FLOW EVALUATION FOR LEUKEMIA/LYMPHOMA

Message
***ONLY DRAW BETWEEN 0400-1500 Monday through Saturday, SPECIMEN NEEDS RECEIVED AT LABCORP WITHIN 24 HOURS OF DRAW***
DO NOT USE FOR PAROXYSMAL NOCTURNAL HEMOGLOBINURIA(PNH)


Test Code
LAB1729


Alias/See Also
LAB1729
LabCorp TC: 480260
LabCorp Test Name: Hematolymphoid/Plasma Cell Neoplasia Assessment (HNA), Immunophenotyping by Flow Cytometry
OSU: IMMUNOPHENOTYPING,PERIPH BLOOD
 


Preferred Specimen
3 mL Dark Green Top (Sodium Heparin) - Whole Blood
2 mL bone marrow aspirate, body fluids
1.0 cm fresh lymph node, spleen, extranodial solid tissue, biopsy, OR needle aspirate.


Minimum Volume
1.0 mL Dark Green Top (Sodium Heparin) - Whole Blood


Other Acceptable Specimens
Lavender (EDTA)
Yellow Top (ACD)


Instructions
Ship specimens in a timely manner based on the specific requirements of the test. Submit blood or bone marrow at room temperature. Collect the specimen so it will arrive at Labcorp Monday through Saturday and within 24 hours of collection. Please state on the test request form the date and time of collection and the name and phone number of the pathologist responsible for the histologic or cytologic diagnosis. For fresh tissue, aseptically cut tissue in pieces and place in lymph node transport bottle. If aspirate is submitted, rinse needle in transport medium. Submit at room temperature using Lymph Node Transport Kit (supplied by LabCorp). If transport kit is not available, place specimen in sterile container with saline. Submit specimen so it will arrive in the laboratory Monday through Saturday and within 24 hours of surgical removal. To avoid transportation delays, submit specimen on the day of collection.


Transport Temperature
Room Temperature


Specimen Stability
Room Temperature: 24 hours


Methodology
Immunophenotyping by flow cytometry

Clinical Significance

Identify and characterize the following: # Reactive lymphocytosis vs chronic lymphocytic leukemia (CLL) # CLL vs mantle cell lymphoma # Prolymphocytic leukemia vs lymphoblastic leukemia large granular lymphocyte proliferations, T-gamma lymphoproliferative disease, natural killer cell proliferations, T-cell CLL, T-cell gamma/delta proliferations # Sezary syndrome # Non-Hodgkin lymphoma # Adult T-cell leukemia/lymphoma Neoplastic B-cell proliferations (chronic leukemias and lymphomas) are clonal expansions of cells that express either kappa or lambda immunoglobulin light chains. In normal or reactive processes, a bimodal distribution of kappa and lambda-positive B cells is present in a ratio of approximately 1.5:1. Immunophenotyping using multiparameter analysis (simultaneous staining with a pan B-cell marker andanti-immunoglobulin light chain antibodies) is a rapid and specific method for detecting and confirming the presence of neoplastic B-cell disorders. Chronic lymphocytic leukemia (CLL) is a clonal lymphoproliferative disorder usually of B-cell origin (95%),that has been traditionally diagnosed using clinical and morphologic criteria. Incorporation of immunophenotypic features into the diagnostic criteria is helpful in separating common B-cell CLL from other lymphoproliferative disorders. Detection of karyotypic abnormalities is useful in assessing prognosis. Lymphocytes in B-CLL coexpress CD19,CD20 and CD23 pan B-cell antigens, CD5, pan T-cell antigen, and a single immunoglobulin light chain, kappa or lambda. CD10 (CALLA) expression is usually absent. Mantle cell lymphoma is distinguished from CLL by absent or very dim expression of CD23. Lymphomas are biologically complex neoplasms of the immune system. Numerous classification schemes have been developed based on morphologic features. This limited approach is often unreliable. Immunophenotyping, by flow cytometry and/or immunohistochemistry, has emerged as a valuable adjunct to conventional morphologic diagnosis and classification. Flow cytometry offers the advantage of rapidmultiparameter analysis. Combining light scatter characteristics with patterns of antigen expression and DNA content provides biological information that is useful in making a diagnosis and assessing prognosis. Various gating strategies can be employed to enhance the detection of minorpopulations, thus providing a level of sensitivity comparable to molecular methods (gene rearrangement studies). T-cell CLL, unlike B-CLL, is associated with rapid onset, anaggressive clinical course poorly responsive to therapy and decreased survival. Immunophenotyping, in the majority of cases, demonstrates expression of CD3 (a pan T-cell antigen), and CD4 (the helper cell antigen). CD8 (the suppressor/cytotoxic cell antigen) is usually not expressed.Genotyping demonstrates a clonal rearrangement of the T-cellreceptor gene. Large granular lymphocyte (LGL) proliferations can be divided into T-cell and natural killer (NK) cell subsets by immunophenotyping. The more common T-cell type expresses CD3, a pan T-cell antigen and CD8, the suppressor/cytotoxic cell antigen. Genotyping demonstrates a rearrangement of theT-cell receptor gene. The NK cell type is relatively rare and expresses CD2 and CD16 and/or CD56. CD3 expression is absent. Genotyping demonstrates a germline configuration of the T-cell receptor gene. In Sezary syndrome, the neoplastic lymphocytes are T cells with a helper cell phenotype. Expression of CD7, a pan T-cell antigen, is absent and is useful in distinguishing the neoplastic cells from normal T-helper cells. Genotyping demonstrates a clonal rearrangement of the T-cell receptor gene. In adult T-cell leukemia/lymphoma, the neoplastic lymphocytes are T-cells with a helper cell phenotype. Expression of CD3, CD4, and CD25 is present. Expression of CD7 is absent. Genotyping demonstrates a clonal rearrangement of the T-cell receptor gene. Detection of a B-cell population coexpressing CD22, CD11c, and CD25 is useful in establishing a diagnosis of hairy cellleukemia when used in conjunction with morphology and cytochemistry. Immunophenotyping by flow cytometry is a sensitive method for detecting residual or recurrent diseasein the peripheral blood of patients with an established diagnosis. Detection of a population of cells expressing CD38 and CD138in the peripheral blood is useful in establishing a diagnosis of plasma cell leukemia when used in conjunction with morphology. Lineage assignment in acute leukemia is necessary for selecting appropriate therapy and is useful in assessing prognosis. Multiparameter analysis using four-color immunophenotyping techniques is a rapid and specific method of assigning lineage in acute leukemia. This profile is also useful in distinguishing lymphoid from myeloid blast crisis in CML and immunophenotyping lymphoblastic lymphoma in blood or bone marrow. Immunophenotyping and cytogenetic analysis are increasingly being used to supplement the traditional methods (morphologyand cytochemistry) of classifying acute leukemias and to provide prognostic information. Acute lymphoblastic leukemia(ALL) can be classified into undifferentiated null T-and B-cell lineages. In ALL of B-cell lineage, expression of CD10 (CALLA) is a favorable prognostic factor. Acute myelogenous leukemias (AML) are a heterogeneous group. In cases where morphology and cytochemical staining is equivocal, immunophenotyping can be useful. Immunophenotyping is particularly useful in classifying megakaryoblastic leukemia (FABM7). A combination of characteristic light scattering properties and myeloid phenotype can suggest a diagnosis of acute promyelocytic leukemia (FABM3). Confirmation of the retinoic acid receptorgene rearrangement by cytogenetic or molecular methods is recommended. See tests listed under Related Information andrelated FISH test (eg, 510362).  
 


Performing Laboratory
LabCorp



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.