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Test ID: PAC1 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 in spinal fluid specimens

Profile Information

Test ID Reporting Name Available Separately Always Performed
PNEOI Paraneoplastic Interpretation, CSF No Yes
AMPHC Amphiphysin Ab, CSF No Yes
AGN1C Anti-Glial Nuclear Ab, Type 1 No Yes
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
CRMC CRMP-5-IgG, CSF No Yes
PCTRC Purkinje Cell Cytoplasmc Ab Type Tr No Yes
PCA1C Purkinje Cell Cytoplasmic Ab Type 1 No Yes
PCA2C Purkinje Cell Cytoplasmic Ab Type 2 No Yes

Testing Algorithm

If indirect immunofluorescence assay (IFA) pattern suggests AGNA-1 antibody, then AGNA-1 immunoblot is performed at an additional charge.

 

If IFA pattern suggests ANNA-1 antibody, then ANNA-1 immunoblot is performed at an additional charge.

 

If IFA pattern suggests ANNA-2 antibody, then ANNA-2 immunoblot is performed at an additional charge.

 

If IFA pattern suggests PCA-1 antibody, then PCA-1 immunoblot is performed at an additional charge.

 

If IFA pattern suggests PCA-Tr antibody, then PCA-Tr immunoblot is performed at an additional charge.

 

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 (RIA) is performed at an additional charge.

 

If IFA patterns suggest neuronal voltage-gated potassium channel-complex (VGKC) autoantibody, then VGKC-complex antibody RIA is performed at an additional charge.

 

If VGKC-complex antibody RIA is greater than 0.00 nmol/L, then LGI1-IgG cell-binding assay (CBA) and CASPR2-IgG CBA are performed at an additional charge.

 

If IFA patterns suggest amphiphysin antibody, then amphiphysin immunoblot is performed at an additional charge.

 

If IFA pattern suggests NMDA-Receptor, then NMDA-Receptor antibody CBA and/or NMDA-Receptor titer is performed at an additional charge.

 

If IFA pattern suggests AMPA-Receptor, then AMPA-Receptor antibody CBA and/or AMPA-Receptor titer is performed at an additional charge.

 

If IFA pattern suggests GABA-B-Receptor, then GABA-B-Receptor antibody CBA and/or GABA-B-Receptor titer is performed at an additional charge.

 

If IFA pattern suggests DPPX, then DPPX antibody CBA and DPPX titer is performed at an additional charge.

 

If IFA pattern suggests mGluR1, then mGluR1 antibody CBA and mGluR1 titer is performed at an additional charge.

 

The following algorithms are available in Special Instructions.

-Paraneoplastic Autoantibody CSF Evaluation Algorithm

-Hereditary Peripheral Neuropathy Diagnostic Algorithm

Method Name

AGN1C, AMPHC, AMPIC, ANN1C, ANN2C, ANN3C, CRMC, DPPIC, DPPTC, GABIC, GL1IC, GL1TC, NMDIC, PCA1C, PCA2C, PCTRC: Indirect Immunofluorescence Assay (IFA)

 

CRMWC: Western Blot

AGNBC, AMIBC, AN1BC, AN2BC, PC1BC, PCTBC: Immunoblot (IB)

 

GD65C, VGKCC: Radioimmunoassay (RIA)

 

AMPCC, CS2CC, DPPCC, GABCC, GL1CC, LG1CC, NMDCC: Cell-Binding Assay (CBA)

Reporting Name

Paraneoplas Autoantibody Eval,CSF

Specimen Type

CSF


Additional Testing Requirements


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.



Necessary Information


Provide the following information:

-Relevant clinical information

-Ordering provider name, phone number, mailing address, and e-mail address



Specimen Required


Container/Tube: Sterile vial

Specimen Volume: 4 mL


Specimen Minimum Volume

2 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
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 more than 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 collapsin response-mediator protein-5-IgG [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 the serum of patients with cancer. Because neurologists typically perform spinal taps in these patients, the recommendation is to submit CSF specimens with serum specimens, 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

Test ID

Reporting name

Methodology

Reference value

AMPHC

Amphiphysin Ab, CSF

Indirect immunofluorescence (IFA)

<1:2

AGN1C

Anti-Glial Nuclear Ab, Type 1

IFA

<1:2

ANN1C

Anti-Neuronal Nuclear Ab, Type 1

IFA

<1:2

ANN2C

Anti-Neuronal Nuclear Ab, Type 2

IFA

<1:2

ANN3C

Anti-Neuronal Nuclear Ab, Type 3

IFA

<1:2

CRMC

CRMP-5-IgG, CSF

IFA

<1:2

PCTRC

Purkinje Cell Cytoplasmc Ab Type Tr

IFA

<1:2

PCA1C

Purkinje Cell Cytoplasmic Ab Type 1

IFA

<1:2

PCA2C

Purkinje Cell Cytoplasmic Ab Type 2

IFA

<1:2

 

