Test Id : CONFL

Laboratory approval is required prior to ordering this test. Contact Mayo Clinic Laboratories at 800-533-1710.

This request will be processed as a consultation case. An interpretation, which includes an evaluation of the specimen and determination of a diagnosis, will be provided within a formal pathology report. Second opinion regarding diagnosis will be rendered by staff pathologists, often in consultation with colleagues who have expertise in the appropriate subspecialty areas. Appropriate additional stains and other ancillary testing may be performed in order to render comprehensive assessment. These additional stains/tests ordered will have the results included within the final pathology report and will be performed at an additional charge.

Note: Special stains and studies performed on the case should be sent with the case for review. To determine an accurate diagnosis, some of these stains or studies may be deemed to warrant being repeated, at an additional charge, at the reviewing Mayo Clinic pathologist's discretion. In addition, testing requested by the referring physician (immunostains, molecular studies, etc) may not be performed if deemed unnecessary by the reviewing Mayo Clinic pathologist. For all pathology consultations, ancillary testing necessary to determine a diagnosis is ordered at the discretion of the Mayo Clinic pathologist.

This test is intended for use with dry tissue - blocks and/or slides - only. For test ordering guidance for other specimen types, see Pathology Consultation Ordering Algorithm.

If requesting only a peripheral blood smear evaluation, order SPSM / Morphology Evaluation (Special Smear), Blood.

Attach the Jacksonville Pathology Fluorescent Pink address label (T987) to the outside of the transport container before putting into the courier mailer.

The following information is required:

1. All requisitions must be labeled with:

-Patient name, date of birth, and medical record number

-Name and phone number of the referring pathologist or ordering physician

-Anatomic site and collection date

2. A preliminary or final pathology report and brief patient history is essential to achieve a consultation fully relevant to the ordering pathologist's needs. If a report is not available, submit the Pathology Consultation Request form with the specimen.

3. A specific diagnostic question is required for each specimen/part submitted. Include diagnostic question in a cover letter or in the requisition notes/comments. For ease of submission, the Pathology Consultation Cover Letter can be completed and sent with the specimen.

4. Additional required information by case type:

Note: Imaging studies should be submitted for the request via Epic Care Everywhere, Mayo Clinic Image Share, or external storage device.

-Bone soft tissue consults: Preoperative imaging studies must be provided; the consultation will not proceed without radiology films, as a diagnosis cannot be definitively determined. Pre-operative imaging studies are often required.

-Neuropathology consults: Clinical and/or radiology imaging should be included if available.

-Bone marrow consults:

1. A recent Hematology/Oncology clinical note; print and submit with the case.

2. Complete blood cell count (CBC) result from testing performed within 14 days of bone marrow collection

3. Indicate clinical reason/context for submitting this case.

4. All pending and final reports for ancillary testing on submitted specimens.

All requisition and supporting information must be submitted in English.

Additional Information:

All specimens and additional paperwork must be labeled with:

-Two patient identifiers (first and last name, date of birth, or medical record number)

-Specimen type and anatomic site

Supplies: MCF Pathology Packaging Kit (T994)

Specimen Type: Tissue

Container/Tube: Formalin fixed paraffin-embedded blocks, stained slides and/or unstained slides

Note: Submit only pertinent hematoxylin and eosin (H and E) and all special stains relevant to the diagnostic questions for the case. Include positively charged unstained slides and/or a formalin-fixed, paraffin-embedded tissue block if it is anticipated that additional stains or ancillary testing may be necessary.

Bone Marrow Case Specimen Requirements

For information on collecting specimens, see Bone Marrow Core Biopsy, Clot, and Aspirate Collection Guideline.

Specimen Type: Bone marrow aspirate

Slides: 5

Preferred: Freshly prepared slides made at the time of specimen collection

Acceptable: Slides made from EDTA specimen, within 2 hours of collection

Submission Container/Tube: Plastic slide holder

Specimen Type: Bone marrow aspirate clot

Container/Tube: Bone marrow aspirate clot embedded in paraffin block

Collection Instructions: Process and embed clot in paraffin

Specimen Type: Bone marrow core biopsy

Container/Tube: Fixed biopsy core embedded in paraffin block

Collection Instructions: Process and embed core in paraffin.

