Test ID: MESOF Mesothelioma, CDKN2A FISH, Tissue
Ordering Guidance
This test is only performed on specimens for the purpose of differentiating mesothelioma from histologic mimics.
This test is not appropriate for identifying CDKN2A deletions when mesothelioma is not included in the differential diagnosis. If this test is ordered and the laboratory is informed that the purpose of testing is not to differentiate mesothelioma from histologic mimics, the laboratory will cancel the testing.
This test does not include a pathology consultation. If a pathology consultation is requested, order PATHC / Pathology Consultation, and appropriate testing will be added at the discretion of the pathologist and performed at an additional charge.
Multiple oncology (cancer) gene panels are also available. For more information see Hematology, Oncology, and Hereditary Test Selection Guide.
Additional Testing Requirements
Confirmation testing using targeted next-generation sequencing for homozygous CDKN2A gene deletion is available, order MCSTP / MayoComplete Solid Tumor Panel, Next-Generation Sequencing, Tumor.
Shipping Instructions
Advise Express Mail or equivalent if not on courier service.
Necessary Information
1. A pathology report is required for testing to be performed. If not provided, appropriate testing and/or interpretation may be compromised or delayed. Acceptable pathology reports include working drafts, preliminary pathology, or surgical pathology reports.
2. The following information must be included in the report provided:
-Patient name
-Block number - must be on all blocks, slides, and paperwork
-Collection date
-Tissue source
3. A reason for testing must be provided. If this information is not provided, an appropriate indication for testing may be entered by Mayo Clinic Laboratories.
Specimen Required
Submit only 1 of the following specimens:
Preferred:
Specimen Type: Tissue block (fresh tissue is not acceptable)
Collection Instructions:
1. Submit a formalin-fixed, paraffin-embedded tumor tissue block.
2. Blocks prepared with alternative fixation methods (eg, Prefer, Bouin's) will be attempted but are less favorable for successful results. Provide fixation method used.
Additional Information:
1. Paraffin-embedded specimens can be from any anatomic location (skin, soft tissue, lymph node, etc).
2. Decalcified paraffin-embedded specimens will have testing attempted; however, the success rate is approximately 50%. Testing may be canceled if sufficient tumor tissue is not present.
3. Submitted fresh tissue specimens will be canceled upon receipt. If only fresh tissue is available, embed in paraffin prior to sending.
Acceptable:
Specimen Type: Tissue slides
Slides: 1 Hematoxylin and eosin-stained and 4 unstained
Collection Instructions: Submit 1 slide stained with hematoxylin and eosin and 4 consecutive unstained, positively charged, unbaked slides with 5-micron thick sections of the tumor tissue.
Additional Information: Broken or cracked unstained slides will be rejected. Stained slides that were broken and repaired (ie, double mounted) at the client site will not be rejected, as, in most cases, they can still be reviewed under the microscope. However, due to the double mounting, digital scanning cannot be performed.
Useful For
Aiding in the diagnosis of mesothelioma by detecting a neoplastic clone associated with homozygous loss involving the CDKN2A gene region at 9p21.3 when used conjunction with an anatomic pathology assessment
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| _PBCT | Probe, +2 | No, (Bill Only) | No |
| _PADD | Probe, +1 | No, (Bill Only) | No |
| _PB02 | Probe, +2 | No, (Bill Only) | No |
| _PB03 | Probe, +3 | No, (Bill Only) | No |
| _IL25 | Interphases, <25 | No, (Bill Only) | No |
| _I099 | Interphases, 25-99 | No, (Bill Only) | No |
| _I300 | Interphases, >=100 | No, (Bill Only) | No |
Testing Algorithm
This test includes a charge for probe application, analysis, and professional interpretation of results for one probe set (2 individual fluorescence in situ hybridization probes). Analysis charges are based on the number of cells analyzed per probe. No analysis charges apply if there are insufficient representative cells for evaluation.
Appropriate ancillary probes may be performed at the consultant's discretion to render comprehensive assessment. Any additional probes will have the results included within the final report and will be performed at an additional charge.
