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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.



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

-Date of collection

-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.

4. A list of probes is required if select probes are necessary or if the patient is being tracked for known abnormalities. See Table in Clinical Information.



Specimen Required


Submit only 1 of the following specimens:

 

Preferred:

Specimen Type: Tissue block

Collection Instructions: Submit a formalin-fixed, paraffin-embedded (FFPE) tumor tissue block. Blocks prepared with alternative fixation methods will be attempted but are less favorable for successful results by fluorescence in situ hybridization testing; 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:

Specimen Type: Tissue slides

Slides: 1 Hematoxylin and eosin stained and 4 unstained

Collection Instructions: Submit 4 consecutive unstained, positively charged, unbaked slides with 5 micron-thick sections of the tumor tissue and 1 slide stained with hematoxylin and eosin.


Useful For

Supporting the diagnosis of mesothelioma when used in conjunction with an anatomic pathology consultation

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 does not include a pathology consultation. If a pathology consultation is requested, PATHC / Pathology Consultation should be ordered, and the appropriate fluorescence in situ hybridization (FISH) test will be ordered and performed at an additional charge.

 

This test includes a charge for the probe application, analysis, and professional interpretation of results for one probe set (2 individual FISH] probes. Analysis charges will be incurred based on the number of cells analyzed per probe set. If no cells are available for analysis, no analysis charges will be incurred.

 

Appropriate ancillary probes may be performed at consultant 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, Ts

Specimen Type

Tissue

Specimen Minimum Volume

Slides: 1 Hematoxylin and eosin stained and 2 unstained

Specimen Stability Information

Specimen Type Temperature Time Special Container
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 or negative.

 

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. Therefore, clinical and pathologic correlation are required.

 

A negative result suggests no deletion of the CDKN2A gene region at 9p21. However, as homozygous deletion is not present in all mesotheliomas, this result does not exclude the diagnosis of malignant mesothelioma. In addition, due to limitations of the technology, fluorescence in situ hybridization cannot detect all CDKN2A deletions.

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 days

Test 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 a Oncology Test Request (T729) with the specimen.

Mayo Clinic Laboratories | Oncology Catalog Additional Information:

mml-pulmonary-cancer