Aetna considers the CEA-scan experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established.
Aetna considers technetium-99m-sestamibi (Tc-MIBI) scintigraphy medically necessary for any of the following indications: Aetna considers technetium-99m-sestamibi scintigraphy experimental and investigational for all other indications such as the following because its role for these indications has not been established: Indium-pentetreotide, medically necessary for the diagnosis and staging of persons with primary and metastatic neuroendocrine tumors bearing somatostatin receptors.
It is reported to be reactive with 83 % of colorectal carcinomas and 97 % of ovarian carcinomas.
According to the available literature, a major advantage of Oncoscint is that it allows one to survey the entire body, thus permitting the detection of occult metastases that can have a major impact on tumor staging.
Such tumors include any of the following: In-pentetreotide (Octreo Scan) experimental and investigational for all other indications such as any of the following because the sensitivity and specificity of this test for the following indications has been demonstrated to be inadequate: In-octreotate) is replaced by a beta imaging therapy radionuclide (90Y-octreotide).
Guidelines from the UKNETwork for Neuroendocrine Tumours (Ramage et al, 2005) state that targeted radionuclide therapy, including 90Y-octreotide (also known as 90Y-DOTATOC), is a useful palliative option for symptomatic individuals with inoperable or metastatic gastroenteropancreatic neuroendocrine tumors where there is corresponding abnormally increased uptake of the corresponding radionuclide imaging agent.
In regards to ovarian cancer, serum CA-125 levels have been shown to be useful in predicting the presence of ovarian cancer, but negative titers do not preclude malignancy.
In clinical trials, Onco Scint has a sensitivity of 70 % versus 44 % for CT, and a specificity of 55 % (79 % for CT) in patients with ovarian cancer.
Aetna considers I-131 labeled meta-iodobenzylguanidine (MIBG, also known as iobenguane I-131) imaging medically necessary for localizing or confirming any of the following conditions: Aetna considers I-123 labeled MIBG imaging experimental and investigational in the management of all conditions, such as any of the following, because its value for these indications has not been established: pheochromocytoma and all other indications because its effectiveness for these indications has not been established.
Aetna considers Prosta Scint scans experimental and investigational for all other indications because its effectiveness for indications other than the ones lsited above has not been established.
Aetna considers monoclonal antibody (MAb) imaging (also known as radioimmunoscintigraphy and Oncoscint immunoscintigraphy) using satumomab pendetide medically necessary for any of the following indications: Aetna considers Oncoscint immunoscintigraphy experimental and investigational for all other indications such as any of the following because it has not been established to have a clearly defined role in the management of individuals with these indications: using Tc-99m-arcitumomab, a radiodiagnostic agent produced by Immunomedics, for use in conjunction with computerized tomography (CT) scans medically necessary for detection of recurrent or metastatic colorectal cancer in the liver and extra-hepatic abdomen and pelvis.
Aetna considers technetium Tc 99m tilmanocept injection experimental and investigational for all other indications (e.g., head and neck squamous cell carcinoma and oral cavity squamous cell carcinoma) Nuclear imaging is assuming an increasing role in the management of patients with cancer.
Tumor scintigraphy involves the intravenous administration of a radio-pharmaceutical, defined as an isotope attached to a carrier molecule, which localizes in certain tumor tissues and the subsequent imaging and computer acquisition of data.