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Test ID PNEFC Neuroimmunology Antibody Follow-up, Spinal Fluid

Useful For

Monitoring patients who have previously tested positive for 1 or more antibodies in a Neuroimmunology Laboratory evaluation

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
ANN1C Anti-Neuronal Nuclear Ab, Type 1 No No
ANN2C Anti-Neuronal Nuclear Ab, Type 2 No No
ANN3C Anti-Neuronal Nuclear Ab, Type 3 No No
AGN1C Anti-Glial Nuclear Ab, Type 1 No No
PCA1C Purkinje Cell Cytoplasmic Ab Type 1 No No
PCA2C Purkinje Cell Cytoplasmic Ab Type 2 No No
PCTRC Purkinje Cell Cytoplasmc Ab Type Tr No No
AMPHC Amphiphysin Ab, CSF No No
CRMC CRMP-5-IgG, CSF No No
NMOCC NMO/AQP4-IgG CBA, CSF No No
NMDCC NMDA-R Ab CBA, CSF No No
AMPCC AMPA-R Ab CBA, CSF No No
GABCC GABA-B-R Ab CBA, CSF No No
NMDIC NMDA-R Ab IF Titer Assay, CSF No No
AMPIC AMPA-R Ab IF Titer Assay, CSF No No
GABIC GABA-B-R Ab IF Titer Assay, CSF No No
VGKCC VGKC-complex Ab IPA, CSF No No

Method Name

This follow-up evaluation is used to monitor patients who tested positive for 1 or more antibodies in the Neuroimmunology Laboratory within the past 15 months.

Reporting Name

Neuroimmunology Ab Follow-up, CSF

Specimen Type

CSF

Container/Tube: Sterile vial

Specimen Volume: 4 mL

Forms: If not ordering electronically, complete, print, and send a Neurology Test Request Form-General (T732) with the specimen (http://www.mayomedicallaboratories.com/it-mmfiles/neurology-request-form.pdf)

Specimen Minimum Volume

3 mL

Specimen Stability Information

Specimen Type Temperature Time
CSF Refrigerated (preferred) 14 days
  Ambient  72 hours
  Frozen 

Clinical Information

Paraneoplastic autoimmune neurological disorders reflect a patient's humoral and cellular immune responses to cancer. The cancer may be new or recurrent, is usually limited in metastatic volume, and is often occult by standard imaging procedures. Autoantibodies specific for onconeural proteins found in the plasma membrane, cytoplasm, and nucleus of neurons or muscle are generated in this immune response, and serve as serological markers of paraneoplastic autoimmunity. The most commonly recognized cancers in this context are small-cell lung carcinoma (SCLC), thymoma, ovarian (or related mullerian) carcinoma, breast carcinoma, and Hodgkin's lymphoma. Pertinent childhood neoplasms recognized thus far include neuroblastoma, thymoma, Hodgkin's lymphoma, and chondroblastoma. An individual patient's autoantibody profile can predict a specific neoplasm with 90% certainty, but not the neurological syndrome.

 

Three classes of autoantibodies are recognized in the spinal fluid analysis:

-Neuronal nuclear (antineuronal nuclear antibody-type 1 [ANNA-1], ANNA-2, ANNA-3)

-Neuronal and muscle cytoplasmic (Purkinje cell cytoplasmic antibody, type 1 [PCA-1]; PCA-2; PCA-Tr, CRMP-5, and amphiphysin)

-Glial nuclear (anti-glial nuclear antibody: AGNA)

 

Seropositive patients usually present with subacute neurological symptoms and signs. The patient may present with encephalopathy, cerebellar ataxia, myelopathy, radiculopathy, plexopathy, sensory, sensorimotor, or autonomic neuropathy, with or without coexisting evidence of a neuromuscular transmission disorder: Lambert-Eaton syndrome (LES), myasthenia gravis, or neuromuscular hyperexcitability. Initial signs may be subtle, but a subacute multifocal and progressive syndrome usually evolves. Sensorimotor neuropathy and cerebellar ataxia are common presentations, but the clinical picture in some patients is dominated by striking gastrointestinal dysmotility, limbic encephalopathy, basal ganglionitis, or cranial neuropathy (especially loss of vision, hearing, smell, or taste). Cancer risk factors include past or family history of cancer, history of smoking, or social/environmental exposure to carcinogens. Early diagnosis and treatment of the neoplasm favor less neurological morbidity and offer the best hope for survival.

Reference Values

ANTINEURONAL NUCLEAR ANTIBODY-Type 1 (ANNA-1)

<1:2

 

ANTINEURONAL NUCLEAR ANTIBODY-Type 2 (ANNA-2)

<1:2

 

ANTINEURONAL NUCLEAR ANTIBODY-Type 3 (ANNA-3)

<1:2

 

PURKINJE CELL CYTOPLASMIC ANTIBODY, Type 1 (PCA-1)

<1:2

 

PURKINJE CELL CYTOPLASMIC ANTIBODY, Type 2 (PCA-2)

<1:2

 

PURKINJE CELL CYTOPLASMIC ANTIBODY, Type Tr (PCA-Tr)

<1:2

 

AMPHIPHYSIN ANTIBODY

<1:2

 

CRMP-5-IgG

<1:2

 

PARANEOPLASTIC AUTOANTIBODY WESTERN BLOT CONFIRMATION

Negative (reported as positive or negative)

    

Neuron-restricted patterns of IgG staining that do not fulfill criteria for the listed autoantibodies may be reported as "unclassified antineuronal IgG." If detected, newly identified autoantibody specificities may be reported. Complex patterns that include non-neuronal elements may be reported as "uninterpretable."

Cautions

This test should only be utilized when the presence of paraneoplastic autoantibodies has been previously documented.

 

This test should not be requested in patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. The specific waiting period before specimen collection will depend on the isotope administered, the dose given and the clearance rate in the individual patient. Specimens will be screened for radioactivity prior to analysis. Radioactive specimens received in the laboratory will be held 1 week and assayed if sufficiently decayed, or canceled if radioactivity remains.

Day(s) Performed

ANNA-1, ANNA-2, ANNA-3, PCA-1, PCA-2, PCA-Tr, Amphiphysin, CRMP-5-IgG: Monday through Friday; 11:30 a.m.

Paraneoplastic autoantibody Western blot confirmation: Monday through Friday; 8 a.m.

Report Available

Varies

Performing Laboratory

Mayo Medical Laboratories in Rochester

CPT Code Information

84182-Paraneoplastic autoantibody Western blot confirmation (if appropriate)

86255-Amphiphysin (if appropriate)

86255-ANNA-1 (if appropriate)

86255-ANNA-2 (if appropriate)

86255-ANNA-3 (if appropriate)

86255-CRMP-5-IgG (if appropriate)

86255-PCA-1 (if appropriate)

86255-PCA-2 (if appropriate)

86255-PCA-Tr (if appropriate)

NY State Approved

N/A