Test Code PAVAL Paraneoplastic, Autoantibody Evaluation, Serum
Additional Codes
Mayo Code |
PAVAL |
EPIC Code |
LAB2232 |
Sunquest Code |
PAVAL |
Reporting Name
Paraneoplastic Autoantibody Eval, SUseful For
Serological evaluation of patients who present with a subacute neurological disorder of undetermined etiology, especially those with known risk factors for cancer
Directing a focused search for cancer
Investigating neurological symptoms that appear in the course of, or after, cancer therapy, and are not explainable by metastasis
Differentiating autoimmune neuropathies from neurotoxic effects of chemotherapy
Monitoring the immune response of seropositive patients in the course of cancer therapy
Detecting early evidence of cancer recurrence in previously seropositive patients
Reflex Tests
Test ID | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
ARBI | ACh Receptor (Muscle) Binding Ab | Yes | No |
ARMO | ACh Receptor (Muscle) Modulating Ab | No | No |
AGNBS | AGNA-1 Immunoblot, S | No | No |
AMPCS | AMPA-R Ab CBA, S | No | No |
AMPIS | AMPA-R Ab IF Titer Assay, S | No | No |
AMIBS | Amphiphysin Immunoblot, S | No | No |
AN1BS | ANNA-1 Immunoblot, S | No | No |
AN2BS | ANNA-2 Immunoblot, S | No | No |
CS2CS | CASPR2-IgG CBA, S | No | No |
CRMWS | CRMP-5-IgG Western Blot, S | Yes | No |
DPPCS | DPPX Ab CBA, S | No | No |
DPPIS | DPPX Ab IFA, S | No | No |
DPPTS | DPPX Ab IFA Titer, S | No | No |
GABCS | GABA-B-R Ab CBA, S | No | No |
GABIS | GABA-B-R Ab IF Titer Assay, S | No | No |
GD65S | GAD65 Ab Assay, S | Yes | No |
LG1CS | LGI1-IgG CBA, S | No | No |
GL1CS | mGluR1 Ab CBA, S | No | No |
GL1IS | mGluR1 Ab IFA, S | No | No |
GL1TS | mGluR1 Ab IFA Titer, S | No | No |
NMDCS | NMDA-R Ab CBA, S | No | No |
NMDIS | NMDA-R Ab IF Titer Assay, S | No | No |
PC1BS | PCA-1 Immunoblot, S | No | No |
PCTBS | PCA-Tr Immunoblot, S | No | No |
Testing Algorithm
If immunofluorescence assay (IFA) patterns suggest AGNA-1 antibody, then AGNA-1 immunoblot is performed at an additional charge.
If IFA patterns suggest amphiphysin antibody, then amphiphysin immunoblot is performed at an additional charge.
If IFA patterns suggest ANNA-1 antibody, then ANNA-1 immunoblot is performed at an additional charge.
If IFA patterns suggest ANNA-2 antibody, then ANNA-2 immunoblot is performed at an additional charge.
If IFA patterns suggest PCA-1 antibody, then PCA-1 immunoblot is performed at an additional charge.
If IFA patterns suggest PCA-Tr antibody, then PCA-Tr immunoblot is performed at an additional charge.
If IFA patterns suggest GAD65 antibody, then GAD65 antibody radioimmunoassay (RIA) is performed at an additional charge.
If IFA pattern suggest NMDA-receptor, then NMDA- receptor antibody cell-binding assay (CBA), and/or NMDA- receptor antibody titer is performed at an additional charge.
If IFA pattern suggest AMPA- receptor, then AMPA- receptor antibody CBA and/or AMPA- receptor antibody titer is performed at an additional charge.
If IFA pattern suggest GABA-B- receptor, then GABA-B- receptor antibody CBA and/or GABA-B- receptor antibody titer is performed at an additional charge.
If IFA pattern suggest DPPX, then DPPX antibody CBA and DPPX antibody titer is performed at an additional charge.
If IFA pattern suggest mGluR1, then mGluR1 antibody CBA and mGluR1 antibody titer is performed at an additional charge.
If VGKC is >0.00 nmol/L, then LGI1-IgG CBA and CASPR2-IgG CBA, S are performed at an additional charge.
