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Test Code MGMTD MGMT Promoter Methylation Analysis, Tumor


Necessary Information


A pathology report (final or preliminary), containing the following information, is required and must accompany specimen for testing to be performed:

1. Patient name

2. Block number-must be on all blocks, slides, and paperwork (can be handwritten on the paperwork)

3. Tissue collection date

4. Source of the tissue



Specimen Required


This assay requires at least 20% tumor nuclei.

-Preferred amount of tumor area with sufficient percent tumor nuclei: tissue 144 mm(2) tissue (4 x 6 mm x 6 mm areas)

-Minimum amount of tumor area: 36 mm(2) tissue (1 x 6 mm x 6 mm area)

-These amounts are cumulative over up to 10 unstained slides and must have adequate percent tumor nuclei.

-Tissue fixation: formalin-fixed paraffin-embedded (FFPE), non-decalcified

 

Submit only 1 of the following specimens:

 

Specimen Type: Tissue block

Collection Instructions: Submit a formalin-fixed non-decalcified, paraffin-embedded tissue block.

 

Specimen Type: Tissue slide

Slides: 1 Stained and 10 unstained

Collection Instructions: Submit 1 slide stained with hematoxylin and eosin and 10 unstained, nonbaked slides with 5-micron thick sections of the tumor tissue.

Note: The total amount of required tumor nuclei can be obtained by scraping up to 10 slides from the same block.


Secondary ID

621858

Useful For

Prognostication of newly diagnosed patients with glioblastoma

 

Identification of newly diagnosed glioblastoma patients that may derive benefit from alkylating chemotherapy (ie, temozolomide)

 

Therapy selection for newly diagnosed glioblastoma in older patients (>60-65 years)

Additional Tests

Test ID Reporting Name Available Separately Always Performed
SLIRV Slide Review in MG No, (Bill Only) Yes

Testing Algorithm

When this test is ordered, slide review will always be performed at an additional charge.

Method Name

Droplet Digital Polymerase Chain Reaction (ddPCR)

Reporting Name

MGMT Promoter Methylation Analysis

Specimen Type

Varies

Specimen Minimum Volume

5 unstained slides at 5-microns thickness

Specimen Stability Information

Specimen Type Temperature Time
Varies Ambient (preferred)
  Refrigerated 

Reject Due To

Specimens that have been decalcified (all methods)
Specimens that have not been formalin-fixed, paraffin-embedded
Extracted nucleic acid (DNA/RNA)
Reject

Reference Values

An interpretive report will be provided.

Day(s) Performed

Varies

Report Available

7 to 10 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

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

81287

88381-Microdissection manual

LOINC Code Information

Test ID Test Order Name Order LOINC Value
MGMTD MGMT Promoter Methylation Analysis 60252-4

 

Result ID Test Result Name Result LOINC Value
621859 Result Summary 50397-9
621860 Result 60252-4
621861 Interpretation 69047-9
621862 Additional Information 48767-8
621863 Specimen 31208-2
621864 Source 31208-2
621865 Tissue ID 80398-1
621866 Method 85069-3
621867 Disclaimer 62364-5
621868 Released by 18771-6