Axonal Neuropathy, Autoimmune/Paraneoplastic Evaluation, Serum

Reporting Name

Axonal, Autoimm/Paraneo, S

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Useful For

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 during, or after, cancer therapy, and are not explainable by metastasis

Differentiating autoimmune neuropathies from neurotoxic effects of chemotherapy

Detecting early evidence of cancer recurrence in previously seropositive patients

Method Name

APBCS, CS2CS, LG1CS, AINCS, NFLCS, NFHCS, GFACS, IG5CS: Cell Binding Assay (CBA)

AGN1S, AGNTS, AMPHS, APHTS, ANN1S, AN1TS, ANN3S, AN3TS, APBIS, APBTS, NIFIS, NIFTS, PCABP, PCAB2, PC1TS, PC2TS, GFAIS, GFATS, CRMTS, IG5TS: Indirect Immunofluorescence Assay (IFA)

CRMWS; Western Blot (WB)

AGNBS, AMIBS, AN1BS, PC1BS, AN2BS: Immunoblot (IB)

Ordering Guidance

Multiple neurological phenotype-specific autoimmune/paraneoplastic evaluations are available. For more information as well as phenotype-specific testing options, see Autoimmune Neurology Test Ordering Guide.

When more than one evaluation is ordered on the same order number, the duplicate test will be canceled.

For a list of antibodies performed with each evaluation, see Autoimmune Neurology Antibody Matrix.

This test should not be requested for 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.

Necessary Information

Provide the following information:

-Relevant clinical information

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

Specimen Required

Patient Preparation:

For optimal antibody detection, specimen collection is recommended prior to initiation of immunosuppressant medication or intravenous immunoglobulin (IVIg) treatment.

Supplies: Sarstedt Aliquot Tube, 5 mL (T914)

Collection Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Submission Container/Tube: Plastic vial

Specimen Volume: 4 mL

Collection Instructions: Centrifuge and aliquot serum into a plastic vial.

Specimen Type

Serum

Specimen Minimum Volume

2 mL

Specimen Stability Information

Specimen Type	Temperature	Time
Serum	Refrigerated (preferred)	28 days
	Frozen	28 days
	Ambient	72 hours

Reject Due To

Gross hemolysis	Reject
Gross lipemia	Reject
Gross icterus	Reject

Reference Values

Test ID	Reporting name	Methodology	Reference value
AIAEI	Autoimmune Axonal Interp, S	Medical interpretation	NA
AGN1S	Anti-Glial Nuclear Ab, Type 1	IFA	Negative
AMPHS	Amphiphysin Ab, S	IFA	Negative
ANN1S	ANNA-1, S	IFA	Negative
ANN3S	ANNA-3, S	IFA	Negative
APBIS	AP3B2 IFA, S	IFA	Negative
CRMWS	CRMP-5-IgG Western Blot, S	WB	Negative
CS2CS	CASPR2-IgG CBA, S	CBA	Negative
IG5CS	IgLON5 CBA, S	CBA	Negative
LG1CS	LGI1-IgG CBA, S	CBA	Negative
NIFIS	NIF IFA, S	IFA	Negative
PCAB2	PCA-2, S	IFA	Negative
PCABP	PCA-1, S	IFA	Negative
GFAIS	GFAP IFA, S	IFA	Negative

Reflex Information:

