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Leukemia/Lymphoma Phenotyping, Flow Cytometry

CPT

For CPT coding, call 800-222-7566, ext 6-8400.

Synonyms
  • Comp panel: Leukemia/Lymphoma
  • Flow Cytometry
  • Flow Cytometry Panel
  • Flow Cytometry Report
  • Flow Immunophenotyping
  • Hematoymphoid Neoplasm Profile
  • Leukemia
  • Leukemia Panel
  • Leukemia Profile
  • Leukemia/Lymphoma Evaluation
  • Leukemia/Lymphoma Profile
  • Lymphoma
  • Lymphoma Panel
  • Lymphoma Profile
  • Plasma Cell Neoplasm Profile

Test Details

Methodology

Immunophenotyping by flow cytometry

Result Turnaround Time

1 - 3 days

Turnaround time is defined as the usual number of days from the date of pickup of a specimen for testing to when the result is released to the ordering provider. In some cases, additional time should be allowed for additional confirmatory or additional reflex tests. Testing schedules may vary.

Related Documents

For more information, please view the literature below.

Leukemia & Lymphoma Management Test Selection Table

Use

This test is used to identify and characterize the following:

• Mature B-Cell lymphoproliferative disorders (chronic lymphocytic leukemia (CLL), mantle cell lymphoma, monoclonal B-cell lymphocytosis, hairy cell leukemia, B-cell lymphomas)

• Mature T-cell and natural killer cell lymphoproliferative disorders (T-cell lymphomas, Sezary syndrome/mycosis fungoides. T-cell and NK cell large granular lymphocyte disorders, adult T-cell leukemia/lymphoma)

• Acute leukemia (acute myeloid leukemia, precursor lymphoid leukemia, acute leukemia of ambiguous lineage)

• Plasma cell neoplasm (multiple myeloma, plasmacytoma, monoclonal Gammopathy)

Special Instructions

If both tissue flow cytometry and histology are required, submit one portion of fresh specimen in transport medium or saline for flow cytometry and one portion in 10% formalin for histologic analysis. A histology test number is required for tissue specimens.

Please direct any questions regarding this test to oncology customer service at 800-345-4363. Pathologist consultation is available Monday through Friday. Acute leukemia reporting is available on the weekend if requested. Please call Friday to coordinate. Indicate differential diagnosis on test request form. Submit recent CBC results for correlation. Billing will be performed back end.

References

Bitter MA. Hairy cell leukemia. In: Knowles DM, ed. Neoplastic Hematopathology. Baltimore, Md: Williams and Wilkins;1992.
Braylan RC. Lymphomas. In: Bauer KD, Duque RE, Shankey TV, eds. Clinical Flow Cytometry: Principles and Applications. Baltimore, Md: Williams and Wilkins;1993.
Foucar K. B-Cell chronic lymphocytic and prolymphocytic leukemia. In: Knowles DM, ed.Neoplastic Hematopathology. Baltimore, Md: Williams and Wilkins;1992.
Knowles DM II. The human T-cell leukemias: Clinical, cytomorphologic, immunophenotypic, and genotypic characteristics. Hum Pathol. 1986; 17(1):14-33. 3002948
McDaniel HL, MacPherson BR, Tindle BH, et al. Lymphoproliferative disorder of granular lymphocytes: A heterogeneous disease. Arch Pathol Lab Med. 1992; 116(3):242-248. 1371379
Miller ML, Fishleder AJ, Tubbs RR. The expression of CD22 (leu 14) and CD11c (leu M5) in chronic lymphoproliferative disorders using two-color flow cytometric analysis. Am J Clin Pathol. 1991; 96(1):100-108. 2069128

Custom Additional Information

In normal or reactive processes, a bimodal distribution of κ- and λ-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 and anti-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 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 cytogenic abnormalities is useful in assessing prognosis. Lymphocytes in B-CLL typically coexpress CD20, CD23, CD5, and a single immunoglobulin light chain, kappa or lambda. CD10 (CALLA) expression is usually absent. Mantle cell lymphoma shows expression of FMC7 with absent or very dim expression of CD23.

Lymphomas include diverse disease entities in the WHO classification, which requires a combination of morphology, immunophenotype, genetics and clinical information for lymphoma diagnosis and classification. Therefore, immunophenotyping by flow cytometry has become a critical component in lymphoma workup. Flow cytometry offers the advantage of rapid multiparameter analysis. Combining light scatter characteristics with patterns of antigen expression provides biological information that is useful in making a diagnosis and assessing prognosis. Various gating strategies can be employed to enhance the detection of minor populations.

