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HelpTest Code PAVAL Paraneoplastic, Autoantibody Evaluation, Serum
Additional Codes
EPIC: LAB3220
Reporting Name
Paraneoplastic Autoantibody Eval, SUseful 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
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| PAINT | Interpretive Comments | No | Yes |
| AMPHS | Amphiphysin Ab, S | No | Yes |
| AGN1S | Anti-Glial Nuclear Ab, Type 1 | No | Yes |
| ANN1S | Anti-Neuronal Nuclear Ab, Type 1 | No | Yes |
| ANN2S | Anti-Neuronal Nuclear Ab, Type 2 | No | Yes |
| ANN3S | Anti-Neuronal Nuclear Ab, Type 3 | No | Yes |
| CRMS | CRMP-5-IgG, S | No | Yes |
| VGKC | Neuronal (V-G) K+ Channel Ab, S | No | Yes |
| CCPQ | P/Q-Type Calcium Channel Ab | No | Yes |
| PCABP | Purkinje Cell Cytoplasmic Ab Type 1 | No | Yes |
| PCAB2 | Purkinje Cell Cytoplasmic Ab Type 2 | No | Yes |
| PCATR | Purkinje Cell Cytoplasmic Ab Type Tr | No | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| ARBI | ACh Receptor (Muscle) Binding Ab | Yes | No |
| AGNBS | AGNA-1 Immunoblot, S | No | No |
| AMPCS | AMPA-R Ab CBA, S | No | No |
| AMPIS | AMPA-R Ab IF Titer Assay, S | No | No |
| AMIBS | Amphiphysin Immunoblot, S | No | No |
| AN1BS | ANNA-1 Immunoblot, S | No | No |
| AN2BS | ANNA-2 Immunoblot, S | No | No |
| CS2CS | CASPR2-IgG CBA, S | No | No |
| CRMWS | CRMP-5-IgG Western Blot, S | Yes | No |
| DPPCS | DPPX Ab CBA, S | No | No |
| DPPIS | DPPX Ab IFA, S | No | No |
| DPPTS | DPPX Ab IFA Titer, S | No | No |
| GABCS | GABA-B-R Ab CBA, S | No | No |
| GABIS | GABA-B-R Ab IF Titer Assay, S | No | No |
| GD65S | GAD65 Ab Assay, S | Yes | No |
| LG1CS | LGI1-IgG CBA, S | No | No |
| GL1CS | mGluR1 Ab CBA, S | No | No |
| GL1IS | mGluR1 Ab IFA, S | No | No |
| GL1TS | mGluR1 Ab IFA Titer, S | No | No |
| NMDCS | NMDA-R Ab CBA, S | No | No |
| NMDIS | NMDA-R Ab IF Titer Assay, S | No | No |
| PC1BS | PCA-1 Immunoblot, S | No | No |
| PCTBS | PCA-Tr Immunoblot, S | No | No |
| ACMFS | AChR Modulating Flow Cytometry, S | No | No |
Testing Algorithm
If immunofluorescence assay (IFA) patterns suggest antiglial nuclear antibody-1 (AGNA-1) antibody, then AGNA-1 immunoblot is performed at an additional charge.
If IFA patterns suggest amphiphysin antibody, then amphiphysin immunoblot is performed at an additional charge.
If IFA patterns suggest antineuronal nuclear antibodies (ANNA)-1 antibody, then ANNA-1 immunoblot is performed at an additional charge.
If IFA patterns suggest ANNA-2 antibody, then ANNA-2 immunoblot is performed at an additional charge.
If IFA patterns suggest Purkinje cytoplasmic antibody (PCA)-1 antibody, then PCA-1 immunoblot is performed at an additional charge.
If IFA patterns suggest PCA-Tr antibody, then PCA-Tr immunoblot is performed at an additional charge.
If IFA patterns suggest glutamic acid decarboxylase 65 (GAD65) antibody, then GAD65 antibody radioimmunoassay (RIA) is performed at an additional charge.
If IFA pattern suggests N-methyl-D-aspartate (NMDA)-receptor, then NMDA-receptor antibody cell-binding assay (CBA), and/or NMDA- receptor antibody titer is performed at an additional charge.
If IFA pattern suggests alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA)-receptor, then AMPA- receptor antibody CBA and/or AMPA- receptor antibody titer is performed at an additional charge.
