Colorectal Cancer Testing

Comprehensive and flexible options
for MMR Protein, MSI, KRAS, and BRAF

NeoGenomics provides IHC and molecular test panels that are easily customized with any combination of tests and tech-only choices. This flexibility allows our clients to:

  • Follow current testing practices at their institutions
  • Control costs by avoiding unnecessary testing
  • Supplement testing they may do in their own laboratories

Our menu supports these three objectives in managing the care of colorectal cancer patients:

  • Screening for HNPCC / Lynch Syndrome
    • Recommended by EGAPP Working Group for all newly-diagnosed individuals
    • NCCN strongly recommends considering MMR protein study for all patients age <50
    • For high-risk patients meeting Bethesda Guidelines or Amsterdam II criteria
  • Predicting response to therapy
    • EGFR-antibody therapy is not recommended with KRAS mutation (+) tumors
    • BRAF mutations appear to confer resistance to EGFR therapy outside first-line use
    • Testing should be considered for stage II patients with a 5-FU therapy plan; negative or low MSI is associated with improved outcome
  • Determining prognosis
    • High MSI or MMR protein deficiency is associated with more favorable outcomes in stage II patients
    • BRAF mutations are associated with a worse prognosis

NeoGenomics’ IHC and/or MSI testing is also appropriate for screening endometrial cancers for Lynch Syndrome in all patients.

Test Summary

Test Name  Description Specimen Requirements TAT (days)   Ordering Options
Individual Tests
MMR IHC Staining with antibodies to MLH1, MSH2, MSH6, and PMS2 to identify mismatch repair defect.  Stains are run concurrently. Cut slides or FFPE tumor block: details for IHC  2 Full IHC consult, global with interpretation, Tech-Only IHC
MSI by PCR PCR-based comparison of tumor and non-tumor DNA to detect microsatellite instability at the five NCI-recommended loci. H&E slide, cut tumor slides or FFPE tumor block, and source of non-tumor patient DNA: details for MSI
 7 n/a
KRAS w/reflex to BRAF

Sequencing to detect KRAS mutations in codons 12, 13, and 61. If negative, BRAF sequencing for V600 and other mutations is added automatically.

H&E slide plus cut slides or FFPE tumor block: details for KRAS/BRAF  7 n/a

Notes: Individual IHC stains are available by request.
             BRAF may be ordered separately from KRAS as follow-up testing when MLH1 is deficient by IHC. 

Multiple Tests
Colorectal Cancer Panel       Any two or three of the above tests on the same patient sample. For multiple tests, please send H&E slide plus FFPE tumor block instead of cut slides for testing.
Follow MSI detailed requirements if ordering that test in a panel.
 7  Clients participating in tech-only can bill one IHC professional component (PC) per antibody per patient sample tested.

Ordering Instructions

Please use the Green/Gray NeoGenomics Solid Tumor Requisition and check all desired tests in the FISH and Solid Tumor Panels section near the bottom.

References

  1. NCCN Guidelines, Colon Cancer v. 3.2012
  2. Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group. Genet Med. 2009;11(1):35-41.