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Requisite Analytic and Diagnostic Performance Characteristics for the Clinical Detection of BRAF V600E in Hairy Cell Leukemia: A Comparison of 2 Allele-specific PCR Assays

Brown, Noah A. MD*; Weigelin, Helmut C. MLS (ASCP)*; Bailey, Nathanael MD*; Laliberte, Julie PhD; Elenitoba-Johnson, Kojo S. J. MD*; Lim, Megan S. MD, PhD*; Betz, Bryan L. PhD*

Applied Immunohistochemistry & Molecular Morphology: September 2015 - Volume 23 - Issue 8 - p 590–600
doi: 10.1097/PAI.0000000000000024
Research Articles

Detection of high-frequency BRAF V600E mutations in hairy cell leukemia (HCL) has important diagnostic utility. However, the requisite analytic performance for a clinical assay to routinely detect BRAF V600E mutations in HCL has not been clearly defined. In this study, we sought to determine the level of analytic sensitivity needed for formalin-fixed, paraffin-embedded (FFPE) and frozen samples and to compare the performance of 2 allele-specific polymerase chain reaction (PCR) assays. Twenty-nine cases of classic HCL, including 22 FFPE bone marrow aspirates and 7 frozen specimens from blood or bone marrow were evaluated using a laboratory-developed allele-specific PCR assay and a commercially available allele-specific quantitative PCR assay—myT BRAF Ultra. Also included were 6 HCL variant and 40 non-HCL B-cell lymphomas. Two cases of classic HCL, 1 showing CD5 expression, were truly BRAF V600E-negative based on negative results by PCR and sequencing despite high-level leukemic involvement. Among the remaining 27 specimens, V600E mutations were detected in 88.9% (17/20 FFPE; 7/7 frozen) and 81.5% (15/20 FFPE; 7/7 frozen), for the laboratory-developed and commercial assays, respectively. No mutations were detected among the 46 non-HCL lymphomas. Both assays showed an analytic sensitivity of 0.3% involvement in frozen specimens and 5% in FFPE tissue. On the basis of these results, an assay with high analytic sensitivity is required for the clinical detection of V600E mutations in HCL specimens. Two allele-specific PCR assays performed well in both frozen and FFPE bone marrow aspirates, although detection in FFPE tissue required 5% or more involvement.

*Molecular Diagnostics Laboratory, Department of Pathology, University of Michigan Health System

Swift Biosciences, Ann Arbor, MI

All testing using myT BRAF Ultra was performed at the expense of Swift Biosciences.

J.L. is an employee of Swift Biosciences. The remaining authors declare no conflict of interest.

Reprints: Bryan Betz, PhD, Molecular Diagnostics Laboratory, Department of Pathology, University of Michigan Health System, Traverwood II 2910, Huron Parkway, Ann Arbor, MI 48105-3450 (e-mail:

Received October 10, 2013

Accepted November 11, 2013

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