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MGMT Promoter Methylation, Tumor

Important Note

Test subject to Local Coverage Determination (LCD) Molecular Pathology Procedures (L35000).

Please check with the patient’s insurance to determine if prior authorization is required. Reminder- Medicare does not provider prior authorization. If in doubt about the coverage for a Medicare patient, please obtain an ABN.

Additional Codes

Primary ID

 Epic Code

Mayo Test ID

MGMT1

N/A

 MGMT

 

Useful For

Prognostication of newly diagnosed patients with glioblastoma, IDH-wildtype

 

Identifying newly diagnosed glioblastoma, IDH-wildtype patients that may respond to alkylating chemotherapy (ie, temozolomide)

 

Guiding therapy decision making for newly diagnosed glioblastoma, IDH-wildtype in older patients (>60-65 years)

Additional Tests

Test ID Reporting Name Available Separately Always Performed
SLIRV Slide Review in MG No, (Bill Only) Yes

Testing Algorithm

When this test is ordered, slide review will always be performed at an additional charge.

Method Name

Methylation-Specific Polymerase Chain Reaction (PCR) Analysis

Reporting Name

MGMT Promoter Methylation, Tumor

Specimen Type

Varies


Necessary Information


Pathology report (final or preliminary), at minimum containing the following information, must accompany specimen for testing to be performed:

1. Patient name

2. Block number-must be on all blocks, slides, and paperwork (can be handwritten on the paperwork)

3. Tissue collection date

4. Source of the tissue



Specimen Required


Preferred:

Specimen Type: Tissue

Container/Tube: Tissue block

Collection Instructions: Submit a formalin-fixed, paraffin-embedded tissue block. At least 40% tumor is required for this assay. In general, a 6 mm x 3 mm area of tissue cut at 5-micron thickness is the minimum amount of tissue needed; this could be collected over multiple slides.

 

Acceptable:

Specimen Type: Tissue sections

Slides: 1 Stained and 5 unstained

Collection Instructions: Submit 1 slide stained with hematoxylin and eosin and 5 unstained, nonbaked slides with 5-micron thick sections of the tumor. At least 40% tumor is required for this assay. In general, a 6 mm x 3 mm area of tissue cut at 5-micron thickness is the minimum amount of tissue needed; this could be collected over multiple slides.


Specimen Minimum Volume

5 Unstained slides at 5-microns thickness

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Ambient (preferred)
  Frozen 
  Refrigerated 

Reject Due To

Specimens that have been decalcified (all methods)
Specimens that have not been formalin-fixed, paraffin-embedded
Bone marrow in EDTA		 Reject

Reference Values

An interpretive report will be provided.

Day(s) Performed

Varies

Report Available

7 to 10 days

Specimen Retention Time

FFPE tissue block: Unused portions of FPPE blocks will be returned; Unused, unstained slides: 5 years; Stained slides: Indefinitely

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

81287

88381

LOINC Code Information

Test ID Test Order Name Order LOINC Value
MGMT MGMT Promoter Methylation, Tumor 60252-4

 

Result ID Test Result Name Result LOINC Value
36734 Result Summary 50397-9
36735 Result 60252-4
36736 Interpretation 69047-9
36737 Additional Information 48767-8
36738 Specimen 31208-2
36739 Source 31208-2
36740 Tissue ID 80398-1
36741 Released by 18771-6

NY State Approved

Yes

Forms

If not ordering electronically, complete, print, and send an Oncology Test Request (T729) with the specimen.