If CRMP IFA is positive, then ACh receptor binding antibody, CRMP-5-IgG Western blot, and ACh receptor (muscle) modulating antibody will be performed at an additional charge.
If striational striated muscle antibody is 1:7,680 or greater, then ACh receptor binding antibody, CRMP-5-IgG Western blot, and ACh receptor (muscle) modulating antibody will be performed at an additional charge.
CRMP-5-IgG Western blot is also performed by specific request for more sensitive detection of CRMP-5-IgG. Testing should be requested in cases of subacute basal ganglionic disorders (chorea, Parkinsonism), cranial neuropathies (especially loss of vision, taste, or smell) and myelopathies.
The following algorithms are available in Special Instructions:
Method Name
AGN1S, AMPHS, AMPIS, ANN1S, ANN2S, ANN3S, CRMS, DPPIS, DPPTS, GABIS, GL1IS, GL1TS, NMDIS, PCAB2, PCABP, PCATR: Indirect Immunofluorescence Assay (IFA)
STR: Enzyme-Linked Immunosorbent Assay (ELISA)
ARBI, CCN, CCPQ, GANG, GD65S, VGKC: Radioimmunoassay (RIA)
CRMWS: Western Blot (WB)
AGNBS, AMIBS, AN1BS, AN2BS, PC1BS, PCTBS: Immunoblot (IB)
AMPCS, CS2CS, DPPCS, GABCS, GL1CS, LG1CS, NMDCS: Cell-Binding Assay (CBA)
ARMO: Live Cell Assay (LCA)
Performing Laboratory

Specimen Type
SerumNecessary Information
Provide the following information:
-Relevant clinical information
-Ordering Provider name, phone number, mailing address, and e-mail address
Specimen Required
Patient Preparation:
1. For optimal antibody detection, specimen collection is recommended prior to initiation of immunosuppressant medication.
2. This test should not be requested in patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. The specific waiting period before specimen collection will depend on the isotope administered, the dose given, and the clearance rate in the individual patient. Specimens will be screened for radioactivity prior to analysis. Radioactive specimens received in the laboratory will be held 1 week and assayed if sufficiently decayed, or canceled if radioactivity remains.
3. Patient should have no general anesthetic or muscle-relaxant drugs in the previous 24 hours.
Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Specimen Volume: 4 mL
Due to reflex testing requirements, minimum volume is 5.0 mL serum. Preferred volume is 7.0 mL serum
Specimen Minimum Volume
2 mL
Specimen Stability Information
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Serum | Refrigerated (preferred) | 28 days | |
Frozen | 28 days | ||
Ambient | 72 hours |
Reject Due To
Gross hemolysis | Reject |
Gross lipemia | Reject |
Gross icterus | Reject |
Special Instructions
Reference Values
Test ID |
Reporting name |
Methodology |
Reference value |
GANG |
AChR Ganglionic Neuronal Ab, S |
Radioimmunoassay (RIA) |
≤0.02 nmol/L |
AMPHS |
Amphiphysin Ab, S |
Immunofluorescence (IFA) |
<1:240 |
AGN1S |
Anti-Glial Nuclear Ab, Type 1 |
IFA |
<1:240 |
ANN1S |
Anti-Neuronal Nuclear Ab, Type 1 |
IFA |
<1:240 |
ANN2S |
Anti-Neuronal Nuclear Ab, Type 2 |
IFA |