T-cell prolymphocytic leukemia is associated with rapid onset, an aggressive clinical course poorly responsive to therapy and decreased survival. Immunophenotyping, in the majority of cases (60% of cases), demonstrates expression of CD3 (a pan T-cell antigen) and CD4 (the helper cell antigen) without CD8 expression (the suppressor/cytotoxic cell antigen). In 25% of cases, the lymphoma cells coexpress CD4 and CD8. The other 15% of cases are CD4 negative and CD8 positive. Genotyping demonstrates a clonal rearrangement of the T-cell receptor 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 clonal rearrangement of the T-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 CD103, CD22, CD11c, and CD25 is useful in establishing a diagnosis of hairy cell leukemia when used in conjunction with morphology and cytochemistry. Immunophenotyping by flow cytometry is a sensitive method for detecting residual or recurrent disease in the peripheral blood of patients with an established diagnosis.

Plasma cells in the blood and bone marrow are detected by expression of CD38 and CD138. Cytoplasmic light chain analysis is used to detect monotypia.

Lineage assignment in acute leukemia is necessary for selecting appropriate therapy and is useful in assessing prognosis. Multiparameter analysis using multi-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/molecular analysis are increasingly being used to supplement the traditional methods (morphology and cytochemistry) of classifying acute leukemias and to provide prognostic information. Acute lymphoblastic leukemia (ALL) can be classified into T-and B-cell lineages. In ALL of B-cell lineage, expression of CD10 (CALLA) is a favorable prognostic factor. Acute myeloid leukemias (AML) are a heterogeneous group. Immunophenotyping is particularly useful in classifying acute megakaryoblastic leukemia. A combination of characteristic light scattering properties and myeloid phenotype can suggest a diagnosis of acute promyelocytic leukemia. Confirmation of the retinoic acid receptor gene rearrangement by cytogenetic or molecular methods is recommended. See tests listed under Related Information, as well as as well as Fluorescence in situ Hybridization (FISH), Oncology [510669].

Specimen Requirements

Specimen

Whole blood, bone marrow aspirate, body fluids, fresh lymph node, spleen, extranodal solid tissue, biopsy, or needle aspirate

Volume

3 mL whole blood or 2 mL bone marrow aspirate, 2 mL body fluid tube. Large volumes of body fluids should be concentrated to <5 mL; 0.5 to 1.0 cm3 fresh tissue.

Minimum Volume

1 mL whole blood or bone marrow (Note: This volume does not allow for repeat testing.)

Container

Green-top (sodium heparin) tube (preferred), lavender-top (EDTA) tube, or yellow-top (ACD) tube for whole blood or bone marrow (acceptable, not preferred); lavender-top (EDTA body fluids) tube; fresh tissue in lymph node transport bottle containing RPMI

Collection Instructions

Note: In an attempt to maintain specimen at room temperature,

• In hot weather, enclose a refrigerated (not frozen) gel pack in shipper kit.

• In cold weather, run hot water over gel pack for three to five minutes and enclose in shipper kit.

• 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 in the laboratory 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.

Storage Instructions

Non-New York state specimens: Maintain specimen at room temperature. New York state specimens: Ship with a refrigerated (not frozen) gel pack in shipper kit.

Causes for Rejection

Hemolysis; specimen clotted; specimen frozen; specimen in formalin or other fixative; blood (non-New York state specimens) more than 72 hours old; blood (New York state specimens) more than 48 hours old; bone marrow aspirates more than five days old; bags or bottles of body fluid or bronchial washing; tissue in formalin or other fixative; contaminated transport medium

