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From CIGNA Healthcare of Arizona (Drs. Blum and Rinne) and Arizona Institute of Nuclear Medicine and Healthcare Technology Group (Dr. Handmaker), Phoenix, AZ, and Diatide, Inc (Dr. Lister-James), Londonderry, NH.
A complete list of participants is located in the Appendix.
Correspondence to: Hirsch Handmaker, MD, Healthcare Technology Group, 2398 East Camelback Rd, Suite 695, Phoenix, AZ 85016
Objective: The affinity of various malignant neoplasms including small cell and non-small cell lung cancer for peptide analogs of somatostatin has been well documented. Depreotide is such an analog and can be complexed with technetium-99m (99mTc depreotide) for optimal imaging properties. Using this radiopharmaceutical, solitary pulmonary nodules (SPN) were previously evaluated in a successful phase II/III trial. The results of the larger multicenter phase III study using 99mTc depreotide to differentiate malignant and benign etiologies in SPN are now presented.
Methods: Patients with SPN 
6 cm on chest radiograph
were referred for evaluation. One hundred fourteen individuals who had
an absence of a benign pattern of calcification on CT scan, age > 30
years, and no demonstrable radiographic stability for the prior 2 years
were studied. All underwent single-photon emission CT (SPECT) with
99mTc depreotide and subsequent tissue histologic
examination. Three nuclear medicine specialists blinded to histologic
findings examined the SPECT images and scored them as positive or
negative based on the presence or absence of activity in the
radiographic region of the SPN. The final result was determined by the
majority score, which was then compared with the histologic
result.
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 false-negative 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.
Key Words: fluorine-18 fluorodeoxyglucose positron emission tomography • [111indium-DTPA-D-Phe1] octreotide • single-photon emission CT • solitary pulmonary nodules • somatostatin
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