<1:240 |
ANN3S |
Anti-Neuronal Nuclear Ab, Type 3 |
IFA |
<1:240 |
CRMS |
CRMP-5-IgG, S |
IFA |
<1:240 |
VGKC |
Neuronal (V-G) K+ Channel Ab, S |
RIA |
≤0.02 nmol/L |
CCN |
N-Type Calcium Channel Ab |
RIA |
≤0.03 nmol/L |
CCPQ |
P/Q-Type Calcium Channel Ab |
RIA |
≤0.02 nmol/L |
PCABP |
Purkinje Cell Cytoplasmic Ab Type 1 |
IFA |
<1:240 |
PCAB2 |
Purkinje Cell Cytoplasmic Ab Type 2 |
IFA |
<1:240 |
PCATR |
Purkinje Cell Cytoplasmic Ab Type Tr |
IFA |
<1:240 |
STR |
Striational (Striated Muscle) Ab, S |
Enzyme-linked immunosorbent assay (ELISA) |
<1:120 |
Reflex Tests:
Test ID |
Reporting name |
Methodology |
Reference value |
ARBI |
ACh Receptor (Muscle) Binding Ab |
RIA |
≤0.02 nmol/L |
ARMO |
ACh Receptor (Muscle) Modulating Ab |
Live cell assay (LCA) |
0-20% (reported as __% loss of AChR) |
AGNBS |
AGNA-1 Immunoblot, S |
Immunoblot (IB) |
Negative |
AMPCS |
AMPA-R Ab CBA, S |
Cell-binding assay (CBA) |
Negative |
AMPIS |
AMPA-R Ab IF Titer Assay, S |
IFA |
<1:120 |
AMIBS |
Amphiphysin Immunoblot, S |
IB |
Negative |
AN1BS |
ANNA-1 Immunoblot, S |
IB |
Negative |
AN2BS |
ANNA-2 Immunoblot, S |
IB |
Negative |
CS2CS |
CASPR2-IgG CBA, S |
CBA |
Negative |
CRMWS |
CRMP-5-IgG Western Blot, S |
Western blot |
Negative |
DPPCS |
DPPX Ab CBA, S |
CBA |
Negative |
DPPIS |
DPPX Ab IFA, S |
IFA |
Negative |
DPPTS |
DPPX Ab IFA Titer, S |
IFA |
<1:240 |
GABCS |
GABA-B-R Ab CBA, S |
CBA |
Negative |
GABIS |
GABA-B-R Ab IF Titer Assay, S |
IFA |
<1:120 |
GD65S |
GAD65 Ab Assay, S |
RIA |
≤0.02 nmol/L Reference values apply to all ages |
LG1CS |
LGI1-IgG CBA, S |
CBA |
Negative |
GL1CS |
mGluR1 Ab CBA, S |
CBA |
Negative |
GL1IS |
mGluR1 Ab IFA, S |
IFA |
Negative |
GL1TS |
mGluR1 Ab IFA Titer, S |
IFA |
<1:240 |
NMDCS |
NMDA-R Ab CBA, S |
CBA |
Negative |
NMDIS |
NMDA-R Ab IF Titer Assay, S |
IFA |
<1:120 |
PC1BS |
PCA-1 Immunoblot, S |
IB |
Negative |
PCTBS |
PCA-Tr Immunoblot, S |
IB |
Negative |
Neuron-restricted patterns of IgG staining that do not fulfill criteria for amphiphysin, ANNA-1, ANNA-2, ANNA-3, AGNA-1, PCA-1, PCA-2, PCA-Tr, or CRMP-5-IgG may be reported as "unclassified antineuronal IgG." Complex patterns that include non-neuronal elements may be reported as "uninterpretable."
Note: Titers lower than 1:240 are detectable by recombinant CRMP-5 Western blot analysis. CRMP-5 Western blot analysis will be done on request on stored serum (held 4 weeks). This supplemental testing is recommended in cases of chorea, vision loss, cranial neuropathy, and myelopathy. Call the Neuroimmunology Laboratory at 800-533-1710 to request CRMP-5 Western blot.
Day(s) and Time(s) Performed
AGN1S, AMPHS, AMPIS, ANN1S, ANN2S, ANN3S, CRMS, DPPIS, DPPTS, GABIS, GL1IS, GL1TS, NMDIS, PCAB2, PCABP, PCATR:
Monday through Friday; 5 a.m., 7 a.m., 5 p.m.
Saturday, Sunday; 6 a.m.
STR:
Monday through Friday; 4 a.m., 3 p.m.
Saturday, Sunday; 6 a.m.
ARBI, CCN, CCPQ, GANG, VGKC:
Monday through Friday; 6 a.m., 8 a.m., 6 p.m.
Saturday, Sunday; 7 a.m.
CRMWS:
Monday through Friday; 8 a.m.
