Immunoglobulin Gene Rearrangement, Bld (BCGR)

Test Code: BCGRSO

Overview
Ordering
Specimen
Performing
Clinical/Interpretive
Contacts
Coding

Synonyms/Keywords

B-Cell Gene Rearrangement
B-Cell Immunoglobulin Gene Rearrangement
Immunoglobulin Gene Rearrange (PCR)
Lymphoma vs Benign Process
IGH
B Cell Gene Rearrangement

Useful For

Determining whether a B-cell or plasma cell population is polyclonal or monoclonal using peripheral blood specimens
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 Requirements

Specimen Type	Preferred Container/Tube	Acceptable Container/Tube	Specimen Volume	Specimen Minimum Volume (allows for 1 repeat)	Pediatric Minimum Volume (no repeat)
Whole Blood	EDTA Lavender Top Tube (LTT)	ACD Yellow Top Tube (YTT)	4 mL	1 mL

Collection Processing Instructions

Specimen must arrive within 168 hours (7 days) of draw.

Send specimen in orginial tube. Do not aliquot.

Specimen Stability Information

Specimen Type	Temperature	Time
Whole Blood	Ambient (preferred)	7 days
Whole Blood	Refrigerate	7 days

Rejection Criteria

Gross Hemolysis
Moderately to severely clotted

Interference

This test is neither 100% sensitive nor 100% specific.

False-negative results may occur if the Ig gene has numerous point alterations introduced during expansion in a follicle center (somatic hypermutation) such that none of the polymerase chain reaction (PCR) primers will bind. False-negative results will also occur if the clonal cells have not rearranged the Ig genes being evaluated or are present below the sensitivity level of the assay (sensitivity is quite variable but the assay requires that at least 1%-5% of the nucleated cells present be clonal). False-positive results are rare but may occur if a predominant clone (or small number of clones) is produced or sampled from a polyclonal expansion.

The test does not provide information regarding:

-The differentiation of the clonal cell population (neoplastic cells other than B cells or plasma cells may occasionally have Ig gene rearrangements)

-Whether a prominent clone is physiologic or neoplastic

Performing Laboratory Information

Performing Location	Day(s) Test Performed	Analytical Time	Methodology/Instrumentation
Mayo Clinic Laboratories	Monday through Friday	5-7 days	Polymerase Chain Reaction (PCR)

Reference Lab

Mayo Clinic Laboratories

Test Information

The immunoglobulin (Ig) 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 and plasma cell has a unique rearrangement profile. Other cell types usually retain the unrearranged gene structures. Clonal expansion of any B cell or plasma cell will result in a population of cells that all contain an identical Ig gene rearrangement profile.

Reactive B-cell or plasma cell expansions are polyclonal, with each clone containing relatively few cells and no 1 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 Ig gene rearrangement profile may be equated to the presence of a neoplastic B-cell or plasma cell clone.

Reference Range Information

An interpretive report will be provided.

Interpretation

The interpretation of the presence or absence of a predominant immunoglobulin (Ig) 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 Ig gene rearrangement by this test is not synonymous with the presence of a B-cell or plasma cell neoplasm.

Outreach CPTs

CPT	Modifier (if needed)	Quantity	Description	Comments
81261			IGH, gene rearrangement analysis, PCR
81264			IGK, gene rearrangement analysis, PCR

Classification

Synonyms/Keywords

B-Cell Gene Rearrangement
B-Cell Immunoglobulin Gene Rearrangement
Immunoglobulin Gene Rearrange (PCR)
Lymphoma vs Benign Process
IGH
B Cell Gene Rearrangement

Ordering Applications

Ordering Application	Description
COM	Immunoglobulin Rearrangement B

If the ordering application you are looking for is not listed, contact your local laboratory for assistance.