Spreadsheet: 76f92901-8a67-40ff-aba2-0219a0f0d79e
Sheet: Sheet1

Test Referenced | Entry Type | Mayo ID | Description | Reporting Description | Method | Collection Container | Temperature | Stability | [NAME] | Unit of Measure | [NAME] | Minimum Volume | Reject Due To | Reference Values | Days/Times Performed | Analytic Time | Maximum Lab Time | CPT Units | CPT Code | LOINC® Code | LOINC® Attributes | Always Performed | Orderable Separately | Performing Location
81504 | Test | 81504 | HER2, Breast, Quantitative Immunohistochemistry, Automated | HER2, [NAME], Automated | US Food and Drug Administration (FDA)-Approved Ventana Pathway Immunoperoxidase Stain | Paraffin block: PB |  |  |  | Varies | [NAME]Preferred: A paraffin-embedded tissue block containing breast cancer tissue that has been fixed in 10% neutral buffered formalin within 1 hour from surgical collection time and for a total of 6 to 48 hours and shipped at ambient temperature Acceptable: 2 unstained sections, containing breast carcinoma, on charged slides cut at 4 microns <1 month ago and shipped at ambient temperature. Tissue on the slides should have been fixed in 10% neutral buffered formalin within 1 hour from surgical collection time and for a total of 6 to 48 hours.  Container/Tube: Surgical Pathology Packaging Kit (Supply T554) Collection Instructions:	 1. Submit paraffin-embedded invasive or metastatic breast carcinoma tissue. 2. Include accompanying pathology report stating the final diagnosis. If not available, a preliminary diagnosis is acceptable only if it refers to invasive or metastatic breast carcinoma. 3. Attach the green pathology address label included in the kit to the outside of the transport container. Additional Information: 1. Information regarding duration of fixation is required. When ordering this test, the following questions, are stated on the order form or presented electronically, and must be answered:  -"Was specimen fixed in 10% neutral buffered formalin within 1 hour from surgical collection time? Yes, No, or Unknown."  -"Has specimen been fixed in 10% neutral-buffered formalin for 6 to 48 hours? Yes, No, or Unknown."  2. According to the College of American Pathologists (CAP)/American Society of Clinical Oncology (ASCO) guidelines, HER2 protein immunohistochemical test results are only valid for nondecalcified, paraffin-embedded specimens fixed in 10% neutral buffered formalin within 1 hour from surgical collection time and for a total time of 6 to 48 hours. Under- or overfixation may affect these results. 3. Paraffin blocks will be returned with final report. Forms: If not ordering electronically, submit a Pathology/Cytology Request Form (Supply T246) with the specimen. |  | Hemolysis	NA Thawing	Warm OK; Cold OK Lipemia	NA Icterus	NA Other	NA | Reported as negative (0, 1+), equivocal (2+), and strongly positive (3+) according to the interpretation guidelines for the FDA-approved Ventana Pathway HER2 (4B5) antibody. | Monday through Friday | 2 days | 10 days | 1 | 88361 |  |  |  |  | Rochester
81504 | [NAME] | VARIES | Varies |  |  |  | Ambient
81504 | Order Question | [NAME] | Was specimen fixed in 10% neutral buffered formalin within 1 hr from surgical collection time? |  | Answer List
81504 | Option | Q0000367-1 | Yes
81504 | Option | Q0000367-2 | No
81504 | Option | Q0000367-3 | Unknown
81504 | Order Question | Q0000262 | Has specimen been fixed in 10% neutral buffered formalin for 6-48 hours? |  | Answer List
81504 | Option | Q0000262-1 | Yes
81504 | Option | Q0000262-2 | No
81504 | Option | Q0000262-3 | Unknown
81504 | Result | 18930 | Accession Number | Accession Number
81504 | Result | 18931 | Referring Pathologist/Physician | Referring Pathologist/Physician |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 46608-6 | Primary referring physician ID:ID:Pt:Provider:Nom:
81504 | Result | 18932 | Ref Path/Phys Address | Ref Path/Phys Address |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | In Process
81504 | Result | 18933 | Material: | Material:
