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Test Code LLPM Leukemia/Lymphoma Immunophenotyping, Flow Cytometry, Varies

Additional Codes



Reporting Name

Leukemia/Lymphoma, Phenotype

Useful For

Evaluating lymphocytoses of undetermined etiology


Identifying B- and T-cell lymphoproliferative disorders involving blood and bone marrow


Distinguishing acute lymphoblastic leukemia (ALL) from acute myeloid leukemia (AML)


Immunologic subtyping of ALL


Distinguishing reactive lymphocytes and lymphoid hyperplasia from malignant lymphoma


Distinguishing between malignant lymphoma and acute leukemia


Phenotypic subclassification of B- and T-cell chronic lymphoproliferative disorders, including chronic lymphocytic leukemia, mantle cell lymphoma, and hairy cell leukemia


Recognizing AML with minimal morphologic or cytochemical evidence of differentiation


Recognizing monoclonal plasma cells

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
FCINT Flow Cytometry Interp, 2-8 Markers No, (Bill Only) No
FCIMS Flow Cytometry Interp, 9-15 Markers No, (Bill Only) No
FCINS Flow Cytometry Interp,16 or greater No, (Bill Only) No
AMLMF AML, Specified FISH Yes No

Testing Algorithm

The testing process begins with a screening panel. The screening panel will be charged based on the number of markers tested (FIRST for first marker, ADD1 for each additional marker). The interpretation will be based on markers tested in increments of 2 to 8, 9 to 15, or 16 and greater. In addition, reflex testing may occur to fully characterize a disease state or clarify any abnormalities from the screening test. Reflex tests will be performed at an additional charge for each marker tested (FIRST if applicable, ADD1 if applicable).


In addition to reflexing flow cytometric panels, acute myeloid leukemia (AML) fluorescence in situ hybridization (FISH) testing for PML-RARA translocation t(15;17) may be added by the Mayo Clinic pathologist to exclude acute promyelocytic leukemia if there is morphologic suspicion or if blasts and promyelocytes are CD34-negative and HLA-DR-negative.


The triage panel is initially performed to evaluate for monotypic B cells by kappa and lambda light chain expression, increased numbers of blast cells by CD34 and CD45 expression along with side scatter gating, and increased plasma cells by CD45 expression and side scatter gating. The triage panel also includes antibodies to assess the number of CD3-positive T cells and CD16-positive/CD3-negative natural killer (NK) cells present. This triage panel also determines if there is an increase in the number of T cells that aberrantly coexpress CD16, an immunophenotypic feature of T-cell granular lymphocytic leukemia.


This panel, together with the provided clinical history and morphologic review, is used to determine what, if any, additional testing is needed for disease diagnosis or classification. If additional testing is required, it will be added per the algorithm to fully characterize a disease state with a charge per unique antibody tested.


If no abnormalities are detected by the initial panel, no further flow cytometric assessment will be performed unless otherwise indicated by specific features of the clinical presentation or prior laboratory results.


Additional FISH or molecular testing may be recommended by the Mayo pathologist to facilitate diagnosis. The referring physician or pathologist will be contacted to confirm the addition of any of these tests. Cytogenetic FISH Studies:

-CCND1/IGH translocation t(11;14), to exclude mantle cell lymphoma in cases of CD5+CD23- B-cell lymphoproliferative disorder.

-TCL-1 break-apart at 14q32, to exclude T-cell prolymphocytic leukemia in cases with CD4-positive T-cell lymphoproliferative disorder (phenotypic aberrancy or very tight CD4+ population with high CD4:CD8 ratio).

-MYC break-apart at 8q24, with or without IGH-BCL2 t(14;18) and BCL6 break-apart at 3q27, for suspected high grade B-cell lymphomas, based on morphologic assessment and immunophenotype (usually CD10-positive).


Molecular Genetic Studies:

-T-cell receptor gene rearrangement to examine clonality of T cells in cases showing phenotypically aberrant T-cell population.


Cytochemical Stains:

-Confirmatory cytochemical stains as needed.


The following algorithms are available:

-Bone Marrow Staging for Known or Suspected Malignant Lymphoma Algorithm

-Acute Myeloid Leukemia: Testing Algorithm

-Acute Myeloid Leukemia: Relapsed with Previous Remission Testing Algorithm

-Acute Promyelocytic Leukemia: Guideline to Diagnosis and Follow-up

-Mast Cell Disorder: Diagnostic Algorithm, Bone Marrow

-Acute Leukemias of Ambiguous Lineage Testing Algorithm

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type


Ordering Guidance

This test is appropriate for hematopoietic specimens only. For solid tissue specimens, order LLPT / Leukemia/Lymphoma Immunophenotyping, Flow Cytometry, Tissue.


For bone marrow specimens being evaluated for possible involvement by a myelodysplastic syndrome (MDS) or a myelodysplastic/myeloproliferative neoplasm (MDS/MPN) including chronic myelomonocytic leukemia (CMML), order MYEFL / Myelodysplastic Syndrome by Flow Cytometry, Bone Marrow.


Bronchoalveolar lavage specimens submitted for evaluation for leukemia or lymphoma are appropriate to send for this test.


