Paraneoplastic Autoantibody Evaluation, Serum (Sendout)

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General Information

Lab Name
Paraneoplastic Autoantibody Evaluation, Serum (Sendout)
Lab Code
RPNPV
Epic Ordering
Paraneoplastic Autoantibody Evaluation, Serum (Sendout)
External Test Id
PAVAL
Description

Useful For:

  • Serological evaluation of patients who present with a subacute neurological disorder of undetermined etiology, especially those with known risk factors for cancer
  • Directing a focused search for cancer
  • Investigating neurological symptoms that appear in the course of, or after, cancer therapy, and are not explainable by metastasis
  • Differentiating autoimmune neuropathies from neurotoxic effects of chemotherapy
  • Monitoring the immune response of seropositive patients in the course of cancer therapy
  • Detecting early evidence of cancer recurrence in previously seropositive patients
  • For a complete list of tests and potential reflex tests included in this panel, refer to the Mayo Paraneoplastic Evaluation Algorithm - Serum.

Ordering Guidance: The Paraneoplastic Autoantibody Evaluation is not the recommended test for patients suspected of autoimmune neurological disorders. A comprehensive neurological phenotype-specific autoimmune/paraneoplastic evaluation (e.g. encephalopathy, movement disorders, myelopathy, axonal neuropathy, etc.) should be considered. For additional guidance, review the Autoimmune Encephalitis Testing Recommendations or consult the Laboratory Medicine Resident on-call.

Individual Antibody Follow-Up Testing: Individual antibody tests within the Paraneoplastic Autoantibody Evaluation are available for patients who have previously tested positive for those antibodies within the past five years at a Mayo laboratory. Refer to Mayo test: Neuroimmunology Antibody Follow-up, Serum.

***Order Alert: Effective 01/23/2025, the Neuronal (V-G) K+ Channel Antibody (VGKC) test in this panel will be temporarily discontinued due to supply chain issues at Mayo. The component will be reported as "test not performed" and removed from profile interpretations until the issue is resolved. The expected duration is >30 days.***

Synonyms
AGNA-1, Amphiphysin Ab, ANNA-1, ANNA-2, ANNA-3, Anti Glial Nuclear Antibody 1, Anti Neuronal Nuclear Antibody 1, Anti Neuronal Nuclear Antibody 2, Anti Neuronal Nuclear Antibody 3, Anti-Glial Nuclear Antibody Type 1, CRMP-5 IgG, Neuronal (V-G) K+ Channel Antibody, Neuronal VGKC, P/Q Type Calcium Channel Ab, PAVAL, PCA-1, PCA-2, PCA-Tr, Purkinje Cell Cytoplasmic Antibody Type 1, Purkinje Cell Cytoplasmic Antibody Type 2, Purkinje Cell Cytoplasmic Antibody Type Tr
Components

Interpretation

Method

Panel and reflex tests include the following methods: Immunofluorescence assay (IFA), Cell-binding assay (CBA), Western blot (WB), Radioimmunoassay (RIA), Immunoblot (IB)

Reference Range
See individual components
Ref. Range Notes

Reference Values:

Amphiphysin Antiibody: Negative
Anti-Glial Nuclear Antibody Type 1 (AGNA-1): Negative
Anti-Neuronal Nuclear Antibody Type 1 (ANNA-1): Negative
Anti-Neuronal Nuclear Antibody Type 2 (ANNA-2): Negative
Anti-Neuronal Nuclear Antibody Type 3 (ANNA-3): Negative
Collapsin Response-Mediator Protein-5 (CRMP-5) IgG: Negative
Neuronal (V-G) K+ Channel Antibody: < or =0.02 nmol/L
P/Q-Type Calcium Channel Antibody: < or =0.02 nmol/L
Purkinje Cell Cytoplasmic Antibody Type 1 (PCA-1): Negative
Purkinje Cell Cytoplasmic Antibody Type 2 (PCA-2): Negative
Purkinje Cell Cytoplasmic Antibody Type Tr (PCA-Tr): Negative

Note: Includes reference values for panel tests only.

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."

CRMP-5 Note: CRMP-5 titers lower than 1:240 are detectable by recombinant CRMP-5 Western blot analysis. CRMP-5 Western blot analysis will be done on request on stored serum (held 4 weeks). This supplemental testing is recommended in cases of chorea, vision loss, cranial neuropathy, and myelopathy.

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.

Guidelines

Ordering & Collection

Specimen Type
Blood
Collection

12 mL blood in RED TOP tubes or GOLD SSTs

Handling Instructions

Outside Laboratories: Centrifuge sample and transfer serum into a separate plastic vial. Refrigerate serum.

Stability: Refrigerated (preferred): 28 days; Frozen: 28 days; Ambient: 72 hours.

Reject Due To: Gross hemolysis, lipemia, icterus.

Quantity
requested: 4 mL serum + 1 mL for UW437
minimum: 2 mL serum

Processing

Processing

Centrifuge samples and transfer 4 mL serum (2 mL minimum) into the RPNPEV aliquot. If specimen volume allows, aliquot 1 mL serum into a separate plastic vial for Immunology (UW437). Prioritize the sendout test (RPNPEV).

  • RPNPEV: Refrigerate 4 mL serum (2 mL minimum) in the Sendouts Mayo rack.
  • UW437: Freeze 1 mL serum at -20°C in Immunology rack.

If individual antibodies are requested (with a previous positive result within the last 5 years at Mayo), refer to separate test guide #982 (Neuroimmunology Follow-up, PNEFS).

Sendouts:

  • Order Mayo Test: PAVAL
  • Interfaced: Yes [Interface: 601: Worksheet: MARF]

Stability: Refrigerated (preferred): 28 days; Frozen: 28 days; Ambient: 72 hours.

Reject Due To: Gross hemolysis, lipemia, icterus.

Performance

LIS Dept Code
Performing Location(s)
Sendout Mayo Clinic Laboratories
800-533-1710

200 First Street Southwest
Rochester, MN 55901
Frequency
Performed: Monday - Sunday. Reflex tests: Varies. Report Available: 10-17 days from sample receipt at the performing laboratory.
Available STAT?
No

Billing & Coding

CPT codes
83519, 86255x9, 86596
LOINC
43104-9
Interfaced Order Code
UOW3348