Accurate preoperative staging with [68Ga]Ga-FAPI PET/CT for patients with oral squamous cell carcinoma: a comparison to 2-[18F]FDG PET/CT

Chen, Shaoming; Chen, Zhenying; Zou, Gengsen; Zheng, Shusen; Zheng, Ke; Zhang, Jiaying; Huang, Chao; Yao, Shaobo; Miao, Weibing

doi:10.1007/s00330-022-08686-7

Cited by 22 publications

(76 citation statements)

References 36 publications

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“…18 F]FDG and [ 68 Ga]Ga-FAPI PET/CT in cervical lymph node metastasis. For 29 patients receiving neck dissection, [ 18 F]FDG PET/CT demonstrated to have a sensitivity of 82.1% and a speci city of 74.7%, as well as an accuracy of 76.9% based on neck levels, all of which were compatible with the results of previous studies[23,[31][32][33][34]. [ 68 Ga]Ga-FAPI PET/CT demonstrated identical sensitivity (82.1% vs 82.1%) in node metastases detection.…”

supporting

confidence: 89%

The performance of [68Ga]Ga-FAPI-04 PET/CT in head and neck squamous cell carcinoma: a prospective comparison with [18F]FDG PET/CT

Jiang

Wen

et al. 2022

Preprint

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Purpose This study aimed to compare the performance of [68Ga]Ga-FAPI-04 and [18F]FDG PET/CT for initial staging and recurrence detection of head and neck squamous cell carcinoma (HNSCC). Methods Prospectively, 77 patients with histologically proven or highly suspected HNSCC, who presented for either initial staging (n = 67) or restaging (n = 10), were referred to paired [18F]FDG and [68Ga]Ga-FAPI-04 PET/CT within one week. The diagnostic performance was compared for the two imaging approaches, especially for N staging. SUVmax, SUVmean, and target-to-background ratio (TBR) were assessed for paired positive lesions. Furthermore, change in management by [68Ga]Ga-FAPI-04 PET/CT and histopathologic FAP expression of some lesions were explored. Results [18F]FDG and [68Ga]Ga-FAPI-04 PET/CT exhibited comparable detection rates for primary tumors (100%) and recurrence (62.5%). In the twenty-nine patients receiving neck dissection, [68Ga]Ga-FAPI-04 PET/CT showed higher specificity and accuracy in evaluating preoperative N staging than [18F]FDG based on patients (p = 0.031 and p = 0.070), neck sides (p = 0.002 and p = 0.006) and neck levels (p < 0.001 and p < 0.001). As for distant metastasis, [68Ga]Ga-FAPI-04 PET/CT detected more positive lesions than [18F]FDG (25 vs 23), and with higher SUVmax (7.99 ± 9.04 vs 3.62 ± 2.68, p = 0.002) by the lesion-based analysis. The types of neck dissection in 9 cases (9/33) were altered by [68Ga]Ga-FAPI-04. Overall, clinical management was significantly changed in 10 patients (10/61). Three patients underwent a follow-up [68Ga]Ga-FAPI-04 PET/CT after neoadjuvant therapy: one showed complete remission, and the others showed progression. The [68Ga]Ga-FAPI-04 uptake intensity was confirmed to