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HelpTest Code LLTOT Leukemia and Lymphoma Immunophenotyping, Technical Only, Tissue
Ordering Guidance
This test is available to clients through MayoAccess or MayoLink.
This test is not intended for product of conception (POC) specimens. For POC specimens see CMAPC / Chromosomal Microarray, Autopsy, Products of Conception, or Stillbirth.
Shipping Instructions
Specimen must arrive within 4 days of collection.
Necessary Information
The following information is required:
1. Reason for testing
2. Tissue type
3. Tissue location
4. Surgical pathology case number
Specimen Required
Specimen Type: Tissue
Supplies: Hank's Solution (T132)
Container/Tube: Sterile container with 15 mL of tissue culture medium (eg, Hank's balanced salt solution, RPMI, or equivalent)
Specimen Volume: 5 mm(3) or larger biopsy
Collection Instructions:
1. Send intact specimen (do not mince).
2. Specimen cannot be fixed.
Specimen Stability Information: Ambient ≤4 days/Refrigerated ≤4 days
Forms
Useful For
Evaluation of tissues for potential involvement by:
-Chronic lymphoproliferative disorders
-Malignant lymphomas
-Acute lymphoblastic leukemia
-Acute myelogenous leukemia
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 |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| 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
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). Additional testing may be performed at an additional charge for each marker tested (ADD1, as applicable) if needed to fully characterize a disease state or clarify any abnormalities from the screening panel.
The tissue panel is initially performed to evaluate for monotypic B cells by kappa and lambda immunoglobulin light chain expression, CD5, CD10, CD19, CD20, and CD23. Increased numbers of blasts and plasma cells are identified by CD45 expression along with side scatter gating. The tissue panel also includes CD3, CD5, and CD7 antibodies to evaluate T cells. Additionally, viability is assessed on all tissue specimens using 7-AAD (7-Amino-Actinomycin D) exclusion.
This initial testing, 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.
Cases requiring testing for granular lymphocytic leukemia (killer-cell immunoglobulin-like receptor panel) will have an interpretation added which will be performed by a Mayo Clinic pathologist at an additional charge.
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.
Special Instructions
Method Name
Immunophenotyping
Reporting Name
Leukemia/Lymphoma; Tech Only TissueSpecimen Type
TissueSpecimen Minimum Volume
1 mm(3)
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Tissue | Refrigerated (preferred) | ||
| Ambient | |||
Reference Values
Not applicable
Interpretation
Report will include a summary of the procedure.
Normal tissues typically contain a mixture of B cells with polytypic surface immunoglobulin light chain expression and T cells with unremarkable expression of the T cell-associated antigens CD3, CD5, and CD7. Typically, no appreciable blast population is present by CD45 and side scatter analysis.
Clinical Reference
1. Morice WG, Hodnefield JM, Kurtin PJ, Hanson CA. An unusual case of leukemic mantle cell lymphoma with a blastoid component showing loss of CD5 and aberrant expression of CD10. Am J Clin Pathol. 2004;122(1):122-127
2. Hanson CA. Acute leukemias and myelodysplastic syndromes. In: McClatchey KD, ed. Clinical Laboratory Medicine. Williams and Wilkins; 1994:939-969
3. Jaffe ES, Cossman J. Immunodiagnosis of lymphoid and mononuclear phagocytic neoplasms. In: Rose NR, Friedman H, Fahey JL, eds. Manual of Clinical Immunology. 3rd ed. ASM Press; 1987:779-790
4. Witzig TE, Banks PM, Stenson MJ, et al. Rapid immunotyping of B-cell non-Hodgkin's lymphomas by flow cytometry. A comparison with the standard frozen-section method. Am J Clin Pathol. 1990;94(3):280-286
5. Jevremovic D, Dronca RS, Morice WG, et al. CD5+ B-cell lymphoproliferative disorders: Beyond chronic lymphocytic leukemia and mantle cell lymphoma. Leuk Res. 2010;34(9):1235-1238
6. Jevremovic D, Olteanu H. Flow cytometry applications in the diagnosis of T/NK-cell lymphoproliferative disorders. Cytometry B Clin Cytom. 2019;96(2):99-115
7. Shi M, Jevremovic D, Otteson GE, Timm MM, Olteanu H, Horna P. Single antibody detection of T-Cell receptor alpha beta clonality by flow cytometry rapidly identifies mature T-Cell neoplasms and monotypic small CD8-positive subsets of uncertain significance. Cytometry B Clin Cytom. 2020;98(1):99-107
Day(s) Performed
Monday through Sunday
Report Available
1 to 4 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
88184-Flow cytometry; first cell surface, cytoplasmic or nuclear marker x 1
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 |
|---|---|---|
| LLTOT | Leukemia/Lymphoma; Tech Only Tissue | 101119-6 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 621506 | LLTOT Result | 69052-9 |
| 621507 | Final Diagnosis | 22637-3 |
| 621508 | Special Studies | 30954-2 |
| 621509 | Microscopic Description | 22635-7 |
| CKR3 | Reason for Referral | 42349-1 |
| CKS3 | Tissue Type | 31208-2 |
| CKT3 | Tissue Location | 22633-2 |
| CKPN3 | Surgical Pathology Number | 80398-1 |