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Test Code PDL12 Programmed Death-Ligand 1 (PD-L1) (22C3), Semi-Quantitative Immunohistochemistry, Manual

Shipping Instructions

Attach the green pathology address label included in the kit to the outside of the transport container.

Necessary Information

A pathology/diagnostic report and a brief history are required.

Specimen Required

Specimen Type: Tissue

Supplies: Pathology Packaging Kit (T554)

Collection Instructions: Formalin-fixed, paraffin-embedded tissue block; or 3 unstained glass, "positively charged" slides with 4-microns formalin-fixed, paraffin-embedded tissue

Additional Information:

1. One slide will be stained with hematoxylin and eosin and returned.

2. For information on selection of PD-L1 testing, see PD-L1 Immunohistochemistry Options in Special Instructions.


If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

Oncology Test Request Form (T729) (

Immunohistochemical (IHC)/In Situ Hybridization (ISH) Stains Request Form (T763) (

Useful For

Identification of neoplasms expressing programmed cell death 1-ligand 1 (clone 22C3)

Special Instructions

Method Name


Reporting Name

PD-L1 (22C3),SemiQuant IHC, Manual

Specimen Type


Specimen Stability Information

Specimen Type Temperature Time
Special Ambient (preferred)

Reject Due To








Wet/frozen tissue
Cytology smears
Nonformalin fixed tissue
Nonparaffin embedded tissue
Noncharged slides
ProbeOn slides

Day(s) and Time(s) Performed

Monday through Friday

Analytic Time

5 days

Performing Laboratory

Mayo Medical Laboratories in Rochester

Test Classification

This test was developed using an analyte specific reagent. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information


LOINC Code Information

Test ID Test Order Name Order LOINC Value
PDL12 PD-L1 (22C3),SemiQuant IHC, Manual In Process


Result ID Test Result Name Result LOINC Value
71724 Interpretation In Process
71725 Participated in the Interpretation No LOINC Needed
71726 Report electronically signed by 19139-5
71727 Material Received 81178-6
71728 Disclaimer 62364-5
72117 Case Number In Process