Clinics and Departments

Laboratory Services

Lab Dept:

Anatomic Pathology

Test Name:

TUBEROUS SCLEROSIS (TSC1) SEQUENCING

General Information

Lab Order Codes:

TUBS

Synonyms:

TSC Mutation Evaluation

CPT Codes:

81406 – TSC1, full gene sequence (Molecular Pathology, Level 7)

Test Includes:

TSC1 evaluation including sequencing. The protein hamartin is encoded by 21 exons (3-23) from the TSC1 gene on chromosome 9q34. Testing is accomplished by amplifying each coding exon and ~50 bp of adjacent noncoding sequence, then determining the nucleotide sequence using standard dideoxy sequencing methods and a capillary electrophoresis instrument.

Logistics

Test Indications:

Any combination of seizures, developmental delay, skin lesions, cortical tubers and hamartomas in various parts of the body. Individuals with a clinical presentation of tuberous sclerosis or having a family history of tuberous sclerosis. This test is specifically designed for heritable germline mutations and is not appropriate for detection of somatic mutations in tumor tissue.

Lab Testing Sections:

Anatomic Pathology - Sendouts

Referred to:

Prevention Genetics (Test: 1001)

Phone Numbers:

MIN Lab: 612-813-6280

STP Lab: 651-220-6550

Test Availability:

Daily, 24 hours

Turnaround Time:

Maximum of 40 days, although many reported in 2-3 weeks

Special Instructions:

A test requisition must be sent with all specimens. Forms can be obtained through the following link: http://preventiongenetics.com/clinical-dna-testing/requisition-forms/

Specimen

Specimen Type:

Whole blood

Container:

Lavender top (EDTA) tube

Draw Volume:

2-5 mL (Minimum: 1 mL for small babies) blood
Note: 5 mL preferred

Processed Volume:

Same as Draw Volume

Collection:

Routine venipuncture for blood specimens, invert gently to mix

Special Processing:

Lab Staff: Do Not centrifuge. Send whole blood in original collection container labeled with patient name, date of birth and medical record number and Prevention requisition filled out by provider. Ship specimens at room temperature in an insulated container.

During hot weather, include a frozen ice pack in the shipping container. Place a paper towel or other thin material between the ice pack and the blood tube.
In cold weather, include an unfrozen ice pack in the shipping container as insulation.

Send specimens Monday – Friday by overnight delivery. Specimens are accepted Monday – Saturday. Specimens collected Saturday and Sunday should be stored in the refrigerator and shipped on Monday or the next business day.

Note: Refrigerated specimens are stable for 1 week, room temperature specimens are stable for 48 hours.

Patient Preparation:

None

Sample Rejection:

Mislabeled or unlabeled specimens; frozen specimens

Interpretive

Reference Range:

Interpretive report

Critical Values:

N/A

Limitations:

In exons where sequencing did not reveal any variation between two alleles, Prevention cannot be certain that they were able to PCR amplify both of the patient’s alleles. Occasionally, a patient may carry an allele which does not amplify, due for example to a deletion or a large insertion. In these cases, the report contains no information about the second allele.

Similarly, Prevention sequencing tests have almost no power to detect duplications, triplications, etc. of the gene sequences.

Only the indicated exons and roughly 50 bp of flanking non-coding sequence on each side are analyzed. Test reports contain no information about other portions of the gene, including many regulatory regions.

In nearly all cases, Prevention is unable to determine the phase of sequence variants. In particular, when two likely causative mutations are found for recessive disorders, Prevention cannot be certain that the mutations are on different alleles.

Prevention’s ability to detect minor sequence variants, due for example to somatic mosaicism is limited. Sequence variants that are present in less than 50% of the patient’s nucleated cells may not be detected.

Runs of mononucleotide repeats (eg(A)n or (T)n) with n>8 in the reference sequence are generally not analyzed because of strand slippage during PCR and cycle sequencing.

Unless otherwise indicated, the sequence data that we report are based on DNA isolation from a specific tissue (usually leukocytes). Test reports contain no information about gene sequences in other tissues.

Methodology:

Polymerase Chain Reaction (PCR) and bidirectional Sanger sequencing

References:

Prevention Genetics March 2013
Phone: 715-387-0484 Fax: 715-384-3661

Updates:

2/11/2013: CPT update
3/1/2013: Test moved from Boston University to Prevention Genetics, no longer includes MPLA, deletion/duplication. If needed, order separately.



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