Reflex Information:

Test ID

Reporting name

Methodology

Reference value

AGNBC

AGNA-1 Immunoblot, CSF

Immunoblot (IB)

Negative

AMPCC

AMPA-R Ab CBA, CSF

Cell-binding assay (CBA)

Negative

AMPIC

AMPA-R Ab IF Titer Assay, CSF

IFA

<1:2

AMIBC

Amphiphysin Immunoblot, CSF

IB

Negative

AN1BC

ANNA-1 Immunoblot, CSF

IB

Negative

AN2BC

ANNA-2 Immunoblot, CSF

IB

Negative

CRMWC

CRMP-5-IgG Western Blot, CSF

Western blot (WB)

Negative

CS2CC

CASPR2-IgG CBA, CSF

CBA

Negative

DPPCC

DPPX Ab CBA, CSF

CBA

Negative

DPPIC

DPPX Ab IFA, CSF

IFA

Negative

DPPTC

DPPX Ab IFA Titer, CSF

IFA

<1:2

GABCC

GABA-B-R Ab CBA, CSF

CBA

Negative

GABIC

GABA-B-R Ab IF Titer Assay, CSF

IFA

<1:2

GD65C

GAD65 Ab Assay, CSF

Radioimmunoassay (RIA)

≤0.02 nmol/L

LG1CC

LGI1-IgG CBA, CSF

CBA

Negative

GL1CC

mGluR1 Ab CBA, CSF

CBA

Negative

GL1IC

mGluR1 Ab IFA, CSF

IFA

Negative

GL1TC

mGluR1 Ab IFA Titer, CSF

IFA

<1:2

NMDCC

NMDA-R Ab CBA, CSF

CBA

Negative

NMDIC

NMDA-R Ab IF Titer Assay, CSF

IFA

<1:2

PC1BC

PCA-1 Immunoblot, CSF

IB

Negative

PCTBC

PCA-Tr Immunoblot, CSF

IB

Negative

VGKCC

VGKC-complex Ab IPA, CSF

RIA

≤0.02 nmol/L

 

Neuron-restricted patterns of IgG staining that do not fulfill criteria for amphiphysin, ANNA-1, ANNA-2, ANNA-3, AGNA-1, PCA-1, PCA-2, PCA-Tr, or CRMP-5-IgG may be reported as "unclassified antineuronal IgG." Complex patterns that include non-neuronal elements may be reported as "uninterpretable."

 

Note: Titers lower than 1:2 are detectable by recombinant CRMP-5 Western blot analysis. CRMP-5 Western blot analysis will be done on request on stored spinal fluid (held 4 weeks). This supplemental testing is recommended in cases of chorea, vision loss, cranial neuropathy, and myelopathy. Call 800-533-1710 to request CRMP-5 Western blot.

Interpretation

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 one paraneoplastic autoantibody to be detected, each predictive of the same cancer.

Clinical Reference

1. Lucchinetti CF, Kimmel DW, Lennon VA: Paraneoplastic and oncological profiles of patients seropositive for type 1 anti-neuronal nuclear antibody. Neurology 1998;50:652-657

2. Graus F, Vincent A, Pozo-Rosich P, et al: Anti-glial nuclear antibody: marker of lung cancer-related paraneoplastic neurological syndromes. J Neuroimmunol 2005;154(1-2):166-171

3. Pittock SJ, Lucchinetti CF, Lennon VA: Anti-neuronal nuclear autoantibody type 2: paraneoplastic accompaniments. Ann Neurol 2003;53(5):580-587

4. Chan KH, Vernino S, Lennon VA: ANNA-3 anti-neuronal nuclear antibody: marker of lung cancer-related autoimmunity. Ann Neurol 2001 September;50(3):301-311

5. Hetzel DJ, Stanhope CR, O'Neill BP, Lennon VA: Gynecologic cancer in patients with subacute cerebellar degeneration predicted by anti-purkinje cell antibodies and limited in metastatic volume. Mayo Clin Proc 1990;65:1558-1563

6. Pittock SJ, Lucchinetti CF, Parisi JE, et al: Amphiphysin autoimmunity: paraneoplastic accompaniments. Ann Neurol 2005;58(1):96-107

7. McKeon A, Pittock SJ: Paraneoplastic encephalomyelopathies: pathology and mechanisms. Acta Neuropathol 2011;122:381-400

8. Horta ES, Lennon VA, Lachance DH, et al: Neural autoantibody clusters aid diagnosis of cancer. Clin Cancer Res 2014;20:3862-3869

Day(s) and Time(s) Performed

AGN1C, AMPHC, AMPIC, ANN1C, ANN2C, ANN3C, CRMC, PCTRC, PCA1C, PCA2C, DPPTC, DPPIC, GABIC, GL1TC, GL1IC, NMDIC:

Monday through Friday; 5 a.m., 7 a.m., 5 p.m.

