Test Id : PC2TC
Purkinje Cell Cytoplasmic Antibody Type 2 (PCA-2) Titer, Spinal Fluid
Useful For
Suggests clinical disorders or settings where the test may be helpful
Evaluating patients who present with a subacute neurological disorder of undetermined etiology and have risk factors for lung cancer
Reporting an end titer result from spinal fluid specimens
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
If the indirect immunofluorescence pattern suggests Purkinje cell cytoplasmic antibody type 2 (PCA-2), then this test will be performed at an additional charge.
Method Name
A short description of the method used to perform the test
Only orderable as a reflex. For more information see:
DMC2 / Dementia, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
ENC2 / Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
EPC2 / Epilepsy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
MDC2 / Movement Disorder, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
MAC1 / Myelopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
Indirect Immunofluorescence Assay (IFA)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
If the indirect immunofluorescence pattern suggests Purkinje cell cytoplasmic antibody type 2 (PCA-2), then this test will be performed at an additional charge.
Specimen Type
Describes the specimen type validated for testing
CSF
Ordering Guidance
Serum is preferred. Spinal fluid testing is particularly useful when interfering antibodies are present in the serum.
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Only orderable as a reflex. For more information see:
-DMC2 / Dementia, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-ENC2 / Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-EPC2 / Epilepsy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-MDC2 / Movement Disorder, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-MAC1 / Myelopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
Container/Tube: Sterile vial
Specimen Volume: 4 mL
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
2 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | Reject |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| CSF | Refrigerated (preferred) | 28 days | |
| Ambient | 72 hours | ||
| Frozen | 28 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Evaluating patients who present with a subacute neurological disorder of undetermined etiology and have risk factors for lung cancer
Reporting an end titer result from spinal fluid specimens
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
If the indirect immunofluorescence pattern suggests Purkinje cell cytoplasmic antibody type 2 (PCA-2), then this test will be performed at an additional charge.
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Purkinje cell autoantibodies (PCA) are among the antineuronal antibodies (ANNA) recognized clinically as markers of a patient's immune response to specific cancers (paraneoplastic autoantibodies).
In 1976, a PCA, defined by indirect immunofluorescence, was described by Dr. John Trotter and colleagues as a serological accompaniment of cerebellar ataxia related to Hodgkin lymphoma. That autoantibody is now known as anti-Tr or PCA-Tr.
PCA-1 (or anti-Yo), first described in 1983, serves as a serological marker for a new or recurrent carcinoma of the ovary, other Mullerian tissue, or breast. PCA-1-positive patients are women in 99% of cases. They usually present with subacute cerebellar degeneration, but 10% have sensory or motor neuropathy.
In 2000, the Mayo Clinic Neuroimmunology Laboratory described and named PCA-2, a new IgG marker of an immune response to small-cell lung carcinoma (SCLC) in patients presenting with a subacute paraneoplastic neurologic disorder.
Other autoantibody markers of immune response to SCLC include ANNA-1, ANNA-2, ANNA-3, amphiphysin, collapsin response-mediator protein-5 (CRMP-5) IgG, antiglial/neuronal nuclear antibody type 1 (AGNA-1), neuronal calcium channel antibodies (N-type > P/Q-type), ganglionic acetylcholine receptor antibodies, muscle acetylcholine receptor antibodies, neuronal potassium channel antibodies, and striational antibodies.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Only orderable as a reflex. For more information see:
-DMC2 / Dementia, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-ENC2 / Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-EPC2 / Epilepsy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-MDC2 / Movement Disorder, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
-MAC1 / Myelopathy, Autoimmune/Paraneoplastic Evaluation, Spinal Fluid
<1:2
Neuron-restricted patterns of IgG staining that do not fulfill criteria for Purkinje cell cytoplasmic antibody type 2 may be reported as "unclassified antineuronal IgG." Complex patterns that include non-neuronal elements may be reported as "uninterpretable."
Interpretation
Provides information to assist in interpretation of the test results
A positive value (at 1:2 dilution or higher) is consistent with neurological autoimmunity and justifies a thorough search for a lung cancer, particularly small-cell carcinoma. The cancers are usually limited in metastasis. An extrapulmonary primary small-cell carcinoma (eg, skin, breast, larynx, cervix, prostate) should be considered.
Purkinje cell autoantibody type 2 is found in less than 2% of patients with uncomplicated small-cell lung carcinoma.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Western blot with native neuronal proteins may be required to detect a positive result when interfering autoantibodies preclude interpretation of immunofluorescence pattern.
Supportive Data
Purkinje cell autoantibody type-2 (PCA-2) binds to the cytoplasm of cerebellar neurons in a characteristic pattern. Western blots of reduced/denatured cerebellar and small-cell lung carcinoma proteins reveal a common antigenic band, approximately 280 kDa.(1) Nine of 10 seropositive patients initially identified had a subacute neurological presentation (elements of encephalomyeloneuropathy) and 9 of 10 had lung cancer confirmed.(1) Similar neurological and oncological correlations have been observed in 30 subsequently identified seropositive patients.(Lennon VA: Unpublished data)
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Galanis E, Frytak S, Rowland KM, et al: Neuronal autoantibody titers in the course of small-cell lung carcinoma and platinum-associated neuropathy. Cancer Immunol Immunother 1999 May-June;48(2-3):85-90
2. Vernino S, Lennon VA: New Purkinje cell antibody (PCA-2): marker of lung cancer-related neurological autoimmunity. Ann Neurol 2000 Mar;47(3):297-305
3. McKeon A, Tracy JA, Pittock SJ, Parisi JE, Klein CJ, Lennon VA. Purkinje cell cytoplasmic autoantibody type 1 accompaniments: the cerebellum and beyond. Arch Neurol. 2011 Oct;68(10):1282-9. doi: 10.1001/archneurol.2011.128
4. 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 Dec;65(12):1558-15635
5. Horta ES, Lennon VA, Lachance DH, et al: Neural autoantibody clusters aid diagnosis of cancer. Clin Cancer Res. 2014 Jul;20(14):3862-3869
Method Description
Describes how the test is performed and provides a method-specific reference
The patient's specimen is tested by a standardized immunofluorescence assay that uses a composite frozen section of mouse cerebellum, kidney, and gut tissues. After incubation with the specimen and washing, fluorescein-conjugated goat-antihuman IgG is applied. Neuron-specific autoantibodies are identified by their characteristic fluorescence staining patterns. Specimens that are scored positive for any neuronal nuclear or cytoplasmic autoantibody are titrated. Interference by coexisting non-neuron-specific autoantibodies can usually be eliminated by serologic absorption.(Honorat JA, Komorowski L, Josephs KA, et al. IgLON5 antibody: Neurological accompaniments and outcomes in 20 patients. Neurol Neuroimmunol Neuroinflamm. 2017;4[5]:e385. Published 2017 Jul 18. doi:10.1212/NXI.0000000000000385)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Sunday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
- Authorized users can sign in to Test Prices for detailed fee information.
- Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
- Prospective clients should contact their account representative. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
86256
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| PC2TC | PCA-2 Titer, CSF | 94364-7 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| 43447 | PCA-2 Titer, CSF | 94364-7 |