From the Guidelines
To test for paraneoplastic syndrome, I recommend ordering a comprehensive paraneoplastic antibody panel, as suggested by the NCCN clinical practice guidelines in oncology 1. This panel typically includes testing for various antibodies associated with different paraneoplastic syndromes, such as anti-Yo antibody, anti-NMDA receptor antibody, anti-dorsal root ganglion antibody, anti-voltage gated calcium channel antibody, and anti-recoverin 1. Some key points to consider when ordering this panel include:
- The panel should be ordered on both serum and cerebrospinal fluid (CSF) when neurological symptoms are present, as some antibodies may be detected only in CSF.
- Testing should be performed before initiating immunotherapy whenever possible to avoid false negative results.
- Additional testing should include complete blood count, comprehensive metabolic panel, and appropriate imaging studies to search for an underlying malignancy, as paraneoplastic syndromes often precede cancer diagnosis by months to years 1. The detection of specific antibodies can help identify the syndrome type and guide the search for the associated cancer, with anti-Yo antibody being considered in the context of comprehensive paraneoplastic antibody panel 1. Key considerations for the panel include:
- Subacute encephalomyelitis (anti-NMDA receptor antibody) presenting with confusion and obtundation.
- Sensory neuropathy (anti-dorsal root ganglion antibody) presenting with pain and sensory loss.
- Eaton-Lambert syndrome (anti-voltage gated calcium channel antibody) presenting with autonomic dysfunction.
- Cancer-associated retinopathy (anti-recoverin) presenting with visual photosensitivity 1.
From the Research
Paraneoplastic Syndrome Testing
To test for paraneoplastic syndrome, a panel of autoantibodies can be ordered. The most common antibodies associated with paraneoplastic neurological syndromes (PNS) include:
- Anti-Hu antibodies, which are often associated with small cell lung cancer (SCLC) 2, 3, 4
- Anti-Yo antibodies, which are commonly found in patients with ovarian or breast cancer 5, 3
- Anti-CV2 antibodies, which can be associated with various types of cancer, including SCLC and ovarian cancer 5
- Anti-NMDA antibodies, which are often linked to autoimmune encephalitis syndromes 5
Panel Sensitivity and Specificity
The sensitivity and specificity of paraneoplastic autoantibody panels have been studied, with one retrospective cohort finding a collective sensitivity of 34% and specificity of 86% 6. This suggests that while panel testing may not be highly sensitive for detecting PNS, it can be useful in confirming the condition in difficult cases.
Antibody Testing
Antibody testing can be performed using various methods, including Line immunoassay or cell-based indirect immunofluorescent assay 5. The presence of positive antibodies can help diagnose PNS and predict the presence of cancer 5. However, treatment of paraneoplastic syndromes is generally unsatisfactory, and management of symptoms can be challenging 2, 4.