AGNBS, AMIBS, AN1BS, AN2BS, PC1BS, PCTBS:
Monday through Friday; 6 p.m.
GD65S:
Monday through Friday; 5 a.m., 2 p.m.
Saturday, Sunday; 7 a.m.
ARMO:
Monday through Thursday; 1 p.m.
Saturday; 8 a.m.
AMPCS, CS2CS, DPPCS, GABCS, LG1CS, NMDCS:
Monday through Friday; 10 p.m.          Â
Sunday; 10 p.m.
GL1CS:
Monday, Thursday; 6 p.m.
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.CPT Code Information
83519 x 4
86255 x 9
83520
83519-ARBI (if appropriate)
83519-ARMO (if appropriate)
84182-AGNBS (if appropriate)
86255-AMPCS (if appropriate)
86256-AMPIS (if appropriate)
84182-AMIBS (if appropriate)
84182-AN1BS (if appropriate)
84182-AN2BS (if appropriate)
86255-CS2CS (if appropriate)
84182-CRMWS (if appropriate)
86255-DPPCS (if appropriate)
86256-DPPTS (if appropriate)
86255-DPPIS (if appropriate)
86255-GABCS (if appropriate)
86256-GABIS (if appropriate)
86341-GD65S (if appropriate)
86255-LG1CS (if appropriate)
86255-GL1CS (if appropriate)
86256-GL1TS (if appropriate)
86255-GL1IS (if appropriate)
86255-NMDCS (if appropriate)
86256-NMDIS (if appropriate)
84182-PC1BS (if appropriate)
84182-PCTBS (if appropriate)
LOINC Code Information
Test ID | Test Order Name | Order LOINC Value |
---|---|---|
PAVAL | Paraneoplastic Autoantibody Eval, S | 43104-9 |
Result ID | Test Result Name | Result LOINC Value |
---|---|---|
80776 | ANNA-2, S | 94343-1 |
83137 | ANNA-3, S | 94344-9 |
81184 | N-Type Calcium Channel Ab | 94348-0 |
81185 | P/Q-Type Calcium Channel Ab | 94349-8 |
83077 | CRMP-5-IgG, S | 94815-8 |
84321 | AChR Ganglionic Neuronal Ab, S | 94694-7 |
29347 | Interpretive Comments | 57771-8 |
83138 | PCA-2, S | 94351-4 |
9477 | PCA-1, S | 94350-6 |
83076 | PCA-Tr, S | 94352-2 |
8746 | Striational (Striated Muscle) Ab, S | 94817-4 |
89165 | Neuronal (V-G) K+ Channel Ab, S | 94816-6 |
89080 | AGNA-1, S | 94341-5 |
81722 | Amphiphysin Ab, S | 94340-7 |
80150 | ANNA-1, S | 94342-3 |
36349 | Reflex Added | 77202-0 |
Profile Information
Test ID | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
PAINT | Interpretive Comments | No | Yes |
GANG | AChR Ganglionic Neuronal Ab, S | No | Yes |
AMPHS | Amphiphysin Ab, S | No | Yes |
AGN1S | Anti-Glial Nuclear Ab, Type 1 | No | Yes |
ANN1S | Anti-Neuronal Nuclear Ab, Type 1 | No | Yes |
ANN2S | Anti-Neuronal Nuclear Ab, Type 2 | No | Yes |
ANN3S | Anti-Neuronal Nuclear Ab, Type 3 | No | Yes |
CRMS | CRMP-5-IgG, S | No | Yes |
VGKC | Neuronal (V-G) K+ Channel Ab, S | No | Yes |
CCN | N-Type Calcium Channel Ab | No | Yes |
CCPQ | P/Q-Type Calcium Channel Ab | No | Yes |
PCABP | Purkinje Cell Cytoplasmic Ab Type 1 | No | Yes |
PCAB2 | Purkinje Cell Cytoplasmic Ab Type 2 | No | Yes |
PCATR | Purkinje Cell Cytoplasmic Ab Type Tr | No | Yes |
STR | Striational (Striated Muscle) Ab, S | Yes | Yes |
Forms
If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:
-General Request (T239)