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HelpTest ID: BCGRV Immunoglobulin Gene Rearrangement, PCR, Varies
Reporting Name
Immunoglobulin Gene Rearrange, VUseful For
Determining whether a B-cell or plasma cell population is polyclonal or monoclonal in specimens other than blood or bone marrow
Identifying neoplastic cells as having B-cell or plasma cell differentiation
Monitoring for a persistent neoplasm by detecting an immunoglobulin gene rearrangement profile similar to one from a previous neoplastic specimen
Specimen Type
VariesShipping Instructions
Body fluid or spinal fluid must arrive within 4 days of collection.
Specimen Required
Submit only 1 of the following specimens:
Preferred:
Specimen Type: Paraffin-embedded tissue
Container/Tube: Paraffin block
Collection Instructions:
1. Decalcified specimens (eg, bone marrow core biopsies) are not acceptable.
2. Indicate specimen source.
3. Include pathology report.
Specimen Stability Information: Ambient
Additional Information: If the quality of the biopsy specimen is poor, testing should not be ordered. Testing may be canceled if DNA requirements are inadequate.
Acceptable:
Specimen Type: Tissue slide
Slides: 20 unstained slides
Container/ Tube: Transport in plastic slide holders.
Collection Instructions:
1. Send 20 unstained, nonbaked slides with 5-micron thick sections of tissue.
2. Decalcified specimens (eg, bone marrow core biopsies) are not acceptable.
3. Indicate specimen source.
4. Include pathology report.
Specimen Stability Information: Ambient
Additional Information: Testing may be canceled if resultant extracted DNA does not meet concentration requirements.
Specimen Type: Body fluid
Sources: Pleural, peritoneal, vitreous, and spinal fluid (CSF)
Container/Tube: Sterile container
Specimen Volume: At least 5 mL
Collection Instructions:
1. If the volume is large, pellet cells prior to sending.
2. Send less volume at ambient temperature or as a frozen cell pellet.
3. Specify the type of fluid being submitted.
Specimen Stability Information:
Body fluid: Ambient 4 days/Refrigerated/Frozen
Cell pellet: Frozen
Specimen Type: Frozen tissue
Container/Tube: Plastic container
Specimen Volume: 100 mg
Collection Instructions:
1. Freeze tissue within 1 hour of collection.
2. Indicate specimen source.
Specimen Stability Information: Frozen
Specimen Type: Extracted DNA
Container/Tube: 1.5- to 2-mL tube
Specimen Volume: Entire specimen
Collection Instructions:
1. DNA must be extracted within 7 days after collection.
2. Label specimen as extracted DNA and source of specimen.
3. Provide volume and concentration of DNA.
Specimen Stability Information: Frozen (preferred)/Refrigerated/Ambient
Additional Information: DNA must be extracted in a CLIA-certified laboratory or equivalent and must be extracted from a specimen type listed as acceptable for this test (including applicable anticoagulants). We cannot guarantee that all extraction methods are compatible with this test. If testing fails, one repeat will be attempted, and if unsuccessful, the test will be reported as failed and a charge will be applied.
Specimen Minimum Volume
Body Fluid: 1 mL; Frozen tissue: 50 mg; Extracted DNA: 50 microliters (mcL) at 20 ng/mcL; Tissue slides: 10 unstained slides
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Varies | Varies | |
Special Instructions
Reference Values
An interpretive report will be provided.
Day(s) Performed
Monday through Friday
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
81261-IGH (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas B-cell), gene rearrangement analysis to detect abnormal clonal populations; amplified methodology (eg. polymerase chain reaction)
81264-IGK (Immunoglobulin kappa light chain locus) (eg, leukemia and lymphoma, B-cell) gene rearrangement analysis, evaluation to detect abnormal clonal populations
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| BCGRV | Immunoglobulin Gene Rearrange, V | 61113-7 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| MP017 | Specimen: | 31208-2 |
| 19915 | Final Diagnosis: | 34574-4 |
| 608950 | Signing Pathologist | 19139-5 |
Clinical Information
The immunoglobulin genes (heavy, kappa, and lambda) are comprised of numerous, discontinuous coding segments. As B cells develop, the segments are rearranged such that each mature B cell or plasma cell has a unique rearrangement profile. Other cell types usually retain unrearranged gene structures. Clonal expansion of any B cell or plasma cell will result in a population of cells that all contain identical immunoglobulin gene rearrangement profiles.
Reactive B-cell or plasma cell expansions are polyclonal, with each clone containing relatively few cells and no single clone predominating. Conversely, neoplastic clones are generally large such that the clonal cells are the predominant B cells or plasma cells present.
In the appropriate clinical and pathologic setting, detection of a prominent immunoglobulin gene rearrangement profile may be equated to the presence of a neoplastic B-cell or plasma cell clone.
Interpretation
Results will be characterized as positive, negative, or indeterminate for a clonal B-cell population and include an interpretive report.
The interpretation of the presence or absence of a predominant immunoglobulin gene rearrangement profile is sometimes subjective. These results must always be interpreted in the context of other clinicopathologic information to determine the significance of the result.
The detection of a clonal immunoglobulin gene rearrangement by this test is not synonymous with the presence of a B-cell or plasma cell neoplasm.
Clinical Reference
1. van Dongen JJ, Langerak AW, Bruggemann M, et al. Design and standardization of PCR primers and protocols for detection of clonal immunoglobulin and T-cell receptor gene recombinations in suspect lymphoproliferations: report of the BIOMED-2 Concerted Action BMH4-CT98-3936. Leukemia. 2003;17(12):2257-2317. doi:10.1038/sj.leu.2403202
2. Gazzola A, Mannu C, Rossi M, et al. The evolution of clonality testing in the diagnosis and monitoring of hematological malignancies [published correction appears in Ther Adv Hematol. 2014 Oct;5(5):181]. Ther Adv Hematol. 2014;5(2):35-47. doi:10.1177/2040620713519729
3. Kokovic I, Novakovic BJ, Novakovic S. Diagnostic value of immunoglobulin k light chain gene rearrangement analysis in B-cell lymphomas. Int J Oncol. 2015;46(3):953-962. doi:10.3892/ijo.2014.2790
4. Wang J, Zhao S, Niu T, et al. Prognostic relevance of immunoglobulin heavy chain rearrangement and immunoglobulin kappa light chain rearrangement in patients with diffuse large B cell lymphoma. Oncologist. 2025;30(3):oyaf016. doi:10.1093/oncolo/oyaf016
Report Available
7 to 14 daysMethod Name
Polymerase Chain Reaction (PCR)
Testing Algorithm
The following algorithms are available:
Forms
1. Hematopathology Patient Information (T676)
2. If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.
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