If IFA pattern suggests gamma-aminobutyric acid B (GABA-B)-receptor, then GABA-B- receptor antibody CBA and/or GABA-B- receptor antibody titer is performed at an additional charge.
If IFA pattern suggests dipeptidyl-peptidase-like protein-6 antibody (DPPX), then DPPX antibody CBA and DPPX antibody titer is performed at an additional charge.
If IFA pattern suggests metabotropic glutamate receptor 1 (mGluR1), then mGluR1 antibody CBA and mGluR1 antibody titer is performed at an additional charge.
If voltage-gated potassium channels (VGKC) is above 0.00 nmol/L, then leucine-rich, glioma inactivated 1 (LGI1)-IgG CBA and contactin-associated protein-like 2 (CASPR2)-IgG are performed at an additional charge.
If collapsin response-mediator protein (CRMP) IFA is positive, then acetylcholine (muscle) receptor (AChR) binding antibody, CRMP-5-IgG Western blot, and ACh receptor (muscle) modulating antibody by fluorescence-activated cell sorting (FACS) will be performed at an additional charge.
CRMP-5-IgG Western blot is also performed by specific request for more sensitive detection of CRMP-5-IgG. Testing should be requested in cases of subacute basal ganglionic disorders (chorea, Parkinsonism), cranial neuropathies (especially loss of vision, taste, or smell) and myelopathies.
The following algorithms are available:
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
SerumNecessary Information
Provide the following information:
-Relevant clinical information
-Ordering Provider name, phone number, mailing address, and e-mail address
Specimen Required
Patient Preparation:
1. For optimal antibody detection, specimen collection is recommended prior to initiation of immunosuppressant medication or intravenous immunoglobulin (IVIg) treatment.
2. 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.
3. Patient should have no general anesthetic or muscle-relaxant drugs in the previous 24 hours.
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 plastic vial.
Specimen Minimum Volume
2 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 28 days | |
| Frozen | 28 days | ||
| Ambient | 72 hours |
Reference Values
|
Test ID |
Reporting name |
Methodology |
Reference value |
|
AMPHS |
Amphiphysin Ab, S |
IFA |
<1:240 |
|
AGN1S |
Anti-Glial Nuclear Ab, Type 1 |
IFA |
<1:240 |
|
ANN1S |
Anti-Neuronal Nuclear Ab, Type 1 |
IFA |
<1:240 |
|
ANN2S |
Anti-Neuronal Nuclear Ab, Type 2 |
IFA |
<1:240 |
|
ANN3S |
Anti-Neuronal Nuclear Ab, Type 3 |
IFA |
<1:240 |
|
CRMS |
CRMP-5-IgG, S |
IFA |
<1:240 |
|
VGKC |
Neuronal (V-G) K+ Channel Ab, S |
RIA |
≤0.02 nmol/L |
|
CCPQ |
P/Q-Type Calcium Channel Ab |
RIA |
≤0.02 nmol/L |
|
PCABP |
Purkinje Cell Cytoplasmic Ab Type 1 |
IFA |
<1:240 |
|
PCAB2 |
Purkinje Cell Cytoplasmic Ab Type 2 |
IFA |
<1:240 |
|
PCATR |
Purkinje Cell Cytoplasmic Ab Type Tr |
IFA |
<1:240 |
Reflex Tests:
|
Test ID |
Reporting name |
Methodology |
Reference value |
|
ARBI |
ACh Receptor (Muscle) Binding Ab |
RIA |
≤0.02 nmol/L |
|
AGNBS |
AGNA-1 Immunoblot, S |
IB |
Negative |
|
AMPCS |
AMPA-R Ab CBA, S |
CBA |
Negative |
|
AMPIS |
AMPA-R Ab IF Titer Assay, S |
IFA |
<1:120 |
|
AMIBS |
Amphiphysin Immunoblot, S |
IB |
Negative |
|
AN1BS |
ANNA-1 Immunoblot, S |
