Cytogenetics

HematoLogics Cytogenetics/FISH Laboratory

Cancer cytogenetics is the analysis of the genetic abnormalities that occur at the chromosome level in patients with leukemia, lymphoma and solid tissue neoplasms. These chromosome abnormalities provide both diagnostic and prognostic information and are important in understanding the nature of the patient’s disease.  Cytogenetic testing at HematoLogics utilizes specialized culture systems to enhance the detection of chromosome abnormalities in the neoplastic cells present in the blood, bone marrow or solid tumor specimens.

Understanding the cellular composition of the submitted specimen is important. Such knowledge allows the appropriate culture systems to be set up for each specimen as they are different for myeloid cells versus lymphoid cells in bone marrow.  The cultures used are determined once results are received from the flow cytometry laboratory regarding the neoplastic cell type present in the specimen. Additionally, the clinical information received with the specimen is also vitally important and will provide clues as to which cultures to set up. This attention to identification and proper stimulation of neoplastic cells is one reason why the abnormality detection rates are consistently high averaging 30% with extremely low failure rates.

At HematoLogics, each department works closely together. This close communication allows integration of morphology, flow cytometry, molecular genetic, FISH and cytogenetic results. This interaction also enables a more complete understanding the cytogenetic abnormalities and the biological nature of the neoplastic disorder.

HematoLogics Cytogenetic/FISH laboratory utilizes MetaSystems automated reading platform for fast, accurate high resolution analysis for greater objectivity and sensitivity. The result:

  1. Culture failures less than 5%.
  2. Abnormal detection rate of over 20%.
  3. Average turnaround less than 4 days including weekends.
  4. Higher resolution of 400-450 band level (superior resolution than 300-350 band level).
  5. Crisp clear karyograms for easier identification of chromosome abnormalities.

Reasons to consider HematoLogics for your Cytogenetic/FISH Laboratory:

