Sign in →

Test ID BLYM B-Cell Lymphoma, FISH, Tissue

Ordering Guidance

This test does not include a pathology consultation. If a pathology consultation is desired, PATHC / Pathology Consultation should be ordered and the appropriate fluorescence in situ hybridization (FISH) test will be ordered and performed at an additional charge. Mayo Hematopathology Consultants are involved in both the pre-analytic (tissue adequacy and probe selection, when applicable) and post-analytic (interpretation of FISH results in context of specific case, when applicable) phases.


This assay detects chromosome abnormalities observed in paraffin-embedded tissue samples of patients with B-cell lymphoma. If a blood or bone marrow specimen is submitted, the test will be canceled and BLPMF / B-Cell Lymphoma, Specified FISH, Varies will be added and performed as the appropriate test.


If either the break-apart MYC or the MYC/IGH D-FISH probe sets are requested in isolation, both probe sets will be performed concurrently to optimize the detection of MYC rearrangements.

Shipping Instructions

Advise Express Mail or equivalent if not on courier service.

Necessary Information

1. A reason for testing and pathology report are required for testing to be performed. Send information with specimen. Acceptable pathology reports include working drafts, preliminary pathology or surgical pathology reports. The laboratory will not reject testing if a reason for testing is not provided; however, appropriate testing and interpretation may be compromised or delayed. If not provided, an appropriate indication for testing may be entered by Mayo Clinic Laboratories.

2. If the patient is being tracked for known abnormalities, an indication of which probes should be used is required for testing to be performed. See Table in Clinical Information.

Specimen Required

Submit only 1 of the following specimens:


Specimen Type: Tissue

Preferred: Tissue block

Collection Instructions: Submit a formalin-fixed, paraffin-embedded (FFPE) tumor tissue block. Blocks prepared with alternative fixation methods may be acceptable; provide fixation method used.

Additional Information:

1. Paraffin embedded specimens can be from any anatomic location (skin, soft tissue, lymph node, etc).

2. Bone specimens that have been decalcified will be attempted for testing, but the success rate is approximately 50%.


Acceptable: Tissue slides

Collection Instructions: For each probe set ordered, 2 consecutive, unstained, 5 micron-thick sections placed on positively charged slides. Include 1 hematoxylin and eosin-stained slide for the entire test order.


If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.

Useful For

Detecting a neoplastic clone associated with the common chromosome abnormalities seen in patients with various B-cell lymphomas


Tracking known chromosome abnormalities and response to therapy in patients with B-cell lymphomas

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
_PRAA Probe, Each Additional (BLYM) No, (Bill Only) No

Testing Algorithm

Depending on the lymphoma subtype suspected, the most appropriate probes to order are listed in the table: Common Chromosome Abnormalities in B-cell Lymphomas in Clinical Information.


If the patient is being tracked for known abnormalities, indicate which probes should be used.


A charge and CPT code is applied for each probe set hybridized, analyzed, and reported.


If, based on testing algorithms, results of the initial probe sets require reflex testing, complete results will be available within 10 days.


The following algorithms are available:

-Aggressive B-cell Lymphoma Diagnostic Algorithm

-Gastric MALT Lymphoma Diagnostic Algorithm

-Gastric MALT Posttherapy Follow-up Algorithm

Method Name

Fluorescence In Situ Hybridization (FISH)

Reporting Name

B-cell Lymphoma, FISH, Tissue

Specimen Type


Specimen Minimum Volume

See Specimen Required

Specimen Stability Information

Specimen Type Temperature Time Special Container
Tissue Ambient (preferred)

Reject Due To

All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

Clinical Information

Mature B-cell lymphoma can be low grade, intermediate grade, or high grade, and the prognosis and clinical course are highly variable. Genetic abnormalities have emerged as one of the most important prognostic markers in B-cell lymphomas and can aid in diagnosis. Several chromosome abnormalities and variants of these abnormalities have been associated with various lymphoma subtypes (see Table). Fluorescence in situ hybridization (FISH) permits the detection of recurrent gene rearrangements associated with various chromosome translocations and inversions in B-cell lymphoma. FISH is available for the specific B-cell lymphoma subtypes; see Table.


