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Non-Hodgkin Lymphoma Panel by Fluorescence In Situ Hybridization (FISH) Analysis

FISH, NHL panel, genetic, GNHLF, IGH/BCL2 fusion FISH for t(14;18), IGH/CCND1 fusion FISH for t(11;14), BCL6 gene rearrangement for t(3q27;var), MYC gene rearrangement for t(8q24;var), MALT1 (18q21) gene rearrangement

Test Codes

EPIC: LAB7096

Department

Cytogenetics

Specimen Collection Criteria

Collect: Bone marrow aspirate, lymph node paraffin tissue section, lymph node touch preparation in a sterile collection container.

A copy of the requisition must be sent with the specimen.

Physician Office/Draw Specimen Preparation

Do not freeze specimen. Maintain specimens at room temperature (20-25°C or 68-77°F) prior to courier pickup. For delays in transport (greater than 48 from the time of collection), refrigerate (2-8°C or 36-46°F) the specimen.

Preparation for Courier Transport

Transport: Bone marrow aspirate, lymph node paraffin tissue section, or lymph node touch preparation, at room temperature (20-26°C or 68-78.8°F) or refrigerated (2-8°C or 36-46°F).

Rejection Criteria

Specimens arriving in the Laboratory 4 days or more following the original collection date.

Fixed or frozen specimens. 

In-Lab Processing

Specimens are processed immediately upon receipt in the Laboratory.

Storage

Specimen Stability for Testing:

Room Temperature (20-26°C or 68-78.8°F): 48 hours
Refrigerated (2-8°C or 36-46°F): 96 hours
Frozen (-20°C/-4°F or below): Unacceptable

Specimen Storage in Department Prior to Disposal:

Refrigerated (2-8°C or 36-46°F): 7 days. A backup cell pellet is maintained for three weeks after the case has been signed out.

Laboratory

Royal Oak Cytogenetics Laboratory

Performed

Monday – Friday, 8:00 am – 5:00 pm.
Results available within 7 days of receipt in the Laboratory.

Reference Range

Positive or negative for a neoplastic clone. An interpretative report will be provided.

Test Methodology

Fluorescence In Situ Hybridization (FISH) Analysis.

Interpretation

Identification of a characteristic cytogenetic abnormality along with morphological and immunophenotypic analysis can establish the specific type of lymphoma present. Studies have shown that the sensitivity of FISH for detecting lymphoma-associated chromosome translocations is higher and more specific than PCR, owing in part to the large genomic region over which some of the translocation breakpoints are spread, precluding their detection by molecular methods in a highly sensitive fashion.

Clinical Utility

The majority of non-Hodgkin lymphomas (NHL) demonstrate clonal chromosomal abnormalities that often cause relocation of oncogenes to the vicinity of highly active promoter/enhancer elements of immunoglobulin or T-cell receptor genes in B-cell or T-cell lymphoma, respectively, and result in deregulation of the oncogene. Conventional cytogenetic analysis is not always possible in lymphomas due to the lack of fresh tissue and small biopsy specimens. FISH can be used to establish the diagnosis in viable and fixed tissue and to assess the involvement of bone marrow by lymphoid tumor. As unfixed tissue may not be available, FISH on paraffin-embedded tissue sections can be an invaluable technique to identify genetic aberrations in lymphoid malignancies, as can FISH analysis of touch imprint specimens.

In NHL, a wide variety of translocation partner chromosomes are involved with 14q32, the site of the IgH gene. These translocations are associated with certain histopathologic subtypes, and therefore can be of diagnostic and prognostic value in these disorders. The most frequent translocation in B-cell NHL, t(14;18)(q32;q21), juxtaposes the BCL2 proto-oncogene at 18q24 to the IgH locus in follicular lymphoma, and to a lesser extent diffuse large B-cell lymphoma. The t(11;14)(q13;q32), associated with mantle cell lymphoma, involves a breakpoint within the BCL1 gene locus at 11q13 that results in relocation of the cyclin D1 (CCND1) gene next to the promoter for the IgH gene causing overexpression of CCND1. The BCL6 gene at 3q27 is involved in a number of variant translocations in 30-40% of diffuse large cell lymphomas. FISH assays offered for NHL include:

• IGH/BCL2 fusion FISH for t(14;18)
• IGH/CCND1 fusion FISH for t(11;14)
• BCL6 gene rearrangement for t(3q27;var)
• MYC gene rearrangement for t(8q24;var)
• MALT1 (18q21) gene rearrangement

Guidelines for Cytogenetic/Molecular Testing of Hematopoietic Malignancy

CPT Codes

88271x7 (DNA probe, each), 88275x5 (100-300 interphase nuclei examined).

Contacts

Last Updated

12/30/2022