Transcript Neotect - people.vcu.edu

NeoTect
Tc99m Depreotide Injection
NeoTect
 Approved by the FDA - August 3, 1999
 Used in Imaging Pulmonary Masses
 Normal activity in high concentrations
noted in:
 Kidney
 Liver
Clinical Studies
 Total of 270 patients either had lung cancer or
classified as highly suspect
 Following the acquisition Two groups of
physicians completed blind interpretation
 3 Radiologists
 3 Nuclear Physicians
 Results where compared to biopsy that had
either adenocarcinomas, squamaous cell,
small cell, non-small cell, or other magilgnant
cell type
Results of Clinical Studies
 Nuclear Physicians
 70% sensitive, 86% specific, 74% accurate
 Radiologist
 71% sensitive, 79% specific, 72% accurate
 False negative = 29%
 1 – 7 cm range on CT
 False positive – 17%
 Usually some type of inflammation
 While CT and NeoTect were completed on
most if not all patient comparative data
between these two modalities was not
completed
Indications
 Identifies somatostatin receptor-bearing
pulmonary masses in patients presenting
with pulmonary lesions on CT and/or
Chest x-ray who have known malignancy
or who are highly suspect for malignancy.
 Is synthetic somatostatin analogue that
binds to somatostatin receptor (SSTR)
subtypes 2, 3 and 5
Radiopharmaceutical and
Dose
 Kit is kept refrigrated and must be brought up
to room temperature
 Add no more than 50 mCi of 99mTc04 Mix for at least 10 second
 Heat in water bath for 10 minutes
 Cool for at least 10 minutes
 Vent with 0.22µm filter an extract 1 mL of air
 Single dose vial of 50ug of Depreotide peptide
labeled with 15-20 mCi Tc99m in 1ml
Method of Localization and
Excretion
 Binds to somatostatin receptors
 Primarily renal clearance 4 hours post
injection
 Kidney is the target organ for dosimetry
Patient Prep and
Precautions
 Well hydrate
 Injection can cause anaphylactic reaction
 Headache most common complaint
 Treat insulinoma patients with IV glucose
prior/during injection.
 No known reaction to this peptide
Scanning
 Planar and SPECT Imaging 2-4 hours
post injection
 SPECT images of the chest are required
for optimal image interpretation.
Findings
 Normal Uptake
 Liver
 Kidneys
A Multicenter Trial With a Somatostatin
Analog 99mTc Depreotide in the
Evaluation of Solitary Pulmonary Nodules
 Results: Of the 114 individuals studied, 88 had a histologic result
compatible with malignant neoplasm. 99mTc depreotide
scintigraphy correctly identified 85 of this group, with three falsenegative determinations compared with histology. There were
seven false-positive determinations, including six granulomas and
one hamartoma. 99mTc depreotide scintigraphy correctly excluded
malignancy in 19 of 26 patients with benign histologic findings.
The sensitivity of this method was 96.6% with a specificity of
73.1%.
 Conclusion: 99mTc depreotide scintigraphy is a safe and useful
method for the noninvasive evaluation of SPN with a sensitivity
and accuracy comparable to that reported for fluorine-18
fluorodeoxyglucose positron emission tomography.

http://www.chestjournal.org/cgi/content/abstract/117/5/1232
Images From Article
Depreotide Compared to FDG
The utility of [sup.99m]Tc depreotide compared with F-18 fluorodeoxyglucose
Positron emission tomography and surgical staging in patients with suspected
non-small cell lung cancer *.
(clinical investigations). Daniel Kahn, Yusuf Menda, Kemp Kernstine,
David Bushnell, Kelley McLaughlin, Sara Miller and Kevin Berbaum.
Chest 125.2 (Feb 2004): p494(8).
Discussion
A review of the literature suggests that the increasing role of CT in the identification
of pulmonary nodules has led to an even larger group of patients in whom the
diagnosis of lung cancer is indeterminate. As noted above, when calcified nodules
are detected on CT, the probability is low that the lesion represents a lung cancer.
However, when a noncalcified nodule is identified, and there is no evidence of
metastatic disease or enlarged lymph nodes, the situation is more complex.
The combination of CT and NeoTect is being employed to evaluate those patients as
to the probability of malignancy. If NeoTect were to be used in a combined fashion,
with CT and fusion imaging one could be able to exactly locate the position of the
lesion on CT and be sure the NeoTect uptake was in the same area. In this setting,
where the NeoTect is positive in a nodule seen on CT, the indications for biopsy
would be much stronger.
Findings
Tumor
Web Sites
 Discription of NeoTech – Do you know
the terms
 http://www.rxlist.com/cgi/generic/NeoTect.ht
m
 Product Information – Insert
 http://www.fda.gov/cder/consumerinfo/drugin
fo/NeoTect.HTM