Test ID: LN
Chromosome Analysis, Lymphoid Tissue
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Assisting in the classification of certain cases of lymphoma
Method Name A short description of the method used to perform the test
Includes 2 banded karyograms, analysis of 20 or more metaphases, and other techniques when required.
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Karyotype for lymphoma
Karyotype, Lymph Node
Reactive Lymphocytic Process vs Malignant
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Provide a reason for referral with each specimen. The laboratory will not reject testing if this information is not provided, but appropriate testing and interpretation may be compromised or delayed. Include pathology reports, if available.
Preferred: Lymphoid tissue
Acceptable: Spleen, extranodal tissue
Container/Tube: Sterile container with sterile Hank's balanced salt solution (Supply T132), Ringer's solution, or normal saline
Specimen Volume: 1 cm(3)
Additional Information:
1. Advise Express Mail or equivalent if not on courier service.
2. Spleen tissue or extranodal tissue may be submitted when a lymphomatous disorder is believed to involve these tissues.
Forms: If not ordering electronically, submit a Cytogenetics Hematologic Disorders Request Form (Supply T607) with the specimen.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | NA |
| Lipemia | NA |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Tissue | Refrigerated (preferred) | |
| Ambient | ||
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Chromosomal abnormalities play a central role in the pathogenesis, diagnosis, and monitoring of treatment of many hematologic disorders.
The observation of a chromosomally abnormal clone is consistent with a clonal neoplastic process.
Certain chromosome abnormalities can help classify the type of lymphoma. For example, t(14;18)(q32;q21.3) involving the IGH and BCL2 genes is usually indicative of a follicular lymphoma. A translocation between C-MYC and IGH genes or a t(8;14)(q24.1;q32) are both associated with Burkitt's lymphoma.
Cytogenetic studies often can help distinguish between B-cell and T-cell disorders. Structural abnormalities involving breakpoints at any immunoglobulin locus is consistent with a B-cell disorder; structural abnormalities involving breakpoints at a T-cell receptor site are usually associated with a T-cell disorder.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
46,XX or 46,XY. No apparent chromosome abnormality.
An interpretive report will be provided.
Interpretation Provides information to assist in interpretation of the test results
The observation of a chromosomally abnormal clone is evidence of a clonal neoplastic process.
Certain chromosome abnormalities also may be associated with certain morphologic classifications. However, a normal karyotype does not eliminate the possibility of a neoplastic process.
On rare occasions, the presence of an abnormality may be associated with a congenital abnormality that is not related to a malignant neoplastic process. Follow-up with a medical genetics consultation is recommended.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Interfering factors
Technical:
-Lack of viable cells
-Bacterial contamination
-Cell death due to failure to transport tissue in appropriate media
-Excessive transport time
-Exposure of the specimen to temperature extremes (freezing or >30 degrees C)
-Specimen has been stored or treated with formalin or another fixative or is paraffin-embedded
Biological:
-Normal cells in the specimen may grow better in culture than tumor cells and interfere with the cytogenetic studies
-Mitogen-stimulation of normal lymphocytes rather than malignant lymphocytes, in the culture process
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Pierre RV, Dewald GW, Banks PM: Cytogenetic studies in malignant lymphoma: possible role in staging studies. Cancer Genet Cytogenet 1980;1:257-261
2. Dewald GW, Jenkins RB: Cytogenetic and molecular genetic studies of patients with monoclonal gammopathies. In Neoplastic Diseases of Blood. Second edition. Edited by PH Wiernik, GP Canello, RA Kyle, CA Schiffer. New York, Churchill Livingstone, 1991, pp 427-438
Method Description Describes how the test is performed and provides a method-specific reference
Tissue is dissociated using enzymes and/or mechanical means, and the tissue is transferred to tissue cultures. The cultures are incubated at 37 degrees C with 5% carbon dioxide (CO2), 5% oxygen (O2) and 90% nitrogen (N2). Cultures may be harvested starting at 24 hours after set up and include harvests up to and including 144 hours (5 days) after set up.
The harvest procedure involves treating the cells with colcemid, and hypotonic solution, then fixing the cells with glacial acetic acid and methanol. Metaphase cells are dropped onto microscope slides and are routinely stained by G- or Q-banding. Twenty metaphases are usually examined. If an abnormal clone is not detected in the unstimulated culture, a 72-hour mitogen (CpG) culture may be analyzed if available. Minimal evidence for the presence of an abnormal clone is defined as 2 or more metaphases with the same structural abnormality or chromosome gain (trisomy), or 3 or more metaphases lacking the same chromosome. Five to 10 metaphases are captured using a computerized imaging system and 1 or more representative karyograms from each clone are prepared to document the type of abnormality and permit systematic interpretation of the anomalies. (Witzig TE, Phyliky RL, Li CY, et al: T-cell chronic lymphocytic leukemia with a helper/inducer membrane phenotype: a distinct clinicopathologic subtype with a poor prognosis. Am J Hematol 1986;21:139-155; Dewald GW, Noel P, Dahl RJ, Spurbeck JL: Chromosome abnormalities in malignant hematologic disorders. Mayo Clin Proc 1985;60:675-689; Inwards DJ, Habermann TM, Banks PM, et al: Cytogenetic findings in 21 cases of peripheral T-cell lymphoma. Am J Hematol 1990;35:88-95)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Samples processed Monday through Sunday. Results reported Monday through Friday, 8 a.m.-5 p.m. CST.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
88239-Tissue culture for tumor
88291-Interpretation and report
88299-Unlisted cytogenetic study (Refer to patient report to apply the appropriate CPT code below in place of this unlisted cytogenetic study CPT code)
Based on the total number of cells analyzed and counted, MML would recommend the following:
Chromosome analysis with less than 5 cells; CPT Code 88261 w/ modifier 52
Chromosome analysis with 5 to 14 cells; CPT Codes 88261, 88285
Chromosome analysis with 15 to 19 cells; CPT Code 88262
Chromosome analysis with 20 to 25 cells; CPT Code 88264
Chromosome analysis with more than 25 cells; CPT Codes 88264, 88285
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 16107 | Specimen | 31208-2 |
| 16332 | Specimen ID | N/A |
| 16787 | Source | N/A |
| 16108 | Order Date | N/A |
| G_527 | Reason For Referral | 42349-1 |
| 16112 | Method | In Process |
| 50468 | Banding Methods | 62359-5 |
| 16114 | Results | 35129-6 |
| 16115 | Interpretation | 69965-2 |
| 16116 | Amendment | In Process |
| 16117 | Consultant | N/A |
| 16118 | Report Date | N/A |
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