Thyroid FNA Cytomorphology with Molecular Reflex

Test Code
90818


CPT Codes
88173<br /> ** For New York patient testing, please contact the EAP Client Services department at 800-336-3718 ext. 61228.**

Includes
Comprehensive Assessment will be added to all Molecular Reflex tests.

If indicated, test may reflex to one or more of following tests at an additional charge:
BRAF Mutation Analysis, Papillary Thyroid Cancer (CPT Code(s): 81210)
RET/PTC Rearrangement, Thyroid Cancer (CPT Code(s): 81311)
PAX8/PPAR [gamma] Translocation, Thyroid Cancer Translocation (CPT Code(s): 81401)
RAS Mutation Analysis, Thyroid Cancer (CPT Code(s): 81403, 81311,81275, 81276)

If indicated, one or more of the following tests could be added at an additional charge:
Level IV, Surgical Pathology (CPT Code(s): 88305)
Histopathology Special Stains-Miscellaneous (CPT Code(s): 88313)

Immunostain(s) (CPT Code(s): 88342 for each), most common are:
Calcitonin, IHC with Interpretation
CD20, IHC with Interpretation
CD3, IHC with Interpretation
PTH, IHC with Interpretation
Thyroid Transcription Factor-1, IHC with Interpretation
Thyroglobulin, IHC with Interpretation


Preferred Specimen
Needle washings in alcohol-based preservative (e.g. CytoLyt®), collected in a plastic, leak-proof container and
4 unstained, fixed or air-dried slides of needle washings, submitted in a slide holder


Instructions
Do not reject.
Express a small portion of the FNA from needle directly onto glass slide and air dry or fix immediately by immersing in alcohol or by fixing with a commercially prepared cytology spray fixative. Label each slide with patient name, pathology sample ID, and the number of needle pass (i.e., 1 for 1st, 2 for 2nd, etc). The needle should then be washed in a screw-capped vial of alcohol-based fixative (e.g., CytoLyt®) and labeled with patient name, pathology sample ID, and FNA location. FNAs from different locations (e.g., distinct nodules) should be collected individually on different slides and needle washings (e.g., A-left lobe, B-right lobe).


Transport Temperature
Room termperature


Specimen Stability
Room temperature: 30 days
Refrigerated: 30 days
Frozen: Unacceptable


Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Broken slides beyond repair • Unlabeled container or slide • Leakage of fluid during transport • Mismatch between name of patient on slide and name on test requisition


Methodology
Cytomorphology Review • Reflex: PCR-based Molecular Testing

FDA Status
This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

Setup Schedule
Set up: Mon-Sat; Report available: 7-10 days


Reference Range
See Laboratory Report


Clinical Significance
This assay provides morphologic review along with appropriate molecular testing for diagnosis of thyroid samples obtained by fine needle aspirate (FNA). Any molecular testing required will be reflexed based on cytologic findings and a comprehensive assessment issued summarizing the overall findings.
Papillary thyroid cancer (PTC) is associated with BRAF V600E mutation (40-50% of cases) and RET overexpression through juxtaposition to the PTC genes by chromosome fusion (5-40% of cases). Follicular thyroid carcinomas are specifically associated with PPARG-PAX8 gene fusions in 25-50% of cases. NRAS, HRAS and KRAS mutations are more commonly associated with follicular thyroid neoplasms than PTC.

For reflex algorithm for molecular testing, see:
http://questdiagnostics.com/testcenter/testguide.action?fn=EndoMetab/Thyroid/TG_Thyroid_Cancer.htm


Performing Laboratory
Quest Diagnostics Nichols Institute
14225 Newbrook Drive
Chantilly, VA 20153



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.