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Test Id : AN1TS

Not Orderable

Antineuronal Nuclear Antibody-Type 1 (ANNA-1) Titer, Serum

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Overview

Useful For

Suggests clinical disorders or settings where the test may be helpful

Diagnosis of paraneoplastic autoimmune neuropathies, encephalomyeloradiculopathies, related neurologic disorders, and intestinal pseudo-obstruction/dysmotility associated with small-cell lung carcinoma

Reporting an end titer result from serum specimens

This test alone should not be used as a general screening test for carcinoma of the lung.

Testing Algorithm

Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If the indirect immunofluorescence pattern suggests antineuronal nuclear antibody type 1 (ANNA-1), then this test will be performed at an additional charge.

Method Name

A short description of the method used to perform the test

Only orderable as a reflex. For more information see:

-AIAES / Axonal Neuropathy, Autoimmune/Paraneoplastic Evaluation, Serum

-DMS2 / Dementia, Autoimmune/Paraneoplastic Evaluation, Serum

-DYS2 / Dysautonomia, Autoimmune/Paraneoplastic Evaluation, Serum

-ENS2 / Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Serum

-EPS2 / Epilepsy, Autoimmune/Paraneoplastic Evaluation, Serum

-GID2 / Gastrointestinal Dysmotility, Autoimmune/Paraneoplastic Evaluation, Serum

-MAS1 / Myelopathy, Autoimmune/Paraneoplastic Evaluation, Serum

-MDS2 / Movement Disorder, Autoimmune/Paraneoplastic Evaluation, Serum

-PAVAL / Paraneoplastic, Autoantibody Evaluation, Serum

-PCDES / Pediatric Autoimmune Encephalopathy/CNS Disorder Evaluation, Serum

Indirect Immunofluorescence Assay (IFA)

NY State Available

Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name

Lists a shorter or abbreviated version of the Published Name for a test

ANNA-1 Titer, S

Aliases

Lists additional common names for a test, as an aid in searching

ANNA (Antineuronal Nuclear Antibodies)

Anti-Enteric Neuronal Antibody

Anti-Hu

Dorsal Root Ganglion Antibody

Hu Antibody

Paraneoplastic Autoantibody Evaluation

Testing Algorithm

Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If the indirect immunofluorescence pattern suggests antineuronal nuclear antibody type 1 (ANNA-1), then this test will be performed at an additional charge.

Specimen Type

Describes the specimen type validated for testing

Serum

Specimen Required

Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Only orderable as a reflex. For more information see:

-AIAES / Axonal Neuropathy, Autoimmune/Paraneoplastic Evaluation, Serum

-DMS2 / Dementia, Autoimmune/Paraneoplastic Evaluation, Serum

-DYS2 / Dysautonomia, Autoimmune/Paraneoplastic Evaluation, Serum

-ENS2 / Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Serum

-EPS2 / Epilepsy, Autoimmune/Paraneoplastic Evaluation, Serum

-GID2 / Gastrointestinal Dysmotility, Autoimmune/Paraneoplastic Evaluation, Serum

-MAS1 / Myelopathy, Autoimmune/Paraneoplastic Evaluation, Serum

-MDS2 / Movement Disorder, Autoimmune/Paraneoplastic Evaluation, Serum

-PAVAL / Paraneoplastic, Autoantibody Evaluation, Serum

-PCDES / Pediatric Autoimmune Encephalopathy/CNS Disorder Evaluation, Serum

Specimen Minimum Volume

Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

0.6 mL

Reject Due To

Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis	Reject
Gross lipemia	Reject
Gross icterus	Reject

Specimen Stability Information

Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

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

Useful For

Suggests clinical disorders or settings where the test may be helpful

Diagnosis of paraneoplastic autoimmune neuropathies, encephalomyeloradiculopathies, related neurologic disorders, and intestinal pseudo-obstruction/dysmotility associated with small-cell lung carcinoma

Reporting an end titer result from serum specimens

This test alone should not be used as a general screening test for carcinoma of the lung.

Testing Algorithm

Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If the indirect immunofluorescence pattern suggests antineuronal nuclear antibody type 1 (ANNA-1), then this test will be performed at an additional charge.

Clinical Information

Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

A spectrum of paraneoplastic neurologic disorders (often multifocal) is found with antineuronal nuclear antibody type 1 (ANNA-1), also known as anti-Hu. Most frequent are neuropathies: mixed sensorimotor, pure sensory, predominantly autonomic, and least commonly, predominantly motor. Other manifestations include limbic encephalitis, subacute cerebellar degeneration, myelopathy, or radiculopathy.

Small-cell lung carcinoma (SCLC) is almost always present, although difficult to find. Extrapulmonary primary small-cell carcinoma thymoma or neuroblastoma is rarely encountered as the pertinent neoplasm. Whole body positron emission tomography (PET) scanning is justifiable in seropositive patients when no cancer is found.

ANNA-1 antibody is an extremely valuable marker of paraneoplastic intestinal dysmotilities associated with SCLC, ranging from gastroparesis to pseudo-obstruction. In this context it may be accompanied by muscle or ganglionic acetylcholine receptor (AChR) antibody, voltage-gated potassium channel antibody, striational antibody, glutamic acid decarboxylase 65 (GAD65) antibody, or thyroid or gastric parietal cell antibodies.

ANNA-1 antibody is uncommon in patients with SCLC without a neuropathy, including patients with Lambert-Eaton myasthenic syndrome or pure cerebellar ataxia.

