• Test Code:
    1694
  • Department:
  • Test Synonyms:
    APCATMBMPR1ABRCA1BRCA2CDK4CDKN2AEPCAMFANCCMEN1MLH1MSH2MSH6NF1PALB2PALLDPMS2SMAD4STK11TP53TSC1TSC2VHL
  • CPT Code(s):
    81408
Background:

Pancreatic cancer is the fourth leading cause of cancer death in both men and women in the United States. About 10% of people who develop pancreatic cancer have a family history of the disease. The Inherited Pancreatic Cancer Panel is a multi-gene panel that analyses genes associated with increased risk for pancreatic cancer. Lifetime risk for developing pancreatic cancer is approximately one in 71 individuals, with the majority of cases diagnosed between ages 60 and 80 years. Cigarette smoking, increased body mass index, heavy alcohol consumption, chronic pancreatitis, obesity, cirrhosis of the liver, a diagnosis of diabetes mellitus and family history have been demonstrated to increase risk of pancreatic cancer.

Understanding the molecular etiology of such cancer incidence can help guide treatment and proper surveillance.  Our next-generation sequencing test is designed to detect mutations in the coding region of 23 genes associated with inherited pancreatic cancer, or increasing the risk for cancer onset.  Our microarray test is designed to identify single exon deletions and duplications in the same 23 inherited pancreatic cancer-associated genes.  Combining deletion/duplication data analyzed by microarray with next generation sequencing data will allow KDL to improve diagnostic yield and deliver more comprehensive results.

The results from genetic tests can facilitate assessment of levels of risk for patients and lead to more efficient and appropriate medical management. It is recommended that this testing be accompanied by a complete family history and genetic counseling.

Reasons for Referral:

  • Confirmation of a clinical diagnosis of an inherited pancreatic cancer.
  • Testing for individuals with a positive family history for inherited pancreatic cancer (targeted testing is available if familial mutation is known).

Methodology:

This test has two components:
Component 1: Next generation sequencing will analyze the exons or coding regions of 23 inherited pancreatic cancer-associated genes using Illumina NextSeq 500 technology and preparing samples using hybridization probes to enrich exonic regions.  Any gaps in coverage in clinically validated genes are completed with traditional Sanger sequencing such that 100% of the coding region of the above genes are covered at 10x coverage or more.  Promoter, intronic, etc. regions are not assessed here but may contain variants that impact gene function.

Component 2: Microarray Analysis – A customized CytoSure “exon-centric” array (Oxford Gene Technology) will be used to detect deletions and duplications. The targeted array has enhanced probes targeted to the exonic regions of the 23 inherited pancreatic cancer-associated genes medically relevant genes. The arrays will be run using Agilent SureScan technology. This array is an ideal complement to the next generation sequencing approach to provide a comprehensive mutation spectrum analysis for inherited cancer.

The 23 inherited pancreatic cancer-associated genes are listed below:
APC, ATM, BMPR1A, BRCA1, BRCA2, CDK4, CDKN2A, EPCAM, FANCC, MEN1, MLH1, MSH2, MSH6, NF1, PALB2, PALLD, PMS2, SMAD4, STK11, TP53, TSC1, TSC2, VHL

Specimen Requirements:

Blood:  EDTA or ACD (Solution A or B):

  • Adult: 5 mL
  • Child: 2-3mL
  • Infant: 1-2mL

Saliva: 2 ORAgene™ Saliva Collection Kit(s) (OGR-500) used according to manufacturer instructions.  Please contact KDL Client Services for a Saliva Collection Kit for patients that cannot provide a blood sample.

Skin Fibroblast: Punch Biopsy (Cell cultures will be prepared at KDL and used for testing), or 2 T-25 confluent flasks.

DNA: 12-15 µg at a minimum of 60-100ng/µL (DNA must be extracted in a CLIA-certified laboratory or a laboratory meeting equivalent requirements as determined by the CAP and/or CMS)

For routine testing of blood and saliva (or DNA extracted from them), KDL does NOT accept samples from patients within two (2) weeks of a packed cell/platelet transfusion or within four (4) weeks of a whole blood transfusion.  For extraordinary circumstances, where testing must be performed outside of the above windows, please contact our lab.

A REQUISITION FORM MUST ACCOMPANY ALL SAMPLES.  Please include detailed clinical information, including ethnicity, clinical history, and family history.

Test Performed (Days):

Weekly

Turn Around Time:

3 weeks

Shipment Sensitivity Requirements:

  • Package and ship specimen to remain cold, but not frozen. 
  • Ship via overnight express, using the FedEx priority overnight label provided. 
  • Contact Client Services for shipping kits and instructions at (855) 535-1522.

References:

Additional Info:

The Knight Cancer Institute at Oregon Health & Science University is a pioneer in the field of precision cancer medicine. The institute's director, Brian Druker, M.D., helped prove it was possible to shut down just the cells that enable cancer to grow. This breakthrough has made once-fatal forms of the disease manageable and transformed how cancer is treated. The OHSU Knight Cancer Institute is the only National Cancer Institute-designated Cancer Center between Sacramento and Seattle – an honor earned only by the nation's top cancer centers. It is headquarters for one of the National Cancer Institute's largest research collaboratives, SWOG, in addition to offering the latest treatments and technologies as well as hundreds of research studies and clinical trials.

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