Test Catalog

Test Id : AN3TC

Not Orderable

Antineuronal Nuclear Antibody Type 3 (ANNA-3) Titer, Spinal Fluid

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Overview

Test Catalog

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 primary lung carcinoma

 

Reporting an end titer result from cerebrospinal fluid specimens

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If the indirect immunofluorescence (IFA) pattern suggests antineuronal nuclear antibody type 3 (ANNA-3), 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.

Yes

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

ANNA-3 Titer, CSF

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If the indirect immunofluorescence (IFA) pattern suggests antineuronal nuclear antibody type 3 (ANNA-3), 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 if 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
Frozen 28 days
Ambient 72 hours

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 primary lung carcinoma

 

Reporting an end titer result from cerebrospinal fluid specimens

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If the indirect immunofluorescence (IFA) pattern suggests antineuronal nuclear antibody type 3 (ANNA-3), 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

Antineuronal nuclear autoantibodies (ANNA) are recognized clinically as markers of a patient's immune response to specific cancers (paraneoplastic autoantibodies).

 

In 1985, an antineuronal nuclear autoantibody (now known as ANNA-1 or anti-Hu)(1) was described as a serological accompaniment of subacute sensory neuropathy related to small-cell lung carcinoma (SCLC). ANNA-1 was subsequently recognized as an IgG marker for a spectrum of encephalomyeloradiculoneuropathy (including gastrointestinal dysmotilities) related to SCLC,(2) childhood neuroblastoma, and thymoma. The second antineuronal nuclear antibody to be recognized (known as ANNA-2 or anti-Ri) is an IgG marker of neurological autoimmunity related to SCLC and breast carcinoma.(3)

 

ANNA-3 is an IgG marker of an immune response to SCLC in patients presenting with a subacute, usually multifocal, paraneoplastic neurologic disorder.(4) Paraneoplastic sensorimotor neuropathy, cerebellar ataxia, and limbic encephalopathy are the most common presentations. However, an ANNA-3-positive patient may present with any element of an encephalomyeloradiculoneuropathy.

 

Other autoantibody markers of immune responses to SCLC include amphiphysin, collapsin response-mediated protein-5 (CRMP-5) IgG, Purkinje cell antibody type 2 (PCA-2), antiglial nuclear antibody, calcium channel antibodies (P/Q-type), and muscle acetylcholine receptor 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 antineuronal nuclear antibody type 3 may be reported as "unclassified antineuronal IgG. "Complex patterns that include nonneuronal elements may be reported as "uninterpretable."

Interpretation
Provides information to assist in interpretation of the test results

A positive result confirms that a patient's subacute neurological disorder has an autoimmune basis and predicts with 90% certainty that the patient has an aerodigestive carcinoma, usually a small-cell lung carcinoma (SCLC) that is new or recurrent and confined to the chest.

 

Fifteen percent of patients who are eventually proven to have small-cell carcinoma have an unrelated often more obvious cancer, either coexisting or in the past.

 

Antineuronal nuclear autoantibody type 3 (ANNA-3) has not yet been encountered in healthy subjects (n=100) or patients with lung carcinoma without a neurological accompaniment (n=100) or with other cancers (n=300).

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

Antineuronal nuclear autoantibody type 3 (ANNA-3) is not detectable when it coexists with ANNA-1 or ANNA-2 unless its titer exceeds that of coexisting neuronal nuclear antibodies or is demonstrable by Western blot.

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

1. Graus F, Cordon-Cardo C, Posner JB: Neuronal antinuclear antibody in sensory neuropathy from lung cancer. Neurology. 1985 April;35(4):538-543

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

3. 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

4. Pittock SJ, Lucchinetti CF, Lennon VA: Anti-neuronal nuclear autoantibody-type 2: paraneoplastic accompaniments. Ann Neurol. 2003 May;53(5):580-587

5. Chan KH, Vernino S, Lennon VA: ANNA-3 anti-neuronal nuclear antibody: marker of lung cancer-related autoimmunity. Ann Neurol. 2001 Sep;50(3):301-311

6. Pittock SJ, Kryzer TJ, Lennon VA: Paraneoplastic antibodies coexist and predict cancer, not neurological syndrome. Ann Neurol. 2004 Nov;56(5):715-719

7. 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

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

The patient's sample is tested by a standardized immunofluorescence assay that uses a composite frozen section of mouse cerebellum, kidney, and gut tissues. After incubation with sample and washing, fluorescein-conjugated goat-antihuman IgG is applied. Neuron-specific autoantibodies are identified by their characteristic fluorescence staining patterns. Samples that are scored positive for any neuronal nuclear or cytoplasmic autoantibody are titrated to an endpoint. 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 Jul 18;4(5):e385. doi: 10.1212/NXI.0000000000000385)

 

Western blot is performed as needed to confirm seropositivity.

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.

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.

6 to 8 days

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

5 weeks

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 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.

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
AN3TC ANNA-3 Titer, CSF 94358-9
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.
43442 ANNA-3 Titer, CSF 94358-9

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