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HelpTest ID PNEOE Paraneoplastic Autoantibody Evaluation, Spinal Fluid
Useful For
Aids in the diagnosis of paraneoplastic neurological autoimmune disorders related to carcinoma of lung, breast, ovary, thymoma, or Hodgkin lymphoma
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| ANN1C | Anti-Neuronal Nuclear Ab, Type 1 | No | Yes |
| ANN2C | Anti-Neuronal Nuclear Ab, Type 2 | No | Yes |
| ANN3C | Anti-Neuronal Nuclear Ab, Type 3 | No | Yes |
| AGN1C | Anti-Glial Nuclear Ab, Type 1 | No | Yes |
| PCA1C | Purkinje Cell Cytoplasmic Ab Type 1 | No | Yes |
| PCA2C | Purkinje Cell Cytoplasmic Ab Type 2 | No | Yes |
| PCTRC | Purkinje Cell Cytoplasmc Ab Type Tr | No | Yes |
| AMPHC | Amphiphysin Ab, CSF | No | Yes |
| CRMC | CRMP-5-IgG, CSF | No | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| WBNC | Paraneoplas Autoantibody WBlot,CSF | No | No |
| CRMWC | CRMP-5-IgG Western Blot, CSF | No | No |
| GD65C | GAD65 Ab Assay, CSF | Yes | No |
| ABLTC | Amphiphysin Western Blot, CSF | No | No |
| NMOCC | NMO/AQP4-IgG CBA, CSF | Yes | 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 |
Testing Algorithm
If indirect immunofluorescence assay (IFA) (ANN1C, ANN2C, ANN3C, PCA1C, PCA2C, PCTRC, AMPHC, CRMC, AGN1C) is indeterminate, then paraneoplastic autoantibody Western blot is performed at an additional charge.
If IFA pattern suggest NMO/AQP4-IgG, then NMO/AQP4-IgG CBA is performed at an additional charge.
If client requests, or if IFA patterns suggest CRMP-5-IgG, then CRMP-5-IgG Western blot is performed at an additional charge.
If IFA patterns suggest GAD65 antibody, then GAD65 antibody radioimmunoassay is performed at an additional charge.
If IFA patterns suggest neuronal voltage-gated potassium channel-complex autoantibody, then VGKC-complex antibody IPA is performed at an additional charge.
If IFA patterns suggest amphiphysin antibody, then amphiphysin Western blot is performed at an additional charge.
If IFA pattern suggest NMDA-R, then NMDA-R antibody CBA and/or NMDA-R titer is performed at an additional charge.
If IFA pattern suggest AMPA-R, then AMPA-R antibody CBA and/or AMPA-R titer is performed at an additional charge.
If IFA pattern suggest GABA-B-R, then GABA-B-R antibody CBA and/or GABA-B-R titer is performed at an additional charge.
In patients with a history of tobacco use or other lung cancer risk, or if thymoma is suspected, PAVAL / Paraneoplastic Autoantibody Evaluation, Serum is also recommended.
See Paraneoplastic Autoantibody CSF Evaluation Algorithm in Special Instructions.
Special Instructions
Method Name
ANN1C, ANN2C, ANN3C, PCA1C, PCA2C, PCTRC, AMPHC, CRMC, AGN1C, NMDIC, AMPIC, GABIC: Indirect Immunofluorescence Assay (IFA)
WBNC, CRMWC, ABLTC: Western Blot
GD65C, VGKCC: Radioimmunoassay
NMOCC, NMDCC, AMPCC, GABCC: Cell-Binding Assay (CBA)
Reporting Name
Paraneoplas Autoantibody Eval,CSFSpecimen Type
CSFContainer/Tube: Sterile vial
Specimen Volume: 4 mL
Additional Information: Include name, phone number, mailing address, and e-mail address (if applicable) of ordering physician.
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
2 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| CSF | Refrigerated (preferred) | 28 days |
| Frozen | 28 days | |
| Ambient | 72 hours |
Clinical Information
Several antineuronal and glial autoantibodies are recognized clinically as markers of a patient's immune response to specific cancers (paraneoplastic autoantibodies). Seropositive patients present with neurologic symptoms and signs in >90% of cases. The cancers are most commonly small-cell lung carcinoma, ovarian (or related mullerian) carcinoma, breast carcinoma, thymoma, or Hodgkin lymphoma. The cancers may be new or recurrent, are usually limited in metastatic volume, and are often occult by standard imaging procedures. Detection of the informative marker autoantibodies allows early diagnosis and treatment of the cancer, which may lessen neurological morbidity and improve survival.
