Test Catalog

Test Id : PNEFC

Neuroimmunology Antibody Follow-up, Spinal Fluid

Useful For
Suggests clinical disorders or settings where the test may be helpful

Monitoring patients who have previously tested positive for 1 or more antibodies within the past 5 years in a Mayo Clinic Neuroimmunology Laboratory spinal fluid evaluation

Reflex Tests
Lists tests that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial tests.

Test Id Reporting Name Available Separately Always Performed
AMPCC AMPA-R Ab CBA, CSF No No
AMPIC AMPA-R Ab IF Titer Assay, CSF No No
AMPHC Amphiphysin Ab, CSF No No
ABLTC Amphiphysin Western Blot, CSF No No
AGN1C Anti-Glial Nuclear Ab, Type 1 No No
ANN1C Anti-Neuronal Nuclear Ab, Type 1 No No
ANN2C Anti-Neuronal Nuclear Ab, Type 2 No No
ANN3C Anti-Neuronal Nuclear Ab, Type 3 No No
CS2CC CASPR2-IgG CBA, CSF No No
CRMWC CRMP-5-IgG Western Blot, CSF No No
CRMC CRMP-5-IgG, CSF No No
GABCC GABA-B-R Ab CBA, CSF No No
GABIC GABA-B-R Ab IF Titer Assay, CSF No No
LG1CC LGI1-IgG CBA, CSF No No
NMDCC NMDA-R Ab CBA, CSF No No
NMDIC NMDA-R Ab IF Titer Assay, CSF No No
WBNC Paraneoplas Autoantibody WBlot,CSF No No
PCTRC Purkinje Cell Cytoplasmc Ab Type Tr No No
PCA1C Purkinje Cell Cytoplasmic Ab Type 1 No No
PCA2C Purkinje Cell Cytoplasmic Ab Type 2 No No
VGKCC VGKC-complex Ab IPA, CSF No No
DPPCC DPPX Ab CBA, CSF No No
DPPIC DPPX Ab IFA, CSF No No
DPPTC DPPX Ab IFA Titer, CSF No No
GL1CC mGluR1 Ab CBA, CSF No No
GL1IC mGluR1 Ab IFA, CSF No No
GL1TC mGluR1 Ab IFA Titer, CSF No No

Method Name
A short description of the method used to perform the test

ANN1C, ANN2C, ANN3C, AGN1C, PCA1C, PCA2C, PCTRC, AMPHC, CRMC, NMDIC, AMPIC, GABIC, DPPIC, DPPTC, GL1CC, GL1TC: Indirect Immunofluorescence (IFA)

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

WBNC, ABLTC: Western Blot

VGKCC: Radioimmunoassay (RIA)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Neuroimmunology Ab Follow-up, CSF

Specimen Type
Describes the specimen type validated for testing

CSF

Ordering Guidance

This test is only appropriate for follow-up in patients who have previously tested positive in a spinal fluid test. If patients have not previously been positive in a spinal fluid test, order 1 of the following:

-PAC1 / Paraneoplastic, Autoantibody Evaluation, Spinal Fluid

-DMC1 / Dementia, Autoimmune Evaluation, Spinal Fluid

-ENC1 / Encephalopathy, Autoimmune Evaluation, Spinal Fluid

-EPC1 / Epilepsy, Autoimmune Evaluation, Spinal Fluid

-MDC1 / Movement Disorder Evaluation, Spinal Fluid

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Container/Tube: Sterile vial

Specimen Volume: 4 mL

Forms

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

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

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
Frozen 28 days
Ambient 72 hours

Useful For
Suggests clinical disorders or settings where the test may be helpful

Monitoring patients who have previously tested positive for 1 or more antibodies within the past 5 years in a Mayo Clinic Neuroimmunology Laboratory spinal fluid evaluation

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Paraneoplastic autoimmune neurological disorders reflect a patient's humoral and cellular immune responses to cancer. The cancer may be new or recurrent, is usually limited in metastatic volume, and is often occult by standard imaging procedures. Autoantibodies specific for onconeural proteins found in the plasma membrane, cytoplasm, and nucleus of neurons or muscle are generated in this immune response, and serve as serological markers of paraneoplastic autoimmunity. The most commonly recognized cancers in this context are small-cell lung carcinoma (SCLC), thymoma, ovarian (or related mullerian) carcinoma, breast carcinoma, and Hodgkin lymphoma. Pertinent childhood neoplasms recognized thus far include neuroblastoma, thymoma, Hodgkin lymphoma, and chondroblastoma. An individual patient's autoantibody profile can predict a specific neoplasm with 90% certainty, but not the neurological syndrome.