Saturday, Sunday; 6 a.m.

 

AGNBC, AMIBC, AN1BC, AN2BC, PC1BC, PCTBC:

Monday through Friday; 6 p.m.

 

AMPCC, CS2CC, DPPCC, GABCC, LG1CC, NMDCC:

Monday through Friday; 10 p.m.

Sunday; 3 p.m.

 

CRMWC:

Monday through Thursday; 8 a.m.

 

GL1CC:

Monday and Thursday; 6 p.m.

 

GD65C:

Monday through Friday; 5 a.m., 2 p.m.

Saturday, Sunday; 7 a.m.

 

VGKCC:

Monday through Friday; 11 a.m., 6 p.m.

Saturday, Sunday; 6 a.m.

Analytic Time

8 days

Test Classification

This test was developed and its performance characteristics 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

86255 x 9

84182-AGNBC (if appropriate)

86255-AMPCC (if appropriate)

86256-AMPIC (if appropriate)

84182-AMIBC (if appropriate)

84182-AN1BC (if appropriate)

84182-AN2BC (if appropriate)

86255-CS2CC (if appropriate)

84182-CRMWC (if appropriate)

86255-DPPCC (if appropriate)

86256-DPPTC (if appropriate)

86255-DPPIC (if appropriate)

86255-GABCC (if appropriate)

86256-GABIC (if appropriate)

86341-GD65C (if appropriate)

86255-LG1CC (if appropriate)

86255-GL1CC (if appropriate)

86256-GL1TC (if appropriate)

86255-GL1IC (if appropriate)

86255-NMDCC (if appropriate)

86256-NMDIC (if appropriate)

84182-PC1BC (if appropriate)

84182-PCTBC (if appropriate)

83519-VGKCC (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
PAC1 Paraneoplas Autoantibody Eval,CSF 94818-2

 

Result ID Test Result Name Result LOINC Value
89079 AGNA-1, CSF 94355-5
5906 Amphiphysin Ab, CSF 94354-8
3852 ANNA-1, CSF 94356-3
7472 ANNA-2, CSF 94357-1
21633 ANNA-3, CSF 94358-9
21650 CRMP-5-IgG, CSF 94706-9
3988 PCA-1, CSF 94363-9
21632 PCA-2, CSF 94364-7
21631 PCA-Tr, CSF 94362-1
34271 Paraneoplastic Interpretation, CSF 69048-7
36429 Reflex Added 77202-0

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
AGNBC AGNA-1 Immunoblot, CSF No No
AMPCC AMPA-R Ab CBA, CSF No No
AMPIC AMPA-R Ab IF Titer Assay, CSF No No
AMIBC Amphiphysin Immunoblot, CSF No No
AN1BC ANNA-1 Immunoblot, CSF No No
AN2BC ANNA-2 Immunoblot, CSF No No
CS2CC CASPR2-IgG CBA, CSF No No
CRMWC CRMP-5-IgG Western Blot, CSF Yes No
DPPCC DPPX Ab CBA, CSF No No
DPPTC DPPX Ab IFA Titer, CSF No No
DPPIC DPPX Ab IFA, CSF No No
GABCC GABA-B-R Ab CBA, CSF No No
GABIC GABA-B-R Ab IF Titer Assay, CSF No No
GD65C GAD65 Ab Assay, CSF Yes No
LG1CC LGI1-IgG CBA, CSF No No
GL1CC mGluR1 Ab CBA, CSF No No
GL1TC mGluR1 Ab IFA Titer, CSF No No
GL1IC mGluR1 Ab IFA, CSF No No
NMDCC NMDA-R Ab CBA, CSF No No
NMDIC NMDA-R Ab IF Titer Assay, CSF No No
PC1BC PCA-1 Immunoblot, CSF No No
PCTBC PCA-Tr Immunoblot, CSF No No
VGKCC VGKC-complex Ab IPA, CSF No No

Forms

If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.

Mayo Clinic Laboratories | Neurology Catalog Additional Information:

mml-neuroimmunology