• Bone Marrow Core Biopsy, Clot, and Aspirate Collection Guideline
• Pathology Consultation Cover Letter-MCF
• Pathology Consultation Ordering Algorithm-MCF

1. Pathology Consultation Cover Letter

2. If not ordering electronically, complete, print, and send the Pathology Consultation Request with the specimen.

See Specimen Required

A subspecialty second opinion for a specific pathology question referred by a primary pathologist

Note: A consultative opinion is not a full rendering of a primary diagnostic report (eg, multiple parts, margin status, CAP synoptics)

Obtaining special studies not available locally

This test is not intended to be used to obtain a primary diagnosis.

Laboratory approval is required prior to ordering this test. Contact Mayo Clinic Laboratories at 800-533-1710.

This request will be processed as a consultation case. An interpretation, which includes an evaluation of the specimen and determination of a diagnosis, will be provided within a formal pathology report. Second opinion regarding diagnosis will be rendered by staff pathologists, often in consultation with colleagues who have expertise in the appropriate subspecialty areas. Appropriate additional stains and other ancillary testing may be performed in order to render comprehensive assessment. These additional stains/tests ordered will have the results included within the final pathology report and will be performed at an additional charge.

Note: Special stains and studies performed on the case should be sent with the case for review. To determine an accurate diagnosis, some of these stains or studies may be deemed to warrant being repeated, at an additional charge, at the reviewing Mayo Clinic pathologist's discretion. In addition, testing requested by the referring physician (immunostains, molecular studies, etc) may not be performed if deemed unnecessary by the reviewing Mayo Clinic pathologist. For all pathology consultations, ancillary testing necessary to determine a diagnosis is ordered at the discretion of the Mayo Clinic pathologist.

Mayo Clinic in Jacksonville, FL is staffed by pathologists whose expertise and special interests cover the entirety of pathology-from surgical pathology with all of its respective subspecialty areas, to hematopathology, renal pathology, and dermatopathology.

Consultation services are provided for difficult diagnostic problems. Consultation cases may be sent by a referring pathologist and directed to one of the pathologists who is an expert in the given area or directed more broadly to the subspecialty group. Cases are frequently shared and, sometimes, transferred between the pathologists, as deemed appropriate for the type of case or diagnostic problem encountered. Emphasis is placed on prompt and accurate results. Stained slides and paraffin blocks received are reviewed in conjunction with the clinical history provided, laboratory findings, radiographic findings (if applicable), and sending pathologist's report or letter. If additional special stains or studies are needed, the results are included in the final interpretive report. In some cases, electron microscopy and other special procedures are utilized as required.

A variety of ancillary studies are available (eg, cytochemistry, immunohistochemistry, immunofluorescence, electron microscopy, mass spectrometry, cytogenetics, and molecular genetics) to aid in establishing a diagnosis. These ancillary studies are often expensive, labor intensive, and most efficiently utilized and interpreted in the context of the morphologic features.

The goal is to provide the highest possible level of diagnostic consultative service, while balancing optimal patient care with a cost-conscious approach to solving difficult diagnostic problems.

An interpretive report will be provided.

Results of the consultation are reported in a formal pathology report that includes a description of ancillary test results (if applicable) and an interpretive comment.

Hematopathology and medical renal pathology can be provided by separate tests (HFWET / Hematopathology Consult, MCL; RFCWT / Renal Pathology Tissue Consultation, Wet Tissue). Otherwise, primary interpretation should be performed by a local pathology service and Mayo Clinic pathologists will render a second opinion if requested.

Appropriate stained and unstained slides and tissue sampling and fixation is required in order to make a diagnosis on routine stains and on the special stains or studies that may be required.

Specific diagnosis may require correlation with clinical information.

1. Renshaw AA, Gould EW. Measuring the value of review of pathology material by a second pathologist. Am J Clin Pathol. 2006;125(5):737-739. doi:10.1309/6A0R-AX9K-CR8V-WCG4

2.  Lester SC. Manual of Surgical Pathology. Elsevier. Churchill Livingstone; 2023

All requests will be processed as a consultation case first. Special studies will be performed only if deemed to be diagnostically indicated. If the need for enzyme cytochemical stains, immunophenotyping, and/or immunohistochemical stains is anticipated, appropriate specimen requirements should be followed as indicated.

Monday through Friday

• Authorized users can sign in to Test Prices for detailed fee information.
• Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
• Prospective clients should contact their account representative. For assistance, contact Customer Service.

Not Applicable

88321 (if appropriate)

88323 (if appropriate)

88325 (if appropriate)