 

Three classes of autoantibodies are recognized in the spinal fluid analysis:

-Neuronal nuclear (antineuronal nuclear antibody-type 1 [ANNA-1], ANNA-2, ANNA-3)

-Neuronal and muscle cytoplasmic (Purkinje cell cytoplasmic antibody, type 1 [PCA-1]; PCA-2; PCA-Tr, CRMP-5, and amphiphysin)

-Glial nuclear (antiglial nuclear antibody: AGNA)

 

Seropositive patients usually present with subacute neurological symptoms and signs. The patient may present with encephalopathy, cerebellar ataxia, myelopathy, radiculopathy, plexopathy, sensory, sensorimotor, or autonomic neuropathy, with or without coexisting evidence of a neuromuscular transmission disorder: Lambert-Eaton syndrome (LES), myasthenia gravis, or neuromuscular hyperexcitability. Initial signs may be subtle, but a subacute multifocal and progressive syndrome usually evolves. Sensorimotor neuropathy and cerebellar ataxia are common presentations, but the clinical picture in some patients is dominated by striking gastrointestinal dysmotility, limbic encephalopathy, basal ganglionitis, or cranial neuropathy (especially loss of vision, hearing, smell, or taste). Cancer risk factors include past or family history of cancer, history of smoking, or social/environmental exposure to carcinogens. Early diagnosis and treatment of the neoplasm favor less neurological morbidity and offer the best hope for survival.

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.

Test ID

Reporting Name

Reference Value

AMPCC

AMPA-R Ab CBA, CSF

Negative

AMPIC

AMPA-R Ab IF Titer Assay, CSF

<1:2

AMPHC

Amphiphysin Ab, CSF

<1:2

ABLTC

Amphiphysin Western Blot, CSF

Negative

AGN1C

Anti-Glial Nuclear Ab, Type 1

<1:2

ANN1C

Anti-Neuronal Nuclear Ab, Type 1

<1:2

ANN2C

Anti-Neuronal Nuclear Ab, Type 2

<1:2

ANN3C

Anti-Neuronal Nuclear Ab, Type 3

<1:2

CS2CC

CASPR2-IgG CBA, CSF

Negative

CRMC

CRMP-5-IgG, CSF

<1:2

GABCC

GABA-B-R Ab CBA, CSF

Negative

GABIC

GABA-B-R Ab IF Titer Assay, CSF

<1:2

LG1CC

LGI1-IgG CBA, CSF

Negative

VGKCC

Neuronal (V-G) K+ Channel Ab, CSF

<0.02

NMDCC

NMDA-R Ab CBA, CSF

Negative

NMDIC

NMDA-R Ab IF Titer Assay, CSF

<1:2

NMOTC

NMO/AQP4 FACS Titer, CSF

<1:2

WBNC

Paraneoplastic Autoantibody WBlot, CSF

Negative

PCA1C

Purkinje Cell Cytoplasmic Ab Type 1

<1:2

PCA2C

Purkinje Cell Cytoplasmic Ab Type 2

<1:2

PCTRC

Purkinje Cell Cytoplasmic Ab Type Tr

<1:2

Interpretation
Provides information to assist in interpretation of the test results

Antibodies directed at onconeural proteins shared by neurons, 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 known 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 autoantibodies to be detected, each predictive of the same cancer.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

This test should only be utilized when the presence of paraneoplastic autoantibodies has been previously documented.

