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Request Forms

Use the buttons below to download the appropriate request form. If you can't find what you're looking for, please get in touch. We ask that the forms are completed in full and, if handwritten, written in block capitals. Missing information could lead to delay in testing as some information is vital in order for a case to be booked in. 

Request requirements

The use of patient ID stickers is permitted, however, please ensure you use the full patient sticker and NOT the smaller blood tube sticker. All specimens received into MPDS must meet the agreed laboratory minimum data set; any specimens not meeting the criteria may be returned to the requesting department. Please ensure that any important information (e.g. clinical history, etc.) is clearly indicated on the form and ensure that any priority or urgent cases are marked as such.

Where possible a copy of the pathology report should be provided.

Shipping requirements

It is the responsibility of the sender of the specimen to arrange safe and appropriate packaging and transport of specimens that meets national/international regulatory requirements for the transport of biological specimens. If multiple patients are being sent in a single package then these should be separated individually within the package and referral forms attached to each individual specimen container. Blocks from different patients should not be kept in direct contact with one another.

Transport from external sources

It is the responsibility of the referring centre sending the specimen to arrange appropriate transport to MPDS. We recommend that all samples posted are sent via recorded/tracked delivery. QEHB are not responsible for any samples that go missing between the referring centre and QEHB.

Transport of Specimens at QEHB

It is the responsibility of the department sending the specimen to arrange appropriate transport to MPDS. This can either be through the internal post system or hand delivered. If a sample is being dropped off at the CLS Specimen Reception, we ask that you contact the Molecular Specimen Reception on Ext: 13325 to alert us that the sample has arrived.

Hazardous Specimens

Reporting

Specimens are reported on the Laboratory Information Management System. For internal patients, the reports are then automatically uploaded to the Clinical Portal. For external users, reports are issued automatically to the email address (.net) provided. If a .net email address is not accessible, an nhs.uk email will be accepted; the report will be encrypted with password protection. All reports are stored with the laboratory LIMS system indefinitely.

The department will not send reports by fax.

Members of MPDS are available from 08:30 – 17:00 Monday – Friday for the reporting of specimens and to offer advice. Please use the link below to contact the laboratory.

Return of Material

Guidance from The Royal College of Pathologists and Institute of Biomedical Science recommends residual DNA remaining following completion of testing is stored for a minimum of 8 weeks. Current storage capacity allows retention of DNA for a minimum period of 3 years. Referred specimens (blocks/ unused slides) will be retained for 2 weeks after testing is complete before being returned to the referring pathology. Material is returned using sample tracking and confirmation of receipt is requested. If a specimen is required prior to test completion or within a specified time frame this should be clearly communicated to the service.

EGFR Testing via Circulating Tumour DNA

Request Plasma Testing Kits

Testing tubes are available upon request. Please ensure that tubes you currently have in stock are still in date as we can not accept samples for testing that have been supplied in expired tubes. Each kit includes one testing tube and one request form.

Please click below to request Plasma testing kits.

Download the Request Form

All blood samples sent MUST be accompanied with a request form, completed in full. Requests can not be processed without this document.

You can download the EGFR plasma request form below.

Post the samples via recorded/tracked delivery

We require 8-10ml blood in PAXgene ccfDNA testing tubes, please invert gently 8-10 times immediately following blood draw. Please note blood to be stored at ROOM TEMPERATURE and to reach the laboratory within 2-3 days post blood draw.

Blood samples MUST be posted within 48 hours of being drawn. Please ensure the bottle is securely packed in an envelope and protected with protective wrapping. Alternatively, Royal Mail's SafeBox can be used to ensure the samples safety. Please send via courier or special delivery.

Test Repertoire

Breast Cancers

The section offers a comprehensive HER2 analysis service for breast cancers. Immunohistochemistry, with the Roche/Ventana 4B5 antibody, is used to screen patients for expression levels of the HER2 protein and identify those “over-expressers” who are most likely to benefit from treatment with Trastuzumab (Herceptin). Where expression levels are equivocal, FISH is used to determine amplification at the gene level. Service users may access the full service, or submit cases for FISH analysis only if performing their own IHC.

Gastric Cancers

As with breast cancers, HER2 analysis is performed in Gastric cancers to assist in predicting which therapies patients will benefit from. As well as this standard-of-care testing, mismatch-repair analysis and ISH for EBV are also available on demand.

Colorectal Cancers

RAS (KRAS and NRAS) mutations confer resistance to anti-EGFR monoclonal antibodies, and act as a negative predictive marker for these therapies.  The National Institute for Clinical Excellence (NICE) has approved the use of Cetuximab and Panitumumab for the treatment of metastatic colorectal cancer in patients who carry normal, “wild-type” RAS genes. RAS testing is mandatory prior to their prescription.

BRAF gene mutation analysis is provided on demand for colorectal cancer patients. This can be used to inform patient management or, in combination with mismatch repair expression (see below), to help establish the presence of the inherited cancer syndrome HNPCC (Lynch syndrome).