Test ID	Reporting name	Methodology	Reference value
AGNBS	AGNA-1 Immunoblot, S	IB	Negative
AGNTS	AGNA-1 Titer, S	IFA	<1:240
AINCS	Alpha Internexin CBA, S	CBA	Negative
AMIBS	Amphiphysin Immunoblot, S	IB	Negative
AN1BS	ANNA-1 Immunoblot, S	IB	Negative
AN1TS	ANNA-1 Titer, S	IFA	<1:240
AN2BS	ANNA-2 Immunoblot, S	IB	Negative
AN3TS	ANNA-3 Titer, S	IFA	<1:240
APBCS	AP3B2 CBA, S	CBA	Negative
APBTS	AP3B2 IFA Titer, S	IFA	<1:240
APHTS	Amphiphysin Ab Titer, S	IFA	<1:240
CRMTS	CRMP-5-IgG Titer, S	IFA	<1:240
GFACS	GFAP CBA, S	CBA	Negative
GFATS	GFAP IFA Titer, S	IFA	<1:240
IG5TS	IgLON5 IFA Titer, S	IFA	<1:240
NFHCS	NIF Heavy Chain CBA, S	CBA	Negative
NFLCS	NIF Light Chain CBA, S	CBA	Negative
NIFTS	NIF IFA Titer, S	IFA	<1:240
PC1BS	PCA-1 Immunoblot, S	IB	Negative
PC1TS	PCA-1 Titer, S	IFA	<1:240
PC2TS	PCA-2 Titer, S	IFA	<1:240

*Methodology abbreviations:

Immunofluorescence assay (IFA)

Cell-binding assay (CBA)

Western blot (WB)

Immunoblot (IB)

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

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 signs and symptoms. Several autoantibodies have a syndromic association, but no autoantibody predicts a specific neurological syndrome. More than one paraneoplastic autoantibody may be detected and associated with specific cancers.

Day(s) Performed

Profile tests: Monday through Sunday; Reflex tests: Varies

Report Available

8 to 12 days

Test Classification

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

86255 x 12

84182

84182 AGNBS (if appropriate)

86256 AGNTS (if appropriate)

86255 AINCS (if appropriate)

84182 AMIBS (if appropriate)

84182 AN1BS (if appropriate)

86256 AN1TS (if appropriate)

84182 AN2BS (if appropriate)

86256 AN3TS (if appropriate)

86255 APBCS (if appropriate)

86256 APBTS (if appropriate)

86256 APHTS (if appropriate)

86256 CRMTS (if appropriate)

86255 GFACS (if appropriate)

86256 GFATS (if appropriate)

86256 IG5TS (if appropriate)

86255 NFHCS (if appropriate)

86255 NFLCS (if appropriate)

86256 NIFTS (if appropriate)

84182 PC1BS (if appropriate)

86256 PC1TS (if appropriate)

86256 PC2TS (if appropriate)

LOINC Code Information

Test ID	Test Order Name	Order LOINC Value
AIAES	Axonal, Autoimm/Paraneo, S	94695-4

Result ID	Test Result Name	Result LOINC Value
606950	IgLON5 CBA, S	96478-3
615863	AP3B2 IFA, S	101907-4
606964	NIF IFA, S	96486-6
89080	AGNA-1, S	84927-3
81722	Amphiphysin Ab, S	72327-0
80150	ANNA-1, S	33615-6
83137	ANNA-3, S	43102-3
83107	CRMP-5-IgG Western Blot, S	47401-5
83138	PCA-2, S	84925-7
9477	PCA-1, S	84924-0
64279	LGI1-IgG CBA, S	94287-0
64281	CASPR2-IgG CBA, S	94285-4
605155	GFAP IFA, S	94346-4
606975	Autoimmune Axonal Interp, S	69048-7
618900	IFA Notes	48767-8

Forms

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

Profile Information

Test ID	Reporting Name	Available Separately	Always Performed
AIAEI	Autoimmune Axonal Interp, S	No	Yes
AMPHS	Amphiphysin Ab, S	No	Yes
ANN1S	Anti-Neuronal Nuclear Ab, Type 1	No	Yes
ANN3S	Anti-Neuronal Nuclear Ab, Type 3	No	Yes
AGN1S	Anti-Glial Nuclear Ab, Type 1	No	Yes
APBIS	AP3B2 IFA, S	No	Yes
CS2CS	CASPR2-IgG CBA, S	No	Yes
CRMWS	CRMP-5-IgG Western Blot, S	Yes	Yes
GFAIS	GFAP IFA, S	No	Yes
IG5CS	IgLON5 CBA, S	No	Yes
LG1CS	LGI1-IgG CBA, S	No	Yes
NIFIS	NIF IFA, S	No	Yes
PCABP	Purkinje Cell Cytoplasmic Ab Type 1	No	Yes
PCAB2	Purkinje Cell Cytoplasmic Ab Type 2	No	Yes