Method Name
Fluorescence In Situ Hybridization (FISH)
Reporting Name
Mesothelioma, FISH, TsSpecimen Type
TissueSpecimen Minimum Volume
Slides: 1 Hematoxylin and eosin-stained and 2 unstained
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Tissue | Ambient (preferred) | |
| Refrigerated | ||
Clinical Information
The histologic distinction of malignant mesothelioma from benign mesothelial proliferations can be challenging. Loss of both copies of CDKN2A has been described as a recurrent abnormality in 59% to 80% of pleural malignant mesotheliomas depending on histologic features.(1-3) Homozygous deletion of CDKN2A is less common in peritoneal mesothelioma, reported to occur in 25% to 35% of cases.(2,4,5) The detection of homozygous deletion of CDKN2A by fluorescence in situ hybridization has been suggested as a useful adjunct to histologic examination in the differentiation of malignant mesothelioma from other processes.(6,7)
Reference Values
An interpretive report will be provided.
Interpretation
CDKN2A will be clinically interpreted as positive, negative, or equivocal.
A neoplastic clone is detected when the percent of cells with an abnormality exceeds the normal cutoff for the CDKN2A/D9Z1 probe set.
In the proper clinical and histologic context, a positive result may support a diagnosis of mesothelioma. However, homozygous loss of CDKN2A can be identified in many neoplasms. Clinical and pathologic correlation is required.
A negative result suggests no homozygous deletion of the CDKN2A gene region at 9p21.3 is present but does not exclude the diagnosis of mesothelioma. Homozygous CDKN2A deletion is not present in all mesotheliomas. Clinical and pathologic correlation is required.
A negative result does not exclude the presence of a neoplastic disorder.
Clinical Reference
1. Illel P, Ladanyl M, Rusch V, Zakowski MF. The use of CDKN2A deletion as a diagnostic marker for malignant mesothelioma in body cavity effusions. Cancer. 2003;99:51-56
2. Chiosea C, Krasinkas A, Cagle P, Mitchell KA, Zander DS, Dacic S. Diagnostic importance of 9p21 homozygous deletion in malignant mesotheliomas. Mod Pathol. 2008;21:742-747
3. Hwang H, Pyott S, Rodriguez S, et al. BAP1 immunohistochemistry and p16 FISH in the diagnosis of sarcomatous and desmoplastic mesotheliomas. Am J Surg Pathol. 2016;40:714-718
4. Krasinskas A, Bartlett D, Cieply K, Dacic S. CDKN2A and MTAP deletions in peritoneal mesotheliomas are correlated with loss of p16 protein expression and poor survival. Mod Pathol. 2010;23:531-538
5. Singhi A, Krasinskas A, Choudry H, et al. The prognostic significance of BAP1, NF2, and CDKN2A in malignant peritoneal mesothelioma. Mod Pathol. 2016;29:14-24
6. Monaco S, Shuai Y, Bansal M, Krasinskas AM, Dacic S. The diagnostic utility of p16 FISH and GLUT-1 immunohistochemical analysis in mesothelial proliferations. Am J Clin Pathol. 2011;135:619-627
7. Wu D, Hiroshima K, Yusa T, et al. Usefulness of p16/CDKN2A Fluorescence in situ hybridization and BAP1 immunohistochemistry for the diagnosis of biphasic mesothelioma. Ann Diagn Pathol. 2017;26:31-37
Day(s) Performed
Monday through Friday
Report Available
7 to 10 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
88271x2, 88291 - DNA probe, each (first probe set), Interpretation and report
88271x2 - DNA probe, each; each additional probe set (if appropriate)
88271x1 - DNA probe, each; coverage for sets containing 3 probes (if appropriate)
88271x2 - DNA probe, each; coverage for sets containing 4 probes (if appropriate)
88271x3 - DNA probe, each; coverage for sets containing 5 probes (if appropriate)
88274 w/modifier 52 - Interphase in situ hybridization, <25 cells, each probe set (if appropriate)
88274 - Interphase in situ hybridization, 25 to 99 cells, each probe set (if appropriate)
88275 - Interphase in situ hybridization, 100 to 300 cells, each probe set (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| MESOF | Mesothelioma, FISH, Ts | 21614-3 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 609715 | Result Summary | 50397-9 |
| 609716 | Interpretation | 69965-2 |
| 609717 | Result | 62356-1 |
| GC086 | Reason for Referral | 42349-1 |
| 609718 | Specimen | 31208-2 |
| 609719 | Source | 31208-2 |
| 609720 | Tissue ID | 80398-1 |
| 609721 | Method | 85069-3 |
| 609722 | Additional Information | 48767-8 |
| 609723 | Disclaimer | 62364-5 |
| 609724 | Released By | 18771-6 |
Forms
If not ordering electronically, complete, print, and send an Oncology Test Request (T729) with the specimen.
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