Gi Pathology Requisition - F#14146 12/15 Form Page 2
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2Detailed breakdown of panels for information only. Please use the front page to order testing.
Specimen Requirements
Test Code
Next-Generation Sequencing Panels
Please choose ONE of the following methods for specimen submission
B821-0
OnkoSight Solid Tumor Panel (31 genes)
A KT1, ALK, BRAF, CTNNB1, DDR2, EGFR, EPHA2, ERBB2,
A. Formalin-fixed, Paraffin-Embedded (FFPE) Tissue Block
Preferred
ESR1, FGFR1, FGFR2, FGFR3, GNA11, GNAQ, HRAS, IDH1,
B. S lides (Please note the specific micron sections below)
IDH2, KIT, KRAS, MAP2K1, MET, MTOR, NOTCH1, NRAS,
In order to facilitate testing, 1 H&E slide from the top of the block is
PDGFRA, PIK3CA, PTEN, RAC1, RET, ROS1, TP53
required for each patient sample. If possible, please also submit an H&E
B822-8
O nkoSight Colorectoral Cancer Panel (7 genes)
slide from the bottom of the block after slides have been cut to ensure
AKT1, BRAF, EGFR, KRAS, MAP2K1, NRAS, PIK3CA
tumor is still present.
OnkoSight Solid Tumor and Colorectal Panels:
10-15 unstained slides cut at 5 micron sections
Test Code
Immunohistochemistry Panels
Single Gene Tests: EGFR, KRAS, BRAF, PDGFRA, NRAS, KIT by NGS
5175-5
GIST Panel
10-15 unstained slides cut at 5 micron sections
A ctin, CD34, CD117, DOG-1, S100, SMA
MSI, MLH1 by PCR
A943-3
M ismatch Repair Protein (MMR) for Lynch Syndrome
3 unstained slides cut at 10 micron sections for each biomarker
MLH1, MSH2, MSH6, PMS2
HER2 by FISH3
unstained slides cut at 4 micron sections for each probe
IHC Tests:
2 unstained slides cut at 4 micron sections for each stain
Panels:
Reflex DX: Colon
10-15 unstained slides cut at 5 micron sections
Lynch Syndrome
10-15 unstained slides cut at 5 micron sections
C. > 100 ng of isolated nucleic acid DNA (minimum 20-40 ng at a
concentration of 1 ng/uL via fluorescent measurement)
In order to facilitate testing, submit DNA at the highest concentration
possible, as degraded DNA may require higher input concentrations.
All submitted DNA must also be accompanied by documentation that
the DNA was derived from a specimen that contained a minimum tumor
percentage of 10% per a pathology report.
D. P araffin block shavings if tumor nuclei content is >50%
6 to 9 rolls cut at 10 microns and placed in a 1.5 mL tube.
Samples must come with a corresponding H&E slide from the
top and bottom of the sample.
The following tumor size and composition is required to avoid potential QNS:
• Minimum 3x3 mm tumor size
• At least 10% of nucleated cells are tumor (ideal is >20%)
• D ecalcified tissue may result in poor nucleic acid, therefore testing may
be cancelled upon DNA characterization.
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