NEW TEST
NOTIFICATION DATE: April 6, 2017
EFFECTIVE DATE:
April 10, 2017
MATEPAIR, TARGETED REARRANGEMENTS, ONCOLOGY
Test ID: MTRTI
USEFUL FOR:
 Second-tier testing in oncologic specimens when previous cytogenetic or FISH testing
have detected an acquired chromosome abnormality of unknown significance
 Determining the size, precise breakpoints, gene content, and any unappreciated
complexity of abnormalities detected by other methods such as conventional
chromosome and FISH studies
 Providing important diagnostic, prognostic, and therapeutic information critical to proper
patient management
METHOD: Mate-Pair Whole Genome Sequencing
REFERENCE VALUES: An interpretive report will be provided.
SPECIMEN REQUIREMENTS:
 Previous cytogenetic or FISH testing is required in order to perform this test. If previous
testing was performed at another institution, supply a copy of those results. If sufficient
information regarding the patient's known chromosome abnormality is not made
available, this testing will be cancelled.

Provide a reason for referral with each specimen. The laboratory will not reject testing if
this information is not provided, but appropriate testing and interpretation may be
compromised or delayed.
Forms:
New York Clients-Informed consent is required. Please document on the request form
or electronic order that a copy is on file. An Informed Consent for Genetic Testing
(T576) is available in Special Instructions.
Submit only 1 of the following specimens:
Supplies: Hank's Solution (T132)
Specimen Type: Tumor biopsy
Container/Tube: Sterile container with sterile Hank's balanced salt solution
(T132), Ringer's solution, or normal saline
Specimen Volume: 0.5-3 cm(3) or larger
Supplies: Hank's Solution (T132)
Specimen Type: Lymph node
Container/Tube: Sterile container with sterile Hank's balanced salt solution
(T132), Ringer's solution, or normal saline.
Specimen Volume: 1 cm(3)
Supplies: Hank's Solution (T132)
Specimen Type: Skin biopsy
Container/Tube: Sterile container with sterile Hank's balanced salt solution
(T132), Ringer's solution, or normal saline.
Specimen Volume: 4-mm diameter
Collection Instructions:
1. Wash biopsy site with an antiseptic soap.
2. Thoroughly rinse area with sterile water.
3. Do not use alcohol or iodine preparations.
4. A local anesthetic may be used.
5. Biopsy specimens are best taken by punch biopsy to include full thickness of dermis.
Specimen Type: Snap Frozen tissue
Container/Tube: Polycon flat
Specimen Volume: 3 cm(3)/Lymph Node: 1 cm(3)/Skin Biopsy: 4 mm diameter
Specimen Type: Cultured tumor cells
Container/Tube: T-25 flask filled with transport media
Specimen Volume: T-25 flask
Specimen Type: Cryo-frozen cultured tumor cells
Container/Tube: Sterile container in media with DMSO or other safe
cryopreservation solution
Specimen Volume: 5 million cells
Specimen Type: Cryo-Frozen tissue
Container/Tube: Polycon flat
Specimen Volume: 3 cm(3)/Lymph Node: 1 cm(3)/Skin Biopsy: 4-mm diameter
SPECIMEN STABILITY INFORMATION:
Specimen Type
Tissue
Temperature
Varies
Time
CAUTIONS:
 This test is not approved by the US Food and Drug Administration and it is best used as
an adjunct to existing clinical and pathologic information.
 This test does not detect point mutations, small deletions or insertions below the
resolution of the assay, or other types of mutations such as epigenetic changes.
 Low level abnormal clones may not be detected by this test; as such it is not
recommended for minimal residual disease monitoring.
 The results of this test may reveal incidental findings not related to the original reason for
referral.
CPT CODE: CPT CODE:
Utilize the final report to determine if another CPT code is more appropriate for this testing.
Search the Molecular Pathology gene table in the CPT 2017 Professional codebook for any gene
variants identified in the final report. If a reported gene variant is listed in the table, the
associated CPT code can be submitted for reimbursement. If a gene variant is not listed or if no
gene variants are identified during testing, the 81479 code (Unlisted molecular pathology
procedure) can be submitted for reimbursement
DAY(S) SET UP: Samples processed Monday through Friday. Results
reported Monday through Friday, 8 a.m.-5 p.m. CST
ANALYTIC TIME: 14 days
QUESTIONS: Contact your Mayo Medical Laboratories’ Regional Manager or
Michaela Erickson/Heather Flynn-Gilmer, MML Laboratory Technologist Resource Coordinator
Telephone: 800-533-1710