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Paraneoplastic Antibody Expanded Evaluation with Reflex to Titer and LB, Serum
Test Code94957
CPT Codes
86255 (x19), 86052, 83519 (x2), 86596 (x2), 86341
Includes
Initial panel consits of:Paraneoplastic Expanded Ab Screen Tissue IFA, AMPAR1, AMPAR2, Aquaporin 4, DPPX, GABAbR, NMDAR1, CASPAR2, LGI1, Ganglionic AChR, VGCC N-Type, VGCC P/Q type and VGKC
If Paraneoplastic Expanded Ab Screen, Tissue IFA suggests one or more positive analytes, a line blot with 10 analytes will be performed: ANNA1 (Hu), ANNA2 (Ri), PCA1 (Yo), Ma2/Ta, CRMP5(CV2), Amphiphysin, AGNA1 (SOX1), GAD65, PCA Tr (DNER), and Zic4.
If the Paraneoplastic Expanded Ab Screen, Tissue IFA suggests ANNA3, then titer will be performed.
If the Paraneoplastic Expanded Ab Screen, Tissue IFA suggests PCA-2, then titer will be performed.
If the Paraneoplastic Expanded Ab Screen, Tissue IFA suggests PCA-Tr (DNER) and Neurology Antibody Line Blot shows PCA Tr (DNER) negative and PCA1 (Yo) negative, then Purkinje Cell Cytoplasmic Antibody Type Tr (DNER), CBA, IFA will be performed at an additional charge (CPT code(s): 86255).
If Purkinje Cell Cytoplasmic Antibody Type Tr (DNER), CBA, IFA is positive, then titer will be performed.
If the Paraneoplastic Expanded Ab Screen, Tissue IFA for Myelin antibody is positive, then:
a. Myelin antibody IFA titer will be performed at an additional charge (CPT code(s): 86256).
b. Myelin Associated Glycoprotein (MAG) Antibody Western Blot will be performed at an additional charge (CPT code(s): 84182)
c. If Myelin Associated Glycoprotein (MAG) Antibody Western Blot is positive, then Myelin Associated Glycoprotein (MAG)-SGPG Antibody and Myelin Associated Glycoprotein (MAG) Antibody (IgM) EIA will be performed at an additional charge (CPT code(s): 83520 x2).
If the Neurology Antibody, CBA is positive for NMDAR1, AMPAR2, LGI-1, or CASPR2, then titers will be performed at an additional charge (CPT code(s): 86256 for each titer performed).
If the Aquaporin 4 (AQP4) Ab, CBA is positive, then titer will be performed at an additional charge (CPT code(s): 86052).
If the Neurology Antibody, CBA is positive for AMPAR1 or GABA-B Receptor, then titers will be performed.
If the DPPX Receptor Antibody, CBA is positive, then titer will be performed.
If Paraneoplastic Expanded Ab Screen, Tissue IFA suggests one or more positive analytes, a line blot with 10 analytes will be performed: ANNA1 (Hu), ANNA2 (Ri), PCA1 (Yo), Ma2/Ta, CRMP5(CV2), Amphiphysin, AGNA1 (SOX1), GAD65, PCA Tr (DNER), and Zic4.
If the Paraneoplastic Expanded Ab Screen, Tissue IFA suggests ANNA3, then titer will be performed.
If the Paraneoplastic Expanded Ab Screen, Tissue IFA suggests PCA-2, then titer will be performed.
If the Paraneoplastic Expanded Ab Screen, Tissue IFA suggests PCA-Tr (DNER) and Neurology Antibody Line Blot shows PCA Tr (DNER) negative and PCA1 (Yo) negative, then Purkinje Cell Cytoplasmic Antibody Type Tr (DNER), CBA, IFA will be performed at an additional charge (CPT code(s): 86255).
If Purkinje Cell Cytoplasmic Antibody Type Tr (DNER), CBA, IFA is positive, then titer will be performed.
If the Paraneoplastic Expanded Ab Screen, Tissue IFA for Myelin antibody is positive, then:
a. Myelin antibody IFA titer will be performed at an additional charge (CPT code(s): 86256).
b. Myelin Associated Glycoprotein (MAG) Antibody Western Blot will be performed at an additional charge (CPT code(s): 84182)
c. If Myelin Associated Glycoprotein (MAG) Antibody Western Blot is positive, then Myelin Associated Glycoprotein (MAG)-SGPG Antibody and Myelin Associated Glycoprotein (MAG) Antibody (IgM) EIA will be performed at an additional charge (CPT code(s): 83520 x2).
If the Neurology Antibody, CBA is positive for NMDAR1, AMPAR2, LGI-1, or CASPR2, then titers will be performed at an additional charge (CPT code(s): 86256 for each titer performed).
If the Aquaporin 4 (AQP4) Ab, CBA is positive, then titer will be performed at an additional charge (CPT code(s): 86052).
If the Neurology Antibody, CBA is positive for AMPAR1 or GABA-B Receptor, then titers will be performed.
If the DPPX Receptor Antibody, CBA is positive, then titer will be performed.
Preferred Specimen
8 mL frozen serum
Minimum Volume
4 mL
Transport Container
Transport tube
Transport Temperature
Frozen
Specimen Stability
Room temperature: 24 hours
Refrigerated: 48 hours
Frozen: 21 days
Refrigerated: 48 hours
Frozen: 21 days
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Gross hemolysis • Grossly lipemic • Grossly icteric samples • Turbid • Bacterial contamination • Received refrigerated • Received room temperature
Methodology
See individual tests
FDA Status
This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.
Setup Schedule
Set up: Tues; Report available: 4-13 days
Reference Range
See Laboratory Report
Clinical Significance
Detection of antineuronal autoantibodies aids the diagnosis of autoimmune paraneoplastic syndromes, encephalopathies, and other autoimmune neurological conditions. Identification of specific antineuronal autoantibodies may also help in the diagnostic workup for occult malignancies. Finally, knowledge of the specific identity of antineuronal autoantibodies aids greatly in making therapeutic decisions for patients. Antineuronal antibodies are detected and identified by indirect immunofluorescence, using multiple neuronal tissues, non-neuronal tissues, and transfected substrate cells, as well as radioimmunoassays. Line blot assays are used for confirmatory reflex testing.
Performing Laboratory
| Quest Diagnostics Nichols Institute-San Juan Capistrano, CA |
| 33608 Ortega Highway |
| San Juan Capistrano, CA 92675-2042 |
