 59050-5
Comments: 69965-2
Beaker LOINC
LOINC Not available
Reviewed Date
10/22/2021
Beaker Names
Beaker Procedure Name: DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) PROBE PANEL BY FISH
Beaker Display Name: Diffuse Large B-Cell Lymphoma (DLBCL) Probe Panel by FISH (Lab Use Only)
BEAKER TEST NAME: DIFFUSE LARGE B-CELL LYMPHOMA PROBE PANEL BY FISH
BEAKER TEST REPORT NAME: Diffuse Large B-Cell Lymphoma Probe Panel by FISH
Beaker Synonyms
DLBCL BY FISH
Beaker Collection and Specimen Handling
BEAKER COLLECTION: AP Ambient
Beaker Location, Container and Temperature
LC CYTOGENETICS: 6 ML NA HEPARIN TUBE A (Preferred)-Ambient
LC CYTOGENETICS: CYTOGENETICS MEDIA (Acceptable)-Ambient
LC CYTOGENETICS: MISCELLANEOUS (Acceptable)-Ambient
LC CYTOGENETICS: STERILE CONTAINER A (Acceptable)-Ambient