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Test Code AN1TC Antineuronal Nuclear Antibody-Type 1 (ANNA-1) Titer, Spinal Fluid


Ordering Guidance


Serum is preferred. Spinal fluid testing is particularly useful if interfering antibodies are present in the serum.



Necessary Information


Provide the ordering physician's name, phone number, mailing address, and e-mail address. 



Specimen Required


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

-PCDEC / Pediatric Autoimmune Encephalopathy/CNS Disorder Evaluation, Spinal Fluid

 

Container/Tube: Sterile vial

Specimen Volume: 2 mL


Useful For

Diagnosis of paraneoplastic autoimmune neuropathies, encephalomyeloradiculopathies, related neurologic disorders, and intestinal pseudo-obstruction/dysmotility associated with small-cell lung carcinoma

 

Reporting an end titer result from cerebrospinal fluid specimens

 

This test alone should not be used as a general screening test for carcinoma of the lung.

Testing Algorithm

If the indirect immunofluorescence pattern suggests antineuronal nuclear antibody-type 1 (ANNA-1), then this test will be performed at an additional charge.

Method Name

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

-PCDEC / Pediatric Autoimmune Encephalopathy/CNS Disorder Evaluation, Spinal Fluid

 

Indirect Immunofluorescence Assay (IFA)

Reporting Name

ANNA-1 Titer, CSF

Specimen Type

CSF

Specimen Minimum Volume

1 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
CSF Refrigerated (preferred) 28 days
  Frozen  28 days
  Ambient  72 hours

Reference Values

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

-PCDEC / Pediatric Autoimmune Encephalopathy/CNS Disorder Evaluation, Spinal Fluid

 

<1:2

Neuron-restricted patterns of IgG staining that do not fulfill criteria for antineuronal nuclear antibody type 1 may be reported as "unclassified antineuronal IgG." Complex patterns that include nonneuronal elements may be reported as "uninterpretable."

Interpretation

This autoantibody is rarely found in adult patients without asbestos exposure, or a long history of tobacco use or passive exposure. Sixty-six percent of seropositive patients are female; small-cell lung carcinoma (SCLC) has been confirmed in 83% of those with adequate follow-up. In 15% of patients with confirmed SCLC, an unrelated and more obvious primary malignancy coexists with SCLC.

 

Antineuronal nuclear antibody type 1 is found before SCLC is diagnosed in 55% of cases.

 

Positron emission tomography (PET) scanning, magnetic resonance imaging of the chest, and transesophageal ultrasound sometimes reveal malignant adenopathy when computed tomography is negative. An extra pulmonary primary small-cell carcinoma (eg, skin, larynx, tongue, breast, cervix, prostate, endocrine, or pancreas) should be considered, especially in nonsmoking patients.

 

Autopsy sometimes reveals SCLC in patients who lack evidence of tumor in life.

Clinical Reference

1. Lucchinetti CF, Kimmel DW, Lennon VA: Paraneoplastic and oncological and profiles of patients seropositive for type 1 antineuronal nuclear autoantibodies. Neurology. 1998 Mar;50(3):652-657

2. Vernino S, Eggenberger ER, Rogers LR, Lennon VA: Paraneoplastic neurological autoimmunity associated with ANNA-1 autoantibody and thymoma. Neurology. 2002 Sep 24;59(6):929-932

3. Pranzatelli MR, McGee NR. Neuroimmunology of OMS and ANNA-1/anti-Hu paraneoplastic syndromes in a child with neuroblastoma. Neurol Neuroimmunol Neuroinflamm. 2017 Dec 22;5(2):e433. doi: 10.1212/NXI.0000000000000433

4. Horta ES, Lennon VA, Lachance DH, et al: Neural autoantibody clusters aid diagnosis of cancer. Clin Cancer Res. 2014 Jul 15;20(14):3862-3869

Day(s) Performed

Monday through Sunday

Report Available

6 to 8 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

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

86256

LOINC Code Information

Test ID Test Order Name Order LOINC Value
AN1TC ANNA-1 Titer, CSF 94356-3

 

Result ID Test Result Name Result LOINC Value
43440 ANNA-1 Titer, CSF 94356-3