Table. Common Chromosome Abnormalities in B-cell Lymphomas

Lymphoma type

Chromosome abnormality

FISH probe

Burkitt (pediatric,

≤18 years old)

8q24.1 rearrangement

5'/3' MYC







3q27 rearrangement

3'/5' BCL6

18q21 rearrangement

3'/5' BCL2

Diffuse large B-cell, "double-hit"

8q24.1 rearrangement

5'/3' MYC



----Reflex: t(8;22)(q24.1;q11.2)


----Reflex: t(2;8)(p12;q24.1)


----Reflex: 3q27 rearrangement

3'/5' BCL6

----Reflex: 18q21 rearrangement

3'/5' BCL2

Large BCL IRF4 rearranged

6p24.3 rearrangement

5’/3' IRF4

18q21 rearrangement

3'/5' BCL2

3q27 rearrangement

3'/5' BCL6


18q21 rearrangement

3'/5' BCL2

3q27 rearrangement

3'/5' BCL6

Predominantly diffuse subtype only: deletion of 1p36


Mantle cell



11q13 rearrangement

5'/3' CCND1

Blastoid subtype only: deletion of 17p


Blastoid subtype only: 8q24.1 rearrangement

5'/3' MYC

Cyclin D1-negative subtype only: 12p13.32 rearrangement

5'/3' CCND2


18q21 rearrangement

5'/3' MALT1

Splenic marginal zone

Deletion of 7q


Deletion of 17p


Reference Values

An interpretive report will be provided.


A neoplastic clone is detected when the percent of cells with an abnormality exceeds the normal reference range for any given probe.


Detection of an abnormal clone is supportive of a diagnosis of a B-cell lymphoma. The specific abnormality detected may help subtype the neoplasm.


The absence of an abnormal clone does not rule out the presence of a neoplastic disorder.


This test is not approved by the US Food and Drug Administration, and it is best used as an adjunct to clinical and pathologic information.


Fixatives other than formalin (eg, Prefer, Bouin) may not be successful for fluorescence in situ hybridization assays.


Bone specimens that have been decalcified will be attempted for testing, but the success rate is approximately 50%.

Supportive Data

Each probe was independently tested on a set of formalin-fixed, paraffin-embedded tissue specimens from patients diagnosed with a B-cell lymphoma and noncancerous lymph node specimens. Normal cutoffs were calculated based on the results from 25 normal specimens. For each probe set, a series of chromosomally abnormal specimens were evaluated to confirm each probe set detected the anomaly it was designed to detect.

Clinical Reference

Swerdlow SH, Campo E, Harris NL, eds, et al: WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. 4th ed. IARC; 2017. WHO Classification of Tumours. Vol 2

Method Description

This test is performed using either commercially available or laboratory-developed probes. Rearrangements involving MYC, BCL2, BCL6, CCND1, CCND2, IRF4, or MALT1 are detected using dual-color break-apart (BAP) strategy probes, translocations involving MYC, or CCND1 are identified using dual-color, dual-fusion (D-FISH) strategy probes, and deletions (7q32, TNFRSF14 (1p36), and TP53) using enumeration strategy probes.


IGH/BCL2 is detected using a dual color, dual fusion probe set. At the laboratory’s discretion, the IGH/BCL2 probe will be performed when necessary to resolve or confirm BCL2 rearrangement concerns.


Formalin-fixed, paraffin-embedded tissues are cut at 5 microns and mounted on positively charged glass slides. The selection of tissue and the target areas on the hematoxylin and eosin (H and E)-stained slide is performed by a pathologist. Using the H and E-stained slide as a reference, target areas are etched with a diamond-tipped etcher on the back of the unstained slide to be assayed. The probe set is hybridized to the appropriate target areas and 2 technologists each analyze 50 interphase nuclei (100 total) with the results expressed as the percent abnormal nuclei.(Unpublished Mayo method)

Day(s) Performed

Monday through Friday

Report Available

4 to 10 days

Test Classification

This test was developed using an analyte specific reagent. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

88377 (if 1 probe set)

88377 x 2 (if 2 probe sets)

88377 x 3 (if 3 probe sets)

88377 x 4 (if 4 probe sets)

88377 x 5 (if 5 probe sets)

88377 x 6 (if 6 probe sets)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
BLYM B-cell Lymphoma, FISH, Tissue 101651-8


Result ID Test Result Name Result LOINC Value
603063 Result Summary 50397-9
603064 Interpretation 69965-2
603065 Result Table 93356-4
603066 Result 62356-1
GC026 Reason for Referral 42349-1
603067 Specimen 31208-2
603068 Source 85298-8
603069 Tissue ID 80398-1
603070 Method 85069-3
603071 Additional Information 48767-8
603072 Disclaimer 62364-5
603073 Released By 18771-6