Serum is the preferred specimen for paraneoplastic autoantibodies. However, cerebrospinal fluid (CSF) results are sometimes positive when serum results are negative (especially for CRMP-5 and other inflammatory central nervous system autoimmunity). Additionally, CSF is more readily interpretable because it generally lacks the interfering nonorgan-specific antibodies that are common in serum of patients with cancer. Because neurologists typically perform spinal taps in these patients, we recommend that CSF be submitted with serum, either for simultaneous testing or to be held for testing only if serum is negative.
CRMP-5-IgG Western blot is also performed by specific request for more sensitive detection of CRMP-5-IgG. Testing should be requested in cases of subacute basal ganglionic disorders (chorea, Parkinsonism), cranial neuropathies (especially loss of vision, taste, or smell), and myelopathies.
Reference Values
NEURONAL NUCLEAR ANTIBODIES
Antineuronal Nuclear Antibody-Type 1 (ANNA-1)
Negative at <1:2
Antineuronal Nuclear Antibody-Type 2 (ANNA-2)
Negative at <1:2
Antineuronal Nuclear Antibody-Type 3 (ANNA-3)
Negative at <1:2
Anti-Glial/Neuronal Nuclear Antibody-Type 1 (AGNA-1)
Negative at <1:2
NEURONAL AND MUSCLE CYTOPLASMIC ANTIBODIES
Purkinje Cell Cytoplasmic Antibody, Type 1 (PCA-1)
Negative at <1:2
Purkinje Cell Cytoplasmic Antibody, Type 2 (PCA-2)
Negative at <1:2
Purkinje Cell Cytoplasmic Antibody, Type TR (PCA-TR)
Negative at <1:2
Amphiphysin Antibody
Negative at <1:2
Collapsin Response-Mediator Protein-5 Neuronal (CRMP-5-IGG)
Negative at <1:2
ISLET CELL ANTIBODIES
Glutamic Acid Decarboxylase (GAD65) Antibody Assay
≤0.02 nmol/L
WESTERN BLOT
Paraneoplastic Western Blot
Negative
CRMP-5-IgG Western Blot
Negative
Amphiphysin Western Blot
Negative
N-Methyl-D-aspartate receptor (NMDA-R)
CBA: Negative
IFA <1:2
2-amino-3-(5-methyl-3-oxo-1,2- oxazol-4-yl) propanoic acid receptor (AMPA-R)
CBA: Negative
IFA <1:2
Gamma-Amino Butyric acid-type B receptor (GABA-B-R)
CBA: Negative
IFA <1:2
NMO/AQP4-IgG
Negative
VGKC-Complex Antibody IPA
< or=0.02 nmol/L
Cautions
Antibodies directed at onconeural proteins shared by neurons, glia, muscle, and certain cancers are valuable serological markers of a patient's immune response to cancer. They are not found in healthy subjects, and are usually accompanied by subacute neurological symptoms and signs. Several autoantibodies have a syndromic association, but no autoantibody predicts a specific neurological syndrome. Conversely, a positive autoantibody profile has 80% to 90% predictive value for a specific cancer. It is not uncommon for more than 1 paraneoplastic autoantibody to be detected, each predictive of the same cancer.
In patients with a history of tobacco use or other lung cancer risk, or if thymoma is suspected, PAVAL / Paraneoplastic Autoantibody Evaluation, Serum is also recommended.
Day(s) Performed
ANNA-1, ANNA-2, ANNA-3, AGNA-1, PCA-1, PCA-2, PCA-Tr, Amphiphysin, CRMP-5-IgG, NMDIC, AMPIC, GABIC: Monday through Friday; 12 p.m. and 5 p.m.
Paraneoplastic autoantibody Western blot confirmation, CRMP-5-IgG Western blot, amphiphysin Western blot: Monday through Friday; 8 a.m.
NMO/AQP4-IgG CBA, NMDCC, AMPCC, GABCC: Monday through Friday; 4 a.m.
GAD65, VGKC-complex antibody: Monday through Friday; 2 a.m.
Report Available
3 days if negative/5 days if positivePerforming Laboratory
Mayo Medical Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Laboratory Medicine and Pathology, Mayo Clinic. This test has not been cleared or approved by the U.S. Food and Drug Administration.CPT Code Information
86255-AGNA-1
86255-Amphiphysin
86255-ANNA-1
86255-ANNA-2
86255-ANNA-3
86255-CRMP-5-IgG
86255-PCA-1
86255-PCA-2
86255-PCA-Tr
83519-VGKCC (if appropriate)
84182-Amphiphysin Western blot (if appropriate)
84182-CRMP-5 Western blot confirmation (if appropriate)
84182-Paraneoplastic autoantibody Western blot confirmation (if appropriate)
86255-NMO/AQP4-IgG CBA (if appropriate)
86255-AMPCC (if appropriate)
86255-GABCC (if appropriate)
86255-NMDCC (if appropriate)
86256-AMPIC (if appropriate)
86256-GABIC (if appropriate)
86256-NMDIC (if appropriate)
86341-GAD65 confirmation (if appropriate)