 

This test should not be requested in patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. The specific waiting period before specimen collection will depend on the isotope administered, the dose given and the clearance rate in the individual patient. Specimens will be screened for radioactivity prior to analysis. Radioactive specimens received in the laboratory will be held 1 week and assayed if sufficiently decayed, or canceled if radioactivity remains.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

Lancaster E, Martinez-Hernandez E, Dalmau J: Encephalitis and antibodies to synaptic and neuronal cell surface proteins. Neurology 2011;77(2):179-189

Method Description
Describes how the test is performed and provides a method-specific reference

Indirect Immunofluorescence Assay (IFA):

After applying patient's prepared specimen to a composite substrate of frozen mouse tissues (brain, kidney, and gut) and washing, fluorescein-conjugated goat-antihuman IgG is applied to detect the distribution and pattern of patient IgG binding.(Pittock SJ, Kryzer TJ, Lennon VA: Paraneoplastic antibodies coexist and predict cancer, not neurological syndrome. Ann Neurol 2004;56:715-719)

 

Radioimmunoprecipitation (RIA):

Goat-antihuman IgG and IgM is used as precipitant in all assays. Cation channel protein antigens are solubilized from neuronal or muscle membrane, in nonionic detergent, and complexed with a selective high-affinity ligand labeled with (125)I.(Griesmann GE, Kryzer TJ, Lennon VA: Autoantibody profiles of myasthenia gravis and Lambert-Eaton myasthenic syndrome. In Manual of Clinical and Laboratory Immunology, Sixth edition. Edited by NR Rose, RG Hamilton, et al. Washington, DC, ASM Press, 2002, pp 1005-1012)

 

Cell-Binding Assay (CBA):

Patient specimen is applied to a composite slide containing transfected and nontransfected HEK-293 cells. After incubation and washing, fluorescein-conjugated goat-antihuman IgG is applied to detect the presence of patient IgG binding.(Package insert: EUROIMMUN AG. Stocker W, et al. Differenzierte Autoantikorper-Diagnostik mit BIOCHIP-Mosaiken. U Conrad, K. (Hrsg) Autoantikorper. Pabst-Verlag 1998, 78-99)

 

Western Blot (WB):

A mixture of neuronal antigens extracted aqueously from adult rat cerebellum is denatured, reduced, and separated by electrophoresis on 10% polyacrylamide gel. Full-length recombinant human CRMP-5 antigen is used to confirm CRMP-5-IgG.(Yu Z, Kryzer TJ, Griesmann GE, et al: CRMP-5 neuronal autoantibody: marker of lung cancer and thymoma-related autoimmunity. Ann Neurol 2001;49[2]:145-154)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

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.

ANN1C, ANN2C, ANN3C, AGN1C, PCA1C, PCA2C, PCTRC, AMPHC, CRMC, NMDIC, AMPIC, GABIC, DPPIC, DPPTC, GL1CC, GL1TC, VGKC: Monday through Sunday

 

AMPCC, GABCC, NMDCC, LG1CC, CS2CC, DPPCC, GL1CC: Monday through Friday

 

WBNC, ABLTC: Monday, Wednesday, Friday

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.

Varies

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

28 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

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 Regional Manager. 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. This test 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.

84182-Paraneoplastic autoantibody Western blot confirmation (if appropriate)

84182-Amphiphysin Western blot confirmation (if appropriate)

86255-Amphiphysin (if appropriate)

86255-ANNA-1 (if appropriate)

86255-ANNA-2 (if appropriate)

86255-ANNA-3 (if appropriate)

86255-CRMP-5-IgG (if appropriate)

86255-PCA-1 (if appropriate)

86255-PCA-2 (if appropriate)

86255-PCA-Tr (if appropriate)

86255-AGNA-1 (if appropriate)

86256-AMPIC (if appropriate)

86256-GABIC (if appropriate)

86256-NMDIC (if appropriate)

86255-DPPIC (if appropriate)

86256-DPPTC (if appropriate)

86255-GL1IC (if appropriate)

86256-GL1TC (if appropriate)

86255-AMPCC (if appropriate)

86255-GABCC (if appropriate)

86255-NMDCC (if appropriate)

83519-VGKCC (if appropriate)

86255-LG1CC (if appropriate)

86255-CS2CC (if appropriate)

86255-DPPCC (if appropriate)

86255-GL1CC (if appropriate)

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports