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HelpTest ID: ALKT ALK Mutation Analysis, Next-Generation Sequencing, Tumor
Ordering Guidance
Multiple oncology (cancer) gene panels are available. For more information see Hematology, Oncology, and Hereditary Test Selection Guide.
Necessary Information
A pathology report (final or preliminary), at minimum containing the following information, must accompany specimen for testing to be performed:
1. Patient name
2. Block number-must be on all blocks, slides, and paperwork (can be handwritten on the paperwork)
3. Tissue collection date
4. Source of the tissue
Specimen Required
This assay requires at least 20% tumor nuclei.
-Preferred amount of tumor area with sufficient percent tumor nuclei: tissue 216 mm(2)
-Minimum amount of tumor area: tissue 36 mm(2)
-These amounts are cumulative over up to 10 unstained slides and must have adequate percent tumor nuclei.
-Tissue fixation: 10% neutral buffered formalin, not decalcified
-For specimen preparation guidance, see Tissue Requirement for Solid Tumor Next-Generation Sequencing. In this document, the sizes are given as 4 mm x 4 mm x 10 slides as preferred: approximate/equivalent to 144 mm(2) and the minimum as 3 mm x 1 mm x 10 slides: approximate/equivalent to 36 mm(2).
Preferred:
Specimen Type: Tissue block
Collection Instructions: Submit a formalin-fixed, paraffin-embedded tissue block with acceptable amount of tumor tissue.
Acceptable:
Specimen Type: Tissue slide
Slides: 1 Stained and 10 unstained
Collection Instructions: Submit 1 slide stained with hematoxylin and eosin and 10 unstained, nonbaked slides with 5-micron thick sections of the tumor tissue.
Note: The total amount of required tumor nuclei can be obtained by scraping up to 10 slides from the same block.
Additional Information: Unused unstained slides will not be returned.
Specimen Type: Cytology slide (direct smears or ThinPrep)
Slides: 1 to 3 Slides
Collection Instructions: Submit 1 to 3 slides stained and coverslipped with a preferred total of 5000 nucleated cells, or a minimum of at least 3000 nucleated cells.
Note: Glass coverslips are preferred; plastic coverslips are acceptable but will result in longer turnaround times.
Additional Information: Cytology slides will not be returned.
Useful For
Identifying mutations within the ALK gene that predict resistance to ALK-inhibitors
Additional Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| SLIRV | Slide Review in MG | No, (Bill Only) | Yes |
Testing Algorithm
When this test is ordered, slide review will always be performed at an additional charge.
Special Instructions
Method Name
Sequence Capture Next-Generation Sequencing (NGS)
Reporting Name
ALK Mutation Analysis, TumorSpecimen Type
VariesSpecimen Minimum Volume
See Specimen Required
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Ambient (preferred) | ||
| Refrigerated | |||
Clinical Information
The ALK gene encodes anaplastic lymphoma kinase. Fusions of the ALK gene with a variety of 5’ (upstream) partner genes upregulate ALK’s kinase activity and contribute to tumorigenesis. ALK gene fusions have been reported in diverse tumor types. Numerous US Food and Drug Administration approved ALK-inhibitors have been developed for the treatment of tumors with ALK gene fusions. However, resistance to ALK inhibition can occur through the development of ALK gene mutations. This test can be used to identify ALK resistance mutations to aid in the management of these patients. In addition, ALK gain-of-function alterations have been reported in a subset of neuroblastomas.
Reference Values
An interpretive report will be provided.
Interpretation
The interpretation of molecular biomarker analysis includes an overview of the results and the associated diagnostic, prognostic, and therapeutic implications.
Clinical Reference
1. Strom SP. Current practices and guidelines for clinical next-generation sequencing oncology testing. Cancer Biol Med. 2016;13(1):3-11. doi:10.28092/j.issn.2095-3941.2016.0004
2. Spurr L, Li M, Alomran N, et al. Systematic pan-cancer analysis of somatic allele frequency. Sci Rep. 2018;8(1):7735. doi:10.1038/s41598-018-25462-0
3. Ou SI, Zhu VW, Nagasaka M: Catalog of 5' Fusion Partners in ALK-positive NSCLC Circa 2020. JTO Clin Res Rep. 2020 Feb 19;1(1):100015
4. Cooper AJ, Sequist LV, Lin JJ: Third-generation EGFR and ALK inhibitors: mechanisms of resistance and management. Nat Rev Clin Oncol. 2022 Aug;19(8):499-514
5. Schneider JL, Lin JJ, Shaw AT: ALK-positive lung cancer: a moving target. Nat Cancer. 2023 Mar;4(3):330-343
6. Trigg RM, Turner SD: ALK in Neuroblastoma: Biological and Therapeutic Implications. Cancers (Basel). 2018 Apr 10;10(4):113
7. Brady SW, Liu Y, Ma X, et al: Pan-neuroblastoma analysis reveals age- and signature-associated driver alterations. Nat Commun. 2020 Oct 14;11(1):5183
Day(s) Performed
Monday through Friday
Report Available
12 to 20 daysTest Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
88381-Microdissection, manual
81479
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| ALKT | ALK Mutation Analysis, Tumor | In Process |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 619695 | Result | 82939-0 |
| 619696 | Interpretation | 69047-9 |
| 619697 | Additional Information | 48767-8 |
| 619698 | Specimen | 31208-2 |
| 619699 | Tissue ID | 80398-1 |
| 619700 | Method | 48767-8 |
| 619701 | Disclaimer | 62364-5 |
| 619702 | Released By | 18771-6 |
Forms
If not ordering electronically, complete, print, and send a Oncology Test Request (T729) with the specimen.
mml-neuro-oncology-oms,MML-Pulmonary-Cancer,