Multiple Myeloma Profile, Fluorescence <i>in situ</i> Hybridization (FISH)

*Multiple Myeloma Profile, Fluorescence in situ* Hybridization (FISH)**

Number
	510586
CPT
	88271 (x5); 88275; 88291
Related Information
	Oncology-Based FISH
Synonyms
	AL ; MGUS ; MM ; Monoclonal Gammopathy of Undetermined Significance ; PCL ; Plasma Cell Leukemia
Test Includes
	Fluorescence in situ hybridization (FISH) for multiple myeloma (MM), targeting 13q, IgH, CCND1, FGFR3, TP53
Special Instructions
	Indicate pertinent clinical diagnosis and previous cytogenetics studies on the request form.
Specimen
	Bone marrow, blood, fixed-cell pellet from a cytogenetic analysis, slides prepared from a cytogenetic analysis
Volume
	10 mL blood, 3-5 mL blood (pediatrics), 1-3 mL bone marrow, four slides, one tube fixed-cell pellet
Minimum Volume
	Three slides, 1 mL blood, 1 mL bone marrow
Container
	Green-top (heparin) tube; pediatric Vacutainer® is optimal or lavender-top (EDTA) tube
Storage Instructions
	Maintain specimen at room temperature.
Causes for Rejection
	Broken Vacutainer®; broken slides; decalcified bone cores if paraffin embedded
Use
	Diagnostic test for multiple myeloma: detection of 13q deletion improved from 15% to 20% to 38% to 54% in newly diagnosed patients; profile improves overall cytogenetic detection rate from 30% to about 80%; IgH translocations detected in 47% of MGUS patients, 60% to 70% of intermedullary MM, and 80% of patients with PCL.
Limitations
	Molecular mutations below the resolution of FISH will not be detected. This procedure may be considered by Medicare and other carriers as investigational and, therefore, may not be payable as a covered benefit for patients.
Methodology
	Fluorescence in situ hybridization (FISH)
References
	Fonseca R, Oken MM, Harrington D, et al, “Deletions of Chromosome 13 in Multiple Myeloma Identified by Interphase FISH Usually Denote Large Deletions of the q Arm or Monosomy,” Leukemia, 2001, 15(6):981-6.