We are a reference centre for Mismatch repair (MMR) protein expression analysis in patients suspected to have Lynch syndrome; we test over 700 cases a year. immunohistochemical testing allows identification of patients without normal DNA repair processes, who are therefore more likely to have Lynch syndrome. In patients with MLH1 loss we can also perform reflex testing for BRAF V600E mutations and MLH1 promoter methylation status. Mismatch repair protein expression is also requested increasingly to help inform patient chemotherapy decisions, as patients lacking MMR expression appear to have reduced sensitivity to certain cytotoxic treatments.

BRAF p.Val600Glu (“V600E”) specific immunohistochemistry (IHC) is available on demand.

Lung Cancers

EGFR mutations correlate with the effectiveness of certain Tyrosine Kinase Inhibitors (TKIs) such as Gefitinib, Erlotinib, Afatinib, and Osimertinib against some Non-Small Cell Lung Cancers (NSCLCs). Activating mutations are reported to correlate with significant responses to such treatment, whilst certain other mutations correlate with resistance to first- and second-generation TKIs, but predict response to newer agents. EGFR mutation status is therefore vital in deciding the most appropriate treatment regime. The service also offers EGFR analysis on circulating tumour DNA extracted from plasma. This is of particular use in testing patients for acquired, targetable secondary mutations when they begin to progress whilst on treatment that targets their primary EGFR mutation. It may also function as a surrogate where clinical circumstances make obtaining a more representative tissue specimen for initial diagnostic testing difficult or impossible. The service can provide specialised collection tubes for users wishing to submit samples.

Anaplastic lymphoma kinase (ALK) gene fusions can be targeted with specific inhibitors, and translocation analysis using immunohistochemistry or Fluorescence In-Situ Hybridisation (FISH) is now standard alongside EGFR mutation analysis to determine 1^st line treatment for lung NSCLC. In addition to ALK analysis, the service provides FISH and IHC testing for ROS1 fusions in lung cancer. 

PD-L1 expression analysis is also important in informing first (and second) line anti PD-1 / anti-PD-L1 monoclonal antibody treatment for lung NSCLC. A relatively recent addition to the testing landscape, in 2016, immunohistochemical analysis using companion-diagnostic antibodies specific to the relevant treatments gives a quantitative expression result.

Gastrointestinal Stromal Tumours (GIST)

Up to 90% of all malignant GISTs harbour gain-of function mutations in the KIT / PDGFRA genes. Primary mutations have been described in exons 8, 9, 11, 13 & 17 of KIT, and exons 12, 14 & 18 of PDGFRA. Secondary (acquired or treatment associated) mutations have also been described. Selective TKIs have a high response rate in patients with advanced GISTs, which are largely radiotherapy and chemotherapy resistant. Evidence suggests that the type and location of KIT or PDGFRA mutations in GISTs predicts the response to TKI treatment.

Melanomas

The BRAF gene is frequently mutated in human melanomas, with mutations seen in 35-50% of cases. Mutations lead to constitutive activation and aberrant signalling, and subsequent malignant behaviour. Drugs that treat those cancers by inhibiting BRAF are now licensed for use in metastatic disease.

The NRAS gene is also frequently mutated in melanoma; between 10-20% of tumours show an NRAS mutation, and these are thought to be mutually exclusive with alterations in BRAF. NRAS testing is offered as a supporting aid in selecting patients for access to novel therapeutic interventions or clinical trials targeting the pathway activated by mutant NRAS.

Mutations in the KIT gene are seen in Acral and mucosal melanomas and represent potential therapeutic targets.

PD-1 and PD-L1 inhibition, particularly in combination with anti-CTLA4 therapies, has shown profound and sustained effects against metastatic melanoma. Whilst PD-L1 expression analysis is not mandatory for prescription, as it is with some lung NSCLC therapies, it has been shown to be helpful in informing decisions on whether to use mono- or combination-therapy.

Brain Tumours

The revision of the WHO classification of CNS tumours in 2016 has expanded the range of essential and desirable molecular analyses performed.

Epigenetic silencing of the MGMT (O6-methylguanine–DNA methyltransferase) gene by promoter methylation is associated with longer overall survival in patients with glioblastoma who, in addition to radiotherapy, received alkylating chemotherapy with temozolomide. High levels of MGMT activity in cancer cells create a resistant phenotype by hindering the therapeutic effect of alkylating agents and may be an important determinant of treatment failure.

Combined loss of chromosome arms 1p and 19q (denoted as 1p-/19q-) is a powerful predictor of chemotherapeutic response and survival in oligodendrogliomas. A FISH based analysis of these loci is available as a tool to assist patient management. More recently it has been employed diagnostically in the differentiation of ATRX-positive Oligodendrogliomas and Astrocytomas.

Mutation analysis of the IDH1 and IDH2 genes is used as a supplement to immunohistochemistry. Whilst the IDH1 R132H-specific antibody detects the majority of IDH mutated tumours, mutation analysis for rarer R132 variants along with IDH R100 and IDH2 R172 mutations is used in particular relevant clinical scenarios.