ANNA-1 has been encountered in children with intestinal dysmotility, cerebellar ataxia, brain stem encephalitis, and myeloneuropathy with and without evident cancer (neuroblastoma).

Reference Values

Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Only orderable as a reflex. For more information see:

-AIAES / Axonal Neuropathy, Autoimmune/Paraneoplastic Evaluation, Serum

-DMS2 / Dementia, Autoimmune/Paraneoplastic Evaluation, Serum

-DYS2 / Dysautonomia, Autoimmune/Paraneoplastic Evaluation, Serum

-ENS2 / Encephalopathy, Autoimmune/Paraneoplastic Evaluation, Serum

-EPS2 / Epilepsy, Autoimmune/Paraneoplastic Evaluation, Serum

-GID2 / Gastrointestinal Dysmotility, Autoimmune/Paraneoplastic Evaluation, Serum

-MAS1 / Myelopathy, Autoimmune/Paraneoplastic Evaluation, Serum

-MDS2 / Movement Disorder, Autoimmune/Paraneoplastic Evaluation, Serum

-PAVAL / Paraneoplastic, Autoantibody Evaluation, Serum

-PCDES / Pediatric Autoimmune Encephalopathy/CNS Disorder Evaluation, Serum

<1:240

Neuron-restricted patterns of IgG staining that do not fulfill criteria for antineuronal nuclear antibody type 1 may be reported as "unclassified anti-neuronal IgG." Complex patterns that include nonneuronal elements may be reported as "uninterpretable."

Interpretation

Provides information to assist in interpretation of the test results

This autoantibody is rarely found in adult patients without asbestos exposure, or a long history of tobacco use or passive exposure. Sixty-six percent of seropositive patients are female; small-cell lung carcinoma (SCLC) has been confirmed in 83% of those with adequate follow-up. In 15% with confirmed SCLC, an unrelated and more obvious primary malignancy coexists with SCLC.

Antineuronal nuclear antibody type 1 is found before SCLC is diagnosed in 55% of cases.

Positron emission tomography (PET) scanning, magnetic resonance imaging of the chest, and transesophageal ultrasound sometimes reveal malignant adenopathy when computerized tomography is negative. An extrapulmonary primary small cell carcinoma should be considered, especially in nonsmoking patients (eg, skin, larynx, tongue, breast, cervix, ovary, prostate, endocrine, or pancreas).

Autopsy sometimes reveals SCLC in patients who lack evidence of tumor in life.

Cautions

Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

A cancer other than small-cell lung carcinoma (SCLC) may be found first but will coexist with SCLC in 15% of cases.

Antineuronal nuclear antibody type 1 (ANNA-1) is only 1 of 7 neuronal (or glial) nuclear or cytoplasmic autoantibodies that are currently recognized as a serological marker of neurologic autoimmunity associated with SCLC. The others are ANNA-2, ANNA-3, amphiphysin, Purkinje cell cytoplasmic autoantibody type 2, collapsin response-mediator protein-5 (CRMP-5-IgG), and antiglial neuronal nuclear antibody (AGNA-1).

Clinical Reference

Recommendations for in-depth reading of a clinical nature

1. Lucchinetti CF, Kimmel DW, Lennon VA. Paraneoplastic and oncologic profile of patients seropositive for type 1 antineuronal nuclear autoantibodies. Neurology. 1998;50(3):652-657

2. Vernino S, Eggenberger ER, Rogers LR, Lennon VA. Paraneoplastic neurological autoimmunity associated with ANNA-1 autoantibody and thymoma. Neurology. 2002;59(6):929-932

3. Pranzatelli MR, McGee NR. Neuroimmunology of OMS and ANNA-1/anti-Hu paraneoplastic syndromes in a child with neuroblastoma. Neurol Neuroimmunol Neuroinflamm. 2017;5(2):e433. doi:10.1212/NXI.0000000000000433

4. Horta ES, Lennon VA, Lachance DH, et al. Neural autoantibody clusters aid diagnosis of cancer. Clin Cancer Res. 2014;20(14):3862-3869

Method Description

Describes how the test is performed and provides a method-specific reference

The patient's sample is tested by a standardized immunofluorescence assay that uses a composite frozen section of mouse cerebellum, kidney, and gut tissues. After incubation with sample and washing, fluorescein-conjugated goat-antihuman IgG is applied. Neuron-specific autoantibodies are identified by their characteristic fluorescence staining patterns. Samples that are scored positive for any neuronal nuclear or cytoplasmic autoantibody are titrated to an endpoint. Interference by coexisting non-neuron-specific autoantibodies can usually be eliminated by serologic absorption.(Honorat JA, Komorowski L, Josephs KA, et al. IgLON5 antibody: neurological accompaniments and outcomes in 20 patients. Neurol Neuroimmunol Neuroinflamm 2017 Jul 18;4(5):e385. doi:10.1212/NXI.0000000000000385)

PDF Report

Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed

Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Sunday

Report Available

The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

6 to 8 days

Specimen Retention Time

Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

28 days

Performing Laboratory Location

Indicates the location of the laboratory that performs the test

Rochester

Fees

Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

Authorized users can sign in to Test Prices for detailed fee information.
Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification

Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

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

Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

86256

LOINC® Information

Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id	Test Order Name	Order LOINC Value
AN1TS	ANNA-1 Titer, S	94342-3

Result Id	Test Result Name	Result LOINC Value Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
43431	ANNA-1 Titer, S	94342-3

Test Setup Resources

Setup Files

Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | PHP Pdf | CMS Pdf

Sample Reports

Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports

International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports