High-Grade B-Cell Lymphoma Reflex FISH Panel

Message

Probes: MYC (8q24). If rearranged, reflex to concurrent BCL2 (18q21) and BCL6 (3q27). Disease(s): B-cell lymphoma, double-hit lymphoma, triple-hit lymphoma

Test Code

LAB6165

CPT Codes
88374x1 automated or 88377x1 manual without reflex; with reflex add 88374x2 automated or 88377x2 manual

Preferred Specimen

Bone Marrow Aspirate: 1-2 mL sodium heparin tube. EDTA tube is acceptable. Peripheral Blood: 2-5 mL sodium heparin tube. EDTA tube is acceptable. Fresh, Unfixed Tissue: Tissue in RPMI.Fluids: Equal parts RPMI to specimen volume.Paraffin Block: H&E slide (required) plus paraffin block. Cut Slides: H&E slide (required) plus 2 unstained slides cut at 4 microns. Note: Please exclude biopsy needles, blades, and other foreign objects from transport tubes. These can compromise specimen viability and yield, and create hazards for employees.

Instructions

Refrigerate specimen. Do not freeze. Use cold pack for transport, making sure cold pack is not in direct contact with specimen.

Methodology
FISH

Report Available

3-5 days

Clinical Significance

The High-Grade B-Cell Lymphoma Reflex Panel differentiates double-hit or triple-hit lymphomas (which have MYC rearrangements together with BCL2 and/or BCL6 rearrangements) from Burkitt lymphoma or diffuse large B-cell lymphoma. Double-hit and triple-hit lymphomas are difficult to classify morphologically without aid of cytogenetics/FISH or IHC, and are associated with an aggressive course. Testing is indicated when B-cell lymphoma patients experience transformation, relapse, or refractory disease. A small subset of lymphomas with MYC rearrangement (4%) may be missed when using the MYC breakapart probe alone, but some of these cases may be detected using the MYC/IgH fusion probe set (PMID: 30523057). This reflex panel may be considered a cost-effective alternative to the High-Grade/Large B-Cell Lymphoma FISH Panel when clinical circumstances allow an additional few days for reflex testing if MYC is rearranged. MYC/IgH/Cen 8 t(8;14) is available as a stand-alone test.

Performing Laboratory
Neogenomics Laboratories

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.