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.

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, 86256x9, 86596
LOINC
43104-9
Interfaced Order Code
UOW3348