Cancer FISH ALK FISH

Gene rearrangements involving the ALK gene are present in approximately 4-5% of non-small cell carcinomas of the lung (primarily adenocarcinomas). The most common of these is the EML4-ALK fusion, although other partner genes have been identified. Activation of ALK kinase through these gene fusions contributes to tumor cell growth and can be inhibited by ALK inhibitors such as crizotinib.

Recommended Use:
The ALK FISH test is recommended for screening NSCLC cases that are negative for an EGFR mutation.

FISH is performed using an FDA-cleared break-apart probe set. Slides are prepared per standard protocols and 100-200 interphase cells are scored.

• FFPE Slides: Specimen Requirements:
  • If sending slides, please include H&E stained slide cut from same block
  • Preferred slice thickness is 4-5 microns on positively charged slides. 
  • Please submit 3-5 slides.  Store at room temperature.
  • Contact Client Services at (855) 535-1522 for shipping supplies and instructions
• Bone Marrow:  Shortly before aspiration add 0.2 cc of Sodium Heparin (1,000 units/ml) to tube of transport medium (please contact lab to arrange for transport medium to be sent).  Add at least 1 cc of bone marrow aspirate to the tube and suspend well.  Allow no clots to form.
• Bone marrow smears:  Provide 10 slides
• Blood: May be used if bone marrow is inaspirable and blasts (.5%) are present.  Send in Sodium Heparin tube.
  • Adult - 3-5 mL drawn into a GREEN top sodium heparin vacutainer tube or into a pre-heparinized plastic syringe (use 0.2 cc sodium heparin, 1000 unit/mL).  Do NOT use lithium heparin.
  • Child - 1-2 mL, as above.
  • Infant - 1-2 mL, as above. 
  • Keep at room temperature and transport to laboratory as soon as possible.
  • Contact Client Services at (855) 535-1522 for supplies and instructions.
• Bone core biopsy: May also provide cells in cases where marrow is severely packed.  Send in transport medium with Sodium Heparin.
• Lymph node or tumor: Tumor specimens of at least 0.5 cm³ (up to 3 inches in diameter) are immediately collected with sterile methods into closable containers with sterile transport medium.* Needle biopsies will be accepted, but are often difficult to grow.  Deliver the specimen in transport medium to the laboratory within a day, if possible, with decreased success rates as specimens are delayed in transit.  Protect sample from temperature extremes during shipping.

*Sterile Ringer’s solution, either lactated or non-lactated and sterile isotonic saline are alternatives, if no complete RPMI is available.  Contact Client Services for more information on media requirements.

It is preferable to collect the specimen before initiation of chemotherapy in the patient.  Tumor samples should be selected from viable areas, with as little normal or necrotic material as possible. 

Unacceptable specimens are acellular, necrotic specimens, septic specimens, specimens in fixative or frozen, or specimens collected more than one week previously.

A REQUISITION FORM MUST ACCOMPANY ALL SAMPLES.  Please include detailed clinical information.

Mon-Sat

5-10 days: Contact Lab at 855-KDL-1LAB (535-1522) - Time varies depending on number and type of tests performed.

• Keep specimen at room temperature during transit. 
• Do not use the cold pack provided in the KDL shipping kit. 
• Ship the specimen overnight express, using the FedEx priority overnight label provided. 
• The specimen must arrive at the lab no more than 24 hours after collection.