This test is not appropriate for and cannot support diagnosis of sarcoidosis, hypersensitivity pneumonitis, interstitial lung diseases, or differentiating between pulmonary tuberculosis and sarcoidosis (requests for CD4/CD8 ratios); specimens sent for these purposes will be rejected.

Additional Testing Requirements

For bone marrow testing, if cytogenetic tests are desired along with this test request, an additional specimen should be submitted. It is important that the specimen be obtained, processed, and transported according to instructions for the other test.

Shipping Instructions

Specimen must arrive within 48 hours of collection for spinal fluid, 72 hours for fluids, or 96 hours for peripheral blood and bone marrow.

Necessary Information

The following information is required:

1. Pertinent clinical history including reason for testing or clinical indication

2. Clinical or morphologic suspicion

3. Specimen source

4. Date and time of collection

5. For spinal fluid specimens: spinal fluid cell and differential counts are required.

Specimen Required

Submit only 1 of the following specimens:


Specimen Type: Whole blood


Preferred: Yellow top (ACD solution A or B)

Acceptable: Green top (sodium heparin) or lavender top (EDTA)

Specimen Volume: 6 mL

Slides: If possible, include 5 to 10 unstained blood smears labeled with two unique identifiers

Collection Instructions:

1. Send whole blood specimen in original tube. Do not aliquot.

2. Label specimen as blood.

Specimen Stability Information: Ambient <96 hours/Refrigerated ≤96 hours


Specimen Type: Bone marrow


Preferred: Yellow top (ACD solution A or B)

Acceptable: Green top (sodium heparin) or lavender top (EDTA)

Specimen Volume: 1 to 5 mL

Slides: If possible, include 5 to 10 unstained bone marrow aspirate smears labeled with two unique identifiers

Collection Instructions:

1. Submission of bilateral specimens is not required.

2. Label specimen as bone marrow.

Specimen Stability Information: Ambient <96 hours/Refrigerated ≤96 hours


Specimen Type: Fluid

Sources: Serous effusions, pleural fluid, pericardial fluid, abdominal (peritoneal) fluid

Container/Tube: Body fluid container

Specimen Volume: 20 mL

Collection Instructions:

1. If possible, fluids other than spinal fluid should be anticoagulated with heparin (1 U/mL of fluid).

2. The volume of fluid necessary to phenotype the lymphocytes or blasts in serous effusions depends upon the cell count in the specimen. Usually 20 mL of pleural or peritoneal fluid is sufficient. Smaller volumes can be used if there is a high cell count.

3. Label specimen with fluid type.

Specimen Stability Information: Refrigerated <72 hours/Ambient ≤72 hours


Specimen Type: Spinal fluid

Container/Tube: Sterile vial

Specimen Volume: 1 to 1.5 mL

Collection Instructions:

1. An original cytospin preparation (preferably unstained) must be included with the spinal fluid specimen so correlative morphologic evaluation can occur.

2. The volume of fluid necessary to phenotype the lymphocytes or blasts in spinal fluid depends upon the cell count in the specimen. A cell count should be determined and submitted with the specimen. Usually 1 to 1.5 mL of spinal fluid is sufficient. Smaller volumes can be used if there is a high cell count. If cell count is <10 cells/mcL, a larger volume of spinal fluid may be required. When cell counts drop below 5 cells/mcL, the immunophenotypic analysis may not be successful.

3. Label specimen as spinal fluid.

Specimen Stability Information: Refrigerated <48 hours/Ambient ≤48 hours

Specimen Minimum Volume

Blood: 3 mL
Bone Marrow, Spinal Fluid: 1 mL
Fluid from Serous Effusions: 5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Varies

Reference Values

An interpretive report will be provided.


This test will be processed as a laboratory consultation. An interpretation of the immunophenotypic findings and correlation with the morphologic features will be provided by a hematopathologist for every case.

Day(s) Performed

Monday through Saturday

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

88184-Flow cytometry; first cell surface, cytoplasmic or nuclear marker x 1

88185-Flow cytometry; additional cell surface, cytoplasmic or nuclear marker (each)

88187-Flow Cytometry Interpretation, 2 to 8 Markers (if appropriate)

88188-Flow Cytometry Interpretation, 9 to 15 Markers (if appropriate)

88189-Flow Cytometry Interpretation, 16 or More Markers (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
LCMS Leukemia/Lymphoma, Phenotype In Process


Result ID Test Result Name Result LOINC Value
CK155 LCMS Result No LOINC Needed
18255 Final Diagnosis: 34574-4
18254 Special Studies: 30954-2
18253 Microscopic Description 22635-7
CKR1 Reason for Referral 42349-1
CKS1 Specimen Source 31208-2

Report Available

1 to 4 days

Reject Due To

Gross hemolysis Reject

Method Name


Secondary ID


Additional Tests

Test ID Reporting Name Available Separately Always Performed
FIRST Flow Cytometry, Cell Surface, First No, (Bill Only) Yes
ADD1 Flow Cytometry, Cell Surface, Addl No, (Bill Only) Yes


1. Hematopathology Patient Information (T676)

2. If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-Hematopathology/Cytogenetics Test Request (T726)

-Benign Hematology Test Request (T755)