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
480260 Flow panel: Leukemia/Lymphoma 490024 Flow Interpretation 50595-8
480260 Flow panel: Leukemia/Lymphoma 490025 Flow Comment 48767-8
480260 Flow panel: Leukemia/Lymphoma 490026 Lab Case Number N/A
480260 Flow panel: Leukemia/Lymphoma 490045 Clinical Information 55752-0
480260 Flow panel: Leukemia/Lymphoma 490027 Specimen Type 31208-2
480260 Flow panel: Leukemia/Lymphoma 490028 Assessment of Leukocytes N/A
480260 Flow panel: Leukemia/Lymphoma 490031 Cellularity Assessment 67127-1
480260 Flow panel: Leukemia/Lymphoma 490032 Viability 33194-2
480260 Flow panel: Leukemia/Lymphoma 490033 Immunophenotypic Profile 67128-9
480260 Flow panel: Leukemia/Lymphoma 490035 Analysis and Gating Strategy N/A
480260 Flow panel: Leukemia/Lymphoma 490036 Phenotype Chart 55230-7
480260 Flow panel: Leukemia/Lymphoma 490052 Reagents Used: N/A
480260 Flow panel: Leukemia/Lymphoma 490039 Resulting Path Name 19139-5
480260 Flow panel: Leukemia/Lymphoma 490040 Clinician provided ICD10: 52797-8
480260 Flow panel: Leukemia/Lymphoma 490041 Resulting ICD10: 52797-8
480260 Flow panel: Leukemia/Lymphoma 490042 Indications for Study 42349-1
480260 Flow panel: Leukemia/Lymphoma 490046 Comment: 77202-0
480260 Flow panel: Leukemia/Lymphoma 481641 PDF 80563-0
480260 Flow panel: Leukemia/Lymphoma 480059 Flow LLS Tracking N/A
480260 Flow panel: Leukemia/Lymphoma 489123 LS Monitor N/A
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490024
Result Code NameFlow Interpretation
UofM
Result LOINC50595-8
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490025
Result Code NameFlow Comment
UofM
Result LOINC48767-8
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490026
Result Code NameLab Case Number
UofM
Result LOINCN/A
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490045
Result Code NameClinical Information
UofM
Result LOINC55752-0
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490027
Result Code NameSpecimen Type
UofM
Result LOINC31208-2
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490028
Result Code NameAssessment of Leukocytes
UofM
Result LOINCN/A
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490031
Result Code NameCellularity Assessment
UofM
Result LOINC67127-1
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490032
Result Code NameViability
UofM
Result LOINC33194-2
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490033
Result Code NameImmunophenotypic Profile
UofM
Result LOINC67128-9
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490035
Result Code NameAnalysis and Gating Strategy
UofM
Result LOINCN/A
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490036
Result Code NamePhenotype Chart
UofM
Result LOINC55230-7
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490052
Result Code NameReagents Used:
UofM
Result LOINCN/A
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490039
Result Code NameResulting Path Name
UofM
Result LOINC19139-5
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490040
Result Code NameClinician provided ICD10:
UofM
Result LOINC52797-8
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490041
Result Code NameResulting ICD10:
UofM
Result LOINC52797-8
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490042
Result Code NameIndications for Study
UofM
Result LOINC42349-1
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code490046
Result Code NameComment:
UofM
Result LOINC77202-0
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code481641
Result Code NamePDF
UofM
Result LOINC80563-0
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code480059
Result Code NameFlow LLS Tracking
UofM
Result LOINCN/A
Order Code480260
Order Code NameFlow panel: Leukemia/Lymphoma
Order Loinc
Result Code489123
Result Code NameLS Monitor
UofM
Result LOINCN/A
Reflex Table for Flow Interpretation
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 452890 Correlative Case View 452889 Summary of Results: 56850-1
Reflex 1
Order Code452890
Order NameCorrelative Case View
Result Code452889
Result NameSummary of Results:
UofM
Result LOINC56850-1
Reflex Table for Flow Interpretation
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 452890 Correlative Case View 452888 Summary Comment: 77202-0
Reflex 1
Order Code452890
Order NameCorrelative Case View
Result Code452888
Result NameSummary Comment:
UofM
Result LOINC77202-0
Reflex Table for Flow Interpretation
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 452890 Correlative Case View 452887 Electronic Signature 19139-5
Reflex 1
Order Code452890
Order NameCorrelative Case View
Result Code452887
Result NameElectronic Signature
UofM
Result LOINC19139-5
Reflex Table for Flow Interpretation
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 452890 Correlative Case View 452886 PDF 11502-2
Reflex 1
Order Code452890
Order NameCorrelative Case View
Result Code452886
Result NamePDF
UofM
Result LOINC11502-2
Reflex Table for Flow Interpretation
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 452890 Correlative Case View 452885 Comprehensive Evaluation: 51848-0
Reflex 1
Order Code452890
Order NameCorrelative Case View
Result Code452885
Result NameComprehensive Evaluation:
UofM
Result LOINC51848-0
Reflex Table for Flow Interpretation
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 452890 Correlative Case View 452884 Disclaimer: 62364-5
Reflex 1
Order Code452890
Order NameCorrelative Case View
Result Code452884
Result NameDisclaimer:
UofM
Result LOINC62364-5