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HelpTest ID: AMPIP Amyloid Protein Identification, Paraffin, Mass Spectrometry
Ordering Guidance
This test should only be ordered on specimens for which a diagnosis of amyloid deposition has already been established. If the diagnosis is unknown, or the nature of the deposits is not established as being amyloid, order PATHC / Pathology Consultation or refer to the Pathology Consultation Ordering Algorithm.
If a pathology consultation is desired in addition to this test, order PATHC / Pathology Consultation alone and send the required paperwork with specimen. Indicate that amyloid protein identification is desired. If needed, this test will be added by the reviewing pathologist and will be reported with the consultation. For more information see PATHC / Pathology Consultation.
Shipping Instructions
Attach the green "Attention Pathology" address label (T498) to the outside of the transport container before putting into the courier mailer.
Necessary Information
1. Preliminary pathology report and history are required.
2. Include performed Congo red slide.
3. A brief explanatory note or consultative letter is also recommended.
Specimen Required
Specimen Type: Formalin-fixed or B5-fixed paraffin-embedded tissue block
Collection Instructions:
1. Do not send fixed tissue slides for testing. Testing can only be done on paraffin-embedded tissue blocks.
2. If Congo red stain has already been performed, send Congo red stained slide along with the tissue block.
Additional Information: Broken or cracked unstained slides will be rejected. Stained slides that were broken and repaired (ie, double mounted) at the client site will not be rejected, as, in most cases, they can still be reviewed under the microscope. However, due to the double mounting, digital scanning cannot be performed.
Useful For
Definitive identification of amyloid proteins
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| MLCPC | Microdissection, Laser Capture | No, (Bill Only) | No |
| MSPTC | Mass Spectrometry | No, (Bill Only) | No |
Testing Algorithm
Testing begins with a Congo red stain. If the Congo red stain is positive, testing proceeds with microdissection to obtain tissue of interest and subsequently perform mass spectrometry to identify protein involved; both steps performed at additional charges.
In some instances, per pathologist discretion, a different initial Congo red stain may be performed using SS2PC / Special Stain, Group II, Other (Bill Only).
-If the stain is negative for amyloid, then this test will not be performed, and only the SS2PC will be charged.
-If the stain is positive for amyloid, this test will be performed, and the SS2PC billing charge will be credited.
A pathology consultation is typically not required. If the amyloid subtyping results do not fit the clinical findings, PATHC / Pathology Consultation may be added if appropriate, upon client approval.
For more information see Amyloidosis: Laboratory Approach to Diagnosis.
Special Instructions
Method Name
Histological Stain/Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
Amyloid Protein ID, Par, LC MS/MSSpecimen Type
AMYLOIDSpecimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| AMYLOID | Ambient (preferred) | |
| Refrigerated | ||
Clinical Information
Amyloidosis is a group of hereditary and acquired diseases unified by extracellular tissue deposition of misfolded proteins resulting in end organ damage. Amyloidosis can be a systemic or localized disease. Although many cases of amyloidosis are hereditary, most are acquired as the result of an underlying monoclonal B-cell/plasma cell malignancy, as a phenomenon of aging, or as the result of long-standing chronic inflammation. Specific amyloid-related diseases are therefore associated with specific amyloid proteins. These include kappa or lambda immunoglobulin light chains (AL amyloidosis), transthyretin (ATTR amyloidosis), serum amyloid A (AA amyloidosis), and other uncommon subtypes. Because treatment of patients with amyloidosis differs radically for the different amyloid subtypes, it is critically important to accurately identify the proteins that constitute the amyloid deposits.
The basic diagnosis of amyloidosis is typically achieved by Congo red staining of paraffin-embedded tissue biopsy specimens obtained from diverse anatomic sites and demonstrating Congo red-positive, apple-green birefringent, amyloid deposits in the tissues. The next step is to definitively subtype the amyloid deposits. This test fulfills that need. It relies on laser microdissection of Congo red-positive amyloid deposits followed by analysis by liquid chromatography tandem mass spectrometry to accurately determine the identity of the proteins that constitute the amyloid.
Interpretation
An interpretation will be provided.
Clinical Reference
1. Ohno T, Mihara S, Morishige M, Nakamura T. Prevalence of amyloid deposits in synovium and flexor retinaculum, risk factors and asymptomatic cardiac involvement in patients with carpal tunnel syndrome. J Hand Surg Eur Vol. 2026;51(5):550-556
2. Chiu A, Dasari S, Kurtin PJ, et al. Bone marrow amyloid: a comprehensive analysis of 1,469 samples, including amyloid type, clinical features, and morphologic distribution. Amyloid. 2022;29(3):156-164
3. Hagen CE, Dasari S, Theis JD, et al. Gastrointestinal amyloidosis: an often unexpected finding with systemic implications. Hum Pathol. 2023;139:27-36
4. Gilani SI, Dasari S, Tekin B, et al. Identification of amyloidosis of the urinary tract and prostate: Opportunities for early diagnosis and intervention in systemic disease. Hum Pathol. 2023;142:62-67
5. Hagen CE, Dasari S, Theis JD, et al. Gallbladder amyloidosis is often unexpected and may have systemic implications. Am J Clin Pathol. 2025;164(4):613-619. doi:10.1093/ajcp/aqaf090
6. Theis JD, Dasari S, Vrana JA, Kurtin PJ, Dogan A. Shotgun-proteomics-based clinical testing for diagnosis and classification of amyloidosis. J Mass Spectrom. 2013;48(10):1067-1077
7. Said SM, Sethi S, Valeri AM, et al. Renal amyloidosis: origin and clinicopathologic correlations of 474 recent cases. Clin J Am Soc Nephrol. 2013;8(9):1515-1523
8. Dasari S, Theis JD, Vrana JA, et al. Amyloid typing by mass spectrometry in clinical practice: a comprehensive review of 16,175 samples. Mayo Clin Proc. 2020;95(9):1852-1864. doi:10.1016/j.mayocp.2020.06.029
9. Klein CJ, Vrana JA, Theis JD, et al. Mass spectrometric-based proteomic analysis of amyloid neuropathy type in nerve tissue. Arch Neurol. 2011;68(2):195-199
10. Vrana JA, Gamez JD, Madden BJ, Theis JD, Bergen HR III, Dogan A. Classification of amyloidosis by laser microdissection and mass spectrometry-based proteomic analysis in clinical biopsy specimens. Blood. 2009;114(24):4957-4959
Day(s) Performed
Monday through Friday
Report Available
7 to 15 daysTest Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
88313
82542 (if appropriate)
88380 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| AMPIP | Amyloid Protein ID, Par, LC MS/MS | 101405-9 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 71185 | Interpretation | 50595-8 |
| 71186 | Participated in the Interpretation | No LOINC Needed |
| 71187 | Report electronically signed by | 19139-5 |
| 71189 | Material Received | 81178-6 |
| 71592 | Disclaimer | 62364-5 |
| 72109 | Case Number | 80398-1 |
Forms
If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:
-Cardiovascular Test Request (T724)
-Hematopathology/Cytogenetics Test Request (T726)
-Renal Diagnostics Test Request (T830)
Reference Values
An interpretive report will be provided.
mcl-amyloid, mcl-path