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Test Code AN3TC Antineuronal Nuclear Antibody Type 3 (ANNA-3) Titer, Spinal Fluid


Ordering Guidance


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



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

 

Container/Tube: Sterile vial

Specimen Volume: 4 mL


Useful For

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

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

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)

Reporting Name

ANNA-3 Titer, CSF

Specimen Type

CSF

Specimen Minimum Volume

2 mL

Specimen Stability Information

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

Reject Due To

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus Reject

Clinical Information

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

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

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).

Day(s) Performed

Monday through Sunday

Report Available

6 to 8 days

Specimen Retention Time

5 weeks

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
AN3TC ANNA-3 Titer, CSF 94358-9

 

Result ID Test Result Name Result LOINC Value
43442 ANNA-3 Titer, CSF 94358-9