  1. A minimum of 2 cultures set up on every patient when possible based on white cell count.
  2. Cell cultures based on clinical information and information received from the flow cytometry lab; therefore, if flow shows something different regarding the patient than is initially suspected, the culturing can be changed at that time for true integration. No “one size fits all” approach and turnaround can vary:
    • Myeloid cases:  Overnight and 48 hour unstimulated cell cultures are established.
    • B-cell Lymphoma cases:  Overnight, 48 hr and 72 hr DSP-30/IL-2 (interleukin-2) cultures are established. DSP-30 and IL-2 are added to act as mitogen for the B- cells, which are terminally differentiated and typically don’t divide spontaneously in culture.
    • T-cell leukemia/lymphoma cases:  overnight, 48 hour and 72 hr PHA/IL-2 cultures are established.  PHA/IL-2 is added to act as a mitogen for the T-cells, again, which are terminally differentiated and don’t always divide spontaneously in culture.
    • Myeloma cases:  Overnight, 72 hr IL-2 stimulated and 72 hr unstimulated cell cultures (SWOG required culture) are established. It is clear from the literature that plasma cells go through the cell cycle slowly. Allowing longer time in culture and increasing the number of metaphase analyzed (30) increases the likelihood of finding an abnormal cell clone.
    • CLL cases:  Overnight, 48 hr, 72 hr DSP-30/IL-2 stimulated cell cultures are established. It is clear from the literature that this latter culture increases the abnormality rate in CLL patients dramatically, from <5% to well over 60%. It is becoming clear that karyotype complexity in these patients, not just the aberrations tested for by interphase FISH, has a bearing on patient prognosis. (Genes, Chrom, Cancer, 6:843, ’09)
    • Culture times and techniques developed to standards set by SWOG (Southwest Oncology Group) and COG (Children’s Oncology Group) for cytogenetic certification required for patients going into clinical trials.
  3. Slides are scanned by a robotic scanner and metaphase images are sent to cytogenetic technologists. Digitally produced karyograms can be imported/exported to other applications, including the use of oncology grand rounds. Automated scanning has shown a productivity increase of 35% and a decrease in technologist error via the use of this technology.
  4. A minimum of 20 metaphase cells are analyzed for all cases, when available, except for myeloma patients, who have 30 cells analyzed. All technologists have more than 10 years of experience and several have over 20 years in cytogenetics. Final review is performed by a board certified Ph.D. level clinical cytogeneticist.
  5. Multiple images are captured for each case (50+), so there are always additional metaphase cells available for analysis without the need of additional slides.
  6. All cytogenetic fixed pellets are kept after the case is signed out and therefore available for further add-on studies (molecular genetics, FISH), if desired.
  7. An extensive FISH probe library is provided and testing uses the MetaSystems automated platform. 200 scanned images are captured and can be saved for future review unlike cells manually read.
  8. All cytogenetic and FISH results are available on Hematolinx and contain full interpretation including references and prognostic information where available. The results are integrated with other technologies that may have been used (flow cytometry, molecular genetics and morphology).
  9. The cytogenetic/FISH laboratory director is available for consultation regarding any cytogenetic or FISH case.
  • Myeloid cases:  Overnight and 48 hour unstimulated cell cultures are established.
  • B-cell Lymphoma cases:  Overnight, 48 hr and 72 hr DSP-30/IL-2 (interleukin-2) cultures are established. DSP-30 and IL-2 are added to act as mitogen for the B- cells, which are terminally differentiated and typically don’t divide spontaneously in culture.
  • T-cell leukemia/lymphoma cases:  overnight, 48 hour and 72 hr PHA/IL-2 cultures are established.  PHA/IL-2 is added to act as a mitogen for the T-cells, again, which are terminally differentiated and don’t always divide spontaneously in culture.
  • Myeloma cases:  Overnight, 72 hr IL-2 stimulated and 72 hr unstimulated cell cultures (SWOG required culture) are established. It is clear from the literature that plasma cells go through the cell cycle slowly. Allowing longer time in culture and increasing the number of metaphase analyzed (30) increases the likelihood of finding an abnormal cell clone.
  • CLL cases:  Overnight, 48 hr, 72 hr DSP-30/IL-2 stimulated cell cultures are established. It is clear from the literature that this latter culture increases the abnormality rate in CLL patients dramatically, from <5% to well over 60%. It is becoming clear that karyotype complexity in these patients, not just the aberrations tested for by interphase FISH, has a bearing on patient prognosis. (Genes, Chrom, Cancer, 6:843, ’09)
  • Culture times and techniques developed to standards set by SWOG (Southwest Oncology Group) and COG (Children’s Oncology Group) for cytogenetic certification required for patients going into clinical trials.

Slides are scanned by a robotic scanner and metaphase images are sent to cytogenetic technologists. Digitally produced karyograms can be imported/exported to other applications, including the use of oncology grand rounds. Automated scanning has shown a productivity increase of 35% and a decrease in technologist error via the use of this technology.

A minimum of 20 metaphase cells are analyzed for all cases, when available, except for myeloma patients, who have 30 cells analyzed. All technologists have more than 10 years of experience and several have over 20 years in cytogenetics. Final review is performed by a board certified Ph.D. level clinical cytogeneticist.

Multiple images are captured for each case (50+), so there are always additional metaphase cells available for analysis without the need of additional slides.

All cytogenetic fixed pellets are kept after the case is signed out and therefore available for further add-on studies (molecular genetics, FISH), if desired.

An extensive FISH probe library is provided and testing uses the MetaSystems automated platform. 200 scanned images are captured and can be saved for future review unlike cells manually read.
All cytogenetic and FISH results are available on Hematolinx and contain full interpretation including references and prognostic information where available. The results are integrated with other technologies that may have been used (flow cytometry, molecular genetics and morphology).
The cytogenetic/FISH laboratory director is available for consultation regarding any cytogenetic or FISH case.

This is a unique website which will require a more modern browser to work!

Please upgrade today!