ANAchoice Specific Antibody Cascading Reflex (ANCHCR)

Test Code

LAB2156

Quest Code

19946

CPT Codes
86038

Includes

ANA Multiplex with Reflex to 11 Antibody Cascade begins with an ANAchoice® Screen.

If the ANAchoice® Screen is positive, it will reflex the following five antibodies at an additional charge: dsDNA (CPT code(s): 86225), Sm/RNP (CPT code(s): 86235), RNP (CPT code(s): 86235), Sm (CPT code(s): 86235), and Chromatin (CPT code(s): 86235).
If any of those five antibodies are positive, the cascade stops and the results are reported.
If all five of those antibodies are negative, four additional antibodies will be reflexed at an additional charge: SSA (CPT code(s): 86235), SSB (CPT code(s): 86235), Scl-70 (CPT code(s): 86235), Jo-1 (CPT code(s): 86235).
If any of those four antibodies are positive, the cascade stops and the results are reported.
If all four of those antibodies are negative, the following two additional antibodies will be reflexed at an additional charge: Ribosomal P (CPT code(s): 83516) and Centromere B (CPT code(s): 86235).

The cascade stops upon the first positive antibody found in a group. It is possible that antibodies in subsequent groups are also positive, but will not be added or reported. Please contact your local Quest Diagnostics Laboratory if you are interested in adding this additional testing.

Preferred Specimen

1 mL serum in gold top tube

Minimum Volume

0.5 mL

Other Acceptable Specimens

Plain red top tube

Transport Container

Transport tube

Transport Temperature

Room temperature

Specimen Stability

Room temperature: 4 days
Refrigerated: 7 days
Frozen: 30 days

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

Gross hemolysis • Grossly lipemic • Grossly icteric

Methodology
Immunoassay (IA)

Setup Schedule

7:00 a.m.; released 5:00 p.m.
2:00 p.m.; released 8:00 p.m. Days and evenings 7 days a week

Report Available

3 days

Reference Range

ANAchoice® Screen

Negative

Clinical Significance

This panel can be helpful in the diagnosis of autoimmune rheumatic diseases, including systemic lupus erythematosus, systemic sclerosis, Sjogren syndrome, mixed connective tissue disease, and rheumatoid arthritis. All specimens are screened for antinuclear antibodies (ANAs) with multiplex immunoassay. This approach simultaneously detects antibodies to dsDNA, chromatin, ribosomal protein, SSA, SSB, Smith (Sm), Sm/RNP, RNP, Scl-70, Jo-1, and centromere B. A positive result indicates the presence of at least 1 of these antibodies; a negative result indicates that none of the component antibodies were detected.

Specimens with positive results are subsequently tested for a series of disease-specific autoantibodies in cascade tiers. The first tier focuses on autoantibodies associated with systemic lupus erythematosus (SLE) and mixed connective tissue disease; the second tier detects autoantibodies seen in Sjogren Syndrome, progressive systemic sclerosis and polymyositis; and the third tier include markers of the limited form of systemic sclerosis and neuropsychiatric SLE. Note that the cascade stops with the first tier in which a positive antibody result is observed. Therefore, even if an antibody included in a subsequent tier is present, it will not be reported with this test.

ANA immunofluorescence assay (IFA) on HEp-2 cells is considered by the American College of Rheumatology as the current gold standard for ANA screening because of its overall high sensitivity for several autoimmune diseases [1]. However, because patients with other diseases and healthy individuals may be positive for ANA IFA, using immunoassays for screening may be more specific for a systemic rheumatic disorder [2]. On the other hand, multiplex immunoassay screening cannot rule out patients with autoimmune diseases characterized by other antibodies, such as autoimmune hepatitis and primary biliary cholangitis, which may be positive for ANA IFA.

The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.

References
1. Methodology of testing for antinuclear antibodies (position statement). 2009. American College of Rheumatology. Updated December 2019. Accessed May 15, 2023. https://assets.contentstack.io/v3/assets/bltee37abb6b278ab2c/blta48818378bc89445/acr-position-statement-methodology-testing-antinuclear-antibodies.pdf
2. Fritzler MJ, et al. J Appl Lab Med. 2022;7:357-361.

Performing Laboratory

Quest Diagnostics - South Region

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.