IB |
Negative |
|
AN2BS |
ANNA-2 Immunoblot, S |
IB |
Negative |
|
CS2CS |
CASPR2-IgG CBA, S |
CBA |
Negative |
|
CRMWS |
CRMP-5-IgG Western Blot, S |
WB |
Negative |
|
DPPCS |
DPPX Ab CBA, S |
CBA |
Negative |
|
DPPIS |
DPPX Ab IFA, S |
IFA |
Negative |
|
DPPTS |
DPPX Ab IFA Titer, S |
IFA |
<1:240 |
|
GABCS |
GABA-B-R Ab CBA, S |
CBA |
Negative |
|
GABIS |
GABA-B-R Ab IF Titer Assay, S |
IFA |
<1:120 |
|
GD65S |
GAD65 Ab Assay, S |
RIA |
≤0.02 nmol/L Reference values apply to all ages |
|
LG1CS |
LGI1-IgG CBA, S |
CBA |
Negative |
|
GL1CS |
mGluR1 Ab CBA, S |
CBA |
Negative |
|
GL1IS |
mGluR1 Ab IFA, S |
IFA |
Negative |
|
GL1TS |
mGluR1 Ab IFA Titer, S |
IFA |
<1:240 |
|
NMDCS |
NMDA-R Ab CBA, S |
CBA |
Negative |
|
NMDIS |
NMDA-R Ab IF Titer Assay, S |
IFA |
<1:120 |
|
PC1BS |
PCA-1 Immunoblot, S |
IB |
Negative |
|
PCTBS |
PCA-Tr Immunoblot, S |
IB |
Negative |
|
ACMFS |
ACh Receptor Modulating FACS, S |
Flow Cytometry |
Negative |
*Methodology abbreviations:
Immunofluorescence assay (IFA)
Cell-binding assay (CBA)
Western blot (WB)
Radioimmunoassay (RIA)
Immunoblot (IB)
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."
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. Call 800-533-1710 to request CRMP-5 Western blot.
Day(s) Performed
Profile tests: Monday through Sunday; Reflex tests: Varies
Test Classification
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
83519
86596
86255 x 9
83519-ARBI (if appropriate)
86255 ACMFS (if appropriate)
84182-AGNBS (if appropriate)
86255-AMPCS (if appropriate)
86256-AMPIS (if appropriate)
84182-AMIBS (if appropriate)
84182-AN1BS (if appropriate)
84182-AN2BS (if appropriate)
86255-CS2CS (if appropriate)
84182-CRMWS (if appropriate)
86255-DPPCS (if appropriate)
86256-DPPTS (if appropriate)
86255-DPPIS (if appropriate)
86255-GABCS (if appropriate)
86256-GABIS (if appropriate)
86341-GD65S (if appropriate)
86255-LG1CS (if appropriate)
86255-GL1CS (if appropriate)
86256-GL1TS (if appropriate)
86255-GL1IS (if appropriate)
86255-NMDCS (if appropriate)
86256-NMDIS (if appropriate)
84182-PC1BS (if appropriate)
84182-PCTBS (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| PAVAL | Paraneoplastic Autoantibody Eval, S | 43104-9 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 80776 | ANNA-2, S | 94343-1 |
| 83137 | ANNA-3, S | 94344-9 |
| 81185 | P/Q-Type Calcium Channel Ab | 94349-8 |
| 83077 | CRMP-5-IgG, S | 94815-8 |
| 29347 | Interpretive Comments | 57771-8 |
| 83138 | PCA-2, S | 94351-4 |
| 9477 | PCA-1, S | 94350-6 |
| 83076 | PCA-Tr, S | 94352-2 |
| 89165 | Neuronal (V-G) K+ Channel Ab, S | 94816-6 |
| 89080 | AGNA-1, S | 94341-5 |
| 81722 | Amphiphysin Ab, S | 94340-7 |
| 80150 | ANNA-1, S | 94342-3 |
| 36349 | Reflex Added | 77202-0 |
Report Available
10 to 17 daysReject Due To
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | Reject |
Special Instructions
Method Name
ARBI, CCPQ, GD65S, VGKC: Radioimmunoassay (RIA)
CRMWS: Western Blot (WB)
AGNBS, AMIBS, AN1BS, AN2BS, PC1BS, PCTBS: Immunoblot (IB)
AMPCS, CS2CS, DPPCS, GABCS, GL1CS, LG1CS, NMDCS: Cell-Binding Assay (CBA)
ACMFS: Flow Cytometry
Forms
If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:
-General Request (T239)