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Comprehenisve Leukemia/ Lymphoma Immunophenotping by Flow Cytometry

FLOW

Test Synonym:

Acute Myeloid Leukemia, Acute Lymphoblastic Leukemia, Chronic Lymphocytic Leukemia, non-Hodgkin Lymphoma

CPT Code:

88184 – Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical  component only, first marker

88185 – Each additional marker (multiple)

88187 – Flow cytometry, interpretation; 2 to 8 markers

88188 – 9 to 15 markers

88189 – 16 or more markers

Turnaround Time:

<24 hours

Methodology:

Flow cytometry, multiparameter analysis

Specimen Requirements:

  • 5.0mL (min. 2.0mL) whole blood Heparin preferred, EDTA whole blood accepted
  • <2.0ml (min. 0.5mL) bone marrow aspirate Heparin preferred, EDTA bone marrow accepted
  • 20mm3 bone marrow core biopsy in MPLN RPMI transport media
  • 5mm3 fresh tissue in MPLN RPMI transport media
  • FNA (cell suspension or core biopsy) in MPLN RPMI transport media (2.0-4.0mL RPMI)
  • 4.0mL (min. 2.0mL) cerebrospinal fluid (CSF) in sterile container
  • 10.0mL (min. 5.0mL) pleural/body fluid in sterile container

    • If RPMI media or MPLN RPMI transport media is not available, send in sterile saline

    Causes for Rejection:

    Specimens stored at incorrect temperature; Non-viable specimens; Specimens in inappropriate anticoagulant; Too few cells; Hemolysis; Specimen clotted

    Specimen Stability:

  • Whole blood or bone marrow stable for 48 hours at 18-25°C 
  • Bone marrow biopsy, fresh tissue, CSF, pleural fluid, or FNA in MPLN RPMI stable for 48 hours at 2-8°C

    • Storage and Handling:

  • Whole blood or bone marrow ship ambient
  • Bone marrow biopsy, fresh tissue, CSF, pleural/body fluid or FNA ship in a styrofoam container with a cool pack (do not allow ice packs to directly contact samples)

    • Reference Range:

    See report

    Indication:

    Immunophenotypic analysis by multiparameter flow cytometry is a useful adjunct to clinical, morphologic, immunohistochemical, and genetic evaluation to aid in the diagnosis and characterization of hematolymphoid neoplasia.

    The W.H.O classification of Tumours of Haematopoietic and Lymphoid Neoplasms provides a consensus description and classification of hematolymphoid neoplasms. Immunophenotypic analysis is an integral part of the classification of hematolymphoid processes. By analyzing the expression of cell surface and cytoplasmic markers, abnormal cells can be identified and defined with respect to cell lineage. Flow cytometric analysis is a useful adjunct in the classification of acute and chronic leukemias, B-cell neoplasms, T-cell and NK cell neoplasms, plasma cell neoplasia, mast cell disease, and myeloproliferative / myelodysplastic processes.

    References:

    1. Special Issue. (2006). Zap-70 and CLL. Cytometry, 70B:4
    2. Craig and Foon. (2008). Flow Cytometric Immunophenotyping for Hematologic Neoplasms. Blood 111, No. 8: 3941-3967
    3. Bethesda International Consensus Conference on Flow Cytometric Immunophenotyping of Hematopoietic Neoplasia.(2006)
    4. Costabel U et al.(1984). T-lymphocytosis in bronchoalveolar lavage fluid of hypersensitivity pneumonitis: changes in profile of T-cell subsets during the course of disease. Chest 85:514-8
    5. Crespo et al. (2003). ZAP-70 expression as a surrogate for Immunoglobulin-Variable-Region mutations in chronic lymphocytic leukemia. NEJM 348 (18):1764
    6. Damle R.N., et al.(1999). Ig V mutation status and CD38 expression as novel prognostic indicators in chronic lymphocytic leukemia. Blood 94:1840-1847
    7. Davis BH et al. 2006 Bethesda International Consensus Recommendations on the Flow Cytometric Immunophenotypic Analysis of Hematolymphoid Neoplasia: Medical Indications (submitted for publication, Cytometry)
    8. Foucar. (2001). Bone Marrow Pathology 2nd edition. ASCP Press
    9. Jaffe et al. (2001) World Health Organization Classification of Tumours, Pathology and Genetics, Tumours of Haematopoietic and Lymphoid Tissues. IARC press
    10. Jennings et al. (1997). Recent advances in flow cytometry: Applications to the diagnosis of hematologic malignance. Blood 90:2863
    11. Keren et al. (2001). Flow Cytometry in Clinical Diagnosis 3rd edition. ASCP Press
    12. Knowles. (2001). Neoplastic Hematopathology 2nd edition. Lippincott Williams and Wilkins
    13. Nguyen et al.(2003). Flow Cytometry in Hematopathology. Humana Press
    14. Stetler-Stevenson et al. (2001). Diagnostic utility of flow cytometric immunophenotyping in myelodysplastic syndrome. Blood 98(4):979
    15. Shapiro H (2003). Practical Flow Cytometry 4th edition. Wiley-Liss
    16. Wells et al. (2003). Myeloid and monocytic dyspoiesis as determined by flow cytometric scoring in myelodysplastic syndrome correlates with the IPSS and with outcome after hematopoietic stem cell transplantation. Blood 102(1):394-403