Paraneoplastic Reflexive Panel, Serum and CSF

Content Review: June 2023 Last Update:

Paraneoplastic neurologic syndromes are rare disorders that occur due to the remote effects of tumors.  Antibodies associated with these conditions may be present in the serum or cerebrospinal fluid (CSF) and can serve as useful markers of disease.

Disease Overview

Paraneoplastic neurologic syndromes are associated with a number of tumor types, including small cell lung cancer, thymoma, neuroblastoma, Hodgkin lymphoma, and ovarian, breast, and testicular tumors.  Researchers believe that paraneoplastic neurologic syndromes are caused by cancer-fighting components of the immune system, particularly antibodies and T cells. Instead of attacking only cancer cells, these immune agents also attack the normal cells of the nervous system and cause neurologic disorders. Paraneoplastic neurologic syndromes may present with multiple clinical manifestations (eg, encephalitis, autonomic failure, peripheral neuropathy, cerebellar ataxia, and visual complaints). 

Certain well-characterized antineural antibodies (eg, Hu, Ri, and Yo) are strongly associated with cancer and provide valuable information about which malignancies might need to be screened for in a patient. The detection of an antibody can also guide treatment decisions.

For more information about laboratory testing for paraneoplastic syndromes and other autoimmune neurologic diseases, including detailed information about panel test selection, refer to the ARUP Consult Autoimmune Neurologic Diseases - Antineural Antibody Testing topic.

Test Description

ARUP’s serum and CSF paraneoplastic reflexive panels can be used to aid in the diagnosis of paraneoplastic neurologic syndromes. Testing for the presence of antineural antibodies in both serum and CSF is recommended in most situations.

These panels evaluate for the presence of high-risk paraneoplastic antibodies, independent of neurologic phenotype. Targeted phenotype-specific panels are preferred for the evaluation of autoimmune neurologic disease; consider choosing one of these panels:

ARUP Phenotype-Specific Panels to Consider for Autoimmune Neurologic Disease
ARUP Panel
Test Code
Serum CSF

Autoimmune Encephalopathy/Dementia Panel

3006201

3006202

Autoimmune Epilepsy Panel

3006204

3006205

Autoimmune Movement Disorder Panel

3006206

3006207

Autoimmune Myelopathy Panel

3006208

3006209

Autoimmune Dysautonomia Panel

3006203

Autoimmune Pediatric CNS Disorders

3006210

3006211

Autoimmune Stiff-Person Disorders

3006234

3006235

Antibodies Tested and Methodology

Paraneoplastic Panel Serum (3002929) and CSF (3004517) Antibodies Tested and Methodology
Autoantibody Marker Method
Individual Autoantibody or Focused Panel Test Code
Serum CSF

Amphiphysin Ab, IgG

IB

2008893

3004510

ANNA-1 (Hu)

IFA, reflex IB, reflex titer

2007961

2010841

ANNA-2 (Ri)

IFA, reflex IB, reflex titer

2007961

2010841

CV2 (CRMP-5) Ab, IgG

CBA-IFA, reflex titer

3016999

3017001

PCCA-1 (Yo)

IFA, reflex IB, reflex titer

2007961

2010841

PCCA-Tr/DNER

IFA, reflex IB, reflex titer

2007961

2010841

SOX1 (AGNA) Ab, IgG

IB

3002885

3002886

Ab, antibody; AGNA, antiglial nuclear antibody; ANNA-1, antineuronal nuclear antibody type 1; ANNA-2, antineuronal nuclear antibody type 2; CBA, cell-binding assay/cell-based assay; CRMP-5, collapsin response-mediator protein 5; DNER, Delta/notch-like epidermal growth factor-related receptor; IB, immunoblot; IFA, indirect immunofluorescence assay; Ig, immunoglobulin; PCCA-1, Purkinje cell cytoplasmic antibody type 1; PCCA-Tr, Purkinje cell cytoplasmic antibody type Tr; SOX1, SRY-box transcription factor 1

Reflex Patterns

Paraneoplastic Reflexive Panel Serum (3002929) and CSF (3004517): Reflex Patterns

Reflex patterns for Paraneoplastic Reflexive Panel serum and CSF tests

Limitations

These tests evaluate only for the presence of high-risk paraneoplastic antibodies. As testing for newly described antibodies becomes available and their clinical relevance is established, these panels may evolve to reflect these discoveries.

Test Interpretation

Results

Results must be interpreted in the clinical context of the individual patient; test results (positive or negative) should not supersede clinical judgment.

Paraneoplastic Reflexive Panel Serum (3002929) and CSF (3004517): Results Interpretation
Result Interpretation

Positive for ≥1 autoantibodies

Autoantibody(ies) detected

May support a diagnosis of a paraneoplastic neurologic syndrome

 

Negative

No autoantibodies detected

The diagnosis of a paraneoplastic neurologic syndrome is not excluded

References