Reflex Tests

Test ID	Reporting Name	Available Separately	Always Performed
AGNBS	AGNA-1 Immunoblot, S	No	No
AINCS	Alpha Internexin CBA, S	No	No
AMIBS	Amphiphysin Immunoblot, S	No	No
AN1BS	ANNA-1 Immunoblot, S	No	No
AN1TS	ANNA-1 Titer, S	No	No
AN2BS	ANNA-2 Immunoblot, S	No	No
AN3TS	ANNA-3 Titer, S	No	No
APBCS	AP3B2 CBA, S	No	No
APBTS	AP3B2 IFA Titer, S	No	No
APHTS	Amphiphysin Ab Titer, S	No	No
CRMTS	CRMP-5-IgG Titer, S	No	No
GFACS	GFAP CBA, S	No	No
GFATS	GFAP IFA Titer, S	No	No
NFHCS	NIF Heavy Chain CBA, S	No	No
NFLCS	NIF Light Chain CBA, S	No	No
NIFTS	NIF IFA Titer, S	No	No
PC1BS	PCA-1 Immunoblot, S	No	No
PC1TS	PCA-1 Titer, S	No	No
PC2TS	PCA-2 Titer, S	No	No
AGNTS	AGNA-1 Titer, S	No	No
IG5TS	IgLON5 IFA Titer, S	No	No

Testing Algorithm

If the indirect immunofluorescence assay (IFA) patterns suggest antiglial nuclear antibody-1 (AGNA-1), then the AGNA-1 antibody IFA titer and AGNA-1 antibody immunoblot will be performed at an additional charge.

If the IFA patterns suggest antineuronal nuclear antibody type 1 (ANNA-1), then the ANNA-1 IFA titer, ANNA-1 immunoblot, and ANNA-2 immunoblot will be performed at an additional charge.

If the client requests or the IFA pattern suggests ANNA-3 antibody, then the ANNA-3 IFA titer will be performed at an additional charge.

If the IFA pattern suggests Purkinje cytoplasmic antibody type 1 (PCA-1), then the PCA-1 antibody IFA titer and PCA-1 antibody immunoblot will be performed at an additional charge.

If the IFA pattern suggests PCA-2 antibody, then the PCA-2 antibody IFA titer will be performed at an additional charge.

If the IFA patterns suggest amphiphysin antibody, then the amphiphysin antibody IFA titer and amphiphysin antibody immunoblot will be performed at an additional charge.

If the IFA pattern suggests glial fibrillary acidic protein (GFAP) antibody, then the GFAP antibody cell binding assay (CBA) and GFAP antibody IFA titer will be performed at an additional charge.

If the collapsin response-mediator protein-5 (CRMP-5)-IgG antibody Western blot is positive, then the CRMP-5-IgG antibody IF titer will be performed at an additional charge.

If the IFA pattern suggests adaptor protein 3 beta 2 (AP3B2) antibody, then the AP3B2 antibody IFA titer and AP3B2 antibody CBA will be performed at an additional charge.

If the IFA pattern suggests neuronal intermediate filament (NIF) antibody, then the alpha internexin CBA, NIF heavy chain CBA, NIF light chain CBA, and NIF IFA titer will be performed at an additional charge.

If the IgLON family member 5 antibody (IgLON5) by CBA result is positive, then the IgLON5 antibody IFA titer will be performed at an additional charge.

For more information see:

-Autoimmune/Paraneoplastic Axonal Neuropathy Evaluation Algorithm.

-Acquired Neuropathy Diagnostic Algorithm

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Test Code Billings Clinic:1413 Mayo:AIAES Axonal Neuropathy, Autoimmune/Paraneoplastic Evaluation, Serum