Oncologic Chromosome Analysis – Non Blood – Bone Marrow

CPT Code(s)

88237, 88264, 88280

Performed

Clinical & Molecular Cytogenetics Laboratory

Clinical Indication and Relevance

A chromosome analysis on bone marrow may be clinically significant to identify and diagnose acquired neoplastic conditions associated with indications such as, cytopenia, T-cell lymphoma, B-cell lymphoma, multiple myeloma, acute myeloid leukemia, acute lymphocytic lymphoma, chronic myeloid leukemia, chronic lymphocytic leukemia, myeloprolypherative disorder and myelodysplastic syndrome. It may also be relevant in cases to confirm or exclude the diagnosis of hematological malignancies based on morphology and track progress of treatment.
Clinical Background
In the hematologic malignant diseases, the recognized recurring chromosomal abnormalities often correlate with particular subtypes of leukemia that have characteristic morphologic and clinical features, such as response to therapy. One example of these abnormalities is the 15;17 translocation which is identified only in patients with promyelocytic leukemia. These consistent chromosomal aberrations acquired new significance with the localization of cellular transforming genes (oncogenes) to chromosome breakpoints that are involved in specific rearrangements.
Thus, the study of chromosomal abnormalities in leukemia serves most importantly to assist in more accurate diagnosis and thereby providing prognostic information and allowing the more rational selection of therapy for patients. Chromosome analysis on bone marrow serves as a diagnostic study for multiple relevant acquired chromosomal aberrations in one test, whereas molecular studies are significant in cases where a diagnosis has been made or a suspicion exists, and specific testing is targeted.

Methodology

Culture / Microscopy / Karyotype

Bone marrow samples are unstimulated.  They are harvested at 24 hours and if volume is sufficient, a 48 hour culture is also initiated followed by G-banding. The bone marrow cells are studied at approximately 400 – 500 band level using the first 20 unselected metaphases with complete analysis and a minimum of 4 karyotypes.

Minimum Specimen Requirements

Container: Sodium Heparin (green top tube)

Optimal Quantity: 2-4 ml

Minimum Quantity: 1-2 ml

Storage: Room Temperature

Stability at Room Temperature: 8 hours, then refrigerate

Transportation: Avoid freezing or heating over 35°C

Turnaround time

Final report in 5 days for 90% cases

Communication

The morphologic interpretation and correlation of results on all cases is performed by a board-certified doctoral level scientist (laboratory director). The final report identifies the chromosomal sex and modal chromosome number.  If abnormalities are present, they are explained in a paragraph which helps to clarify and correlate clinical findings with pathological morphology. FISH testing is recommended to support or confirm chromosome aberrations or when inconclusive results are found.  References are included in the report to help the referring physician with interpretation, which include books or journals that contain appropriate information.

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