81504 | Result | 18977 | Tissue: | Tissue: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 31208-2 | [NAME] source:Prid:Pt:[NAME]:Nom:
81504 | Result | 18934 | Interpretation: | Interpretation: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 48676-1 | HER2:Imp:Pt:Tiss:Nom:
81504 | Result | 18978 | Comment: | Comment: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 48767-8 | Annotation comment:Imp:Pt:{system}:Nar:
81504 | Result | 18935 | SP Signing Pathologist: | SP Signing Pathologist:
81504 | Result | 18936 | *Previous Report Follows* | *Previous Report Follows*
81504 | Result | 18937 | [NAME]: | [NAME]: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 35265-8 | Path report.addendum:Find:Pt:[NAME]:Nar:
81504 | Result | 19216 | [NAME] Comment: | [NAME] Comment: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 22638-1 | Path report.comments:Imp:Pt:[NAME]:Nar:
81504 | Result | 18938 | [NAME] Pathologist: | [NAME] Pathologist: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 19139-5 | Pathologist name:PN:Pt:Provider:Nom:
81504 | [NAME] | [NAME] | HER2 Amplification Associated with Breast Cancer, FISH, Tissue | [NAME], Breast Cancer, FISH | Fluorescence In Situ Hybridization (FISH) |  |  |  |  |  | Provide a pathology report with each tissue specimen. The pathology report must include type of fixation used (ie, >6 hours and <72 hours). The laboratory will not reject a specimen that arrives without this information but will hold analysis of the specimen until a pathology report is received.  Advise Express Mail or equivalent if not on courier service.   Forms: If not ordering electronically, submit a Cytogenetics Hematologic Disorders Request Form (Supply T607) with the specimen.  Submit only 1 of the following specimens:  Specimen Type: Tissue Container/Tube: Formalin-fixed, paraffin-embedded tumor tissue block   Specimen Type: Slides Specimen Volume: 4 Consecutive, unstained, 5 micron-thick sections placed on positively charged slides and 1 hematoxylin and eosin-stained slide |  | Note: No specimen should be rejected. If specimen not received at appropriate temperature, include note to laboratory. If questions, contact laboratory. | An interpretive report will be provided. | Samples processed Monday through Sunday. Results reported Monday through Friday, 8 a.m.-5 p.m. CST. | 8 days | 11 days |  | Profile |  |  | No | Yes
[NAME] | [NAME] | TISSUE | Tissue |  |  |  | Ambient
[NAME] | Order Question | G_652 | Reason For Referral |  | Plain Text
[NAME] | Result | 16878 | [NAME] | [NAME] | Alphanumeric
[NAME] | Result | 16879 | [NAME] | [NAME] | Alphanumeric
[NAME] | Result | 16880 | Source | Source | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 31208-2 | [NAME] source:Prid:Pt:[NAME]:Nom:
[NAME] | Result | 16881 | Order Date | Order Date | Alphanumeric
[NAME] | Result | G_652 | Reason For Referral | Reason For Referral | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 42349-1 | Reason for referral:Find:Pt:^Patient:Nar:
[NAME] | Result | 29636 | Fixative | Fixative | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | In Process
[NAME] | Result | 16882 | Method | Method | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 49549-9
[NAME] | Result | 16884 | Results | Results | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 31150-6 | HER2:ACnc:Pt:Tiss:[NAME]:FISH
[NAME] | Result | 16885 | Interpretation | Interpretation | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 69965-2
[NAME] | Result | 16886 | Amendment | Amendment | Alphanumeric |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 31150-6 | HER2:ACnc:Pt:Tiss:[NAME]:FISH
[NAME] | Result | 16887 | Consultant | Consultant | Alphanumeric
[NAME] | Result | 16888 | Report Date | Report Date | Alphanumeric
[NAME] | Component | [NAME] |  | Cytogenetic Interp/Report |  |  |  |  |  |  |  |  |  |  |  |  |  | 1 | 88291 |  |  | No | No
[NAME] | Component | [NAME] |  | Inter In Situ Hybrid |  |  |  |  |  |  |  |  |  |  |  |  |  | 1 | 88274 |  |  | No | No
[NAME] | Component | [NAME] |  | Molec cyto, DNA Probe, Ea |  |  |  |  |  |  |  |  |  |  |  |  |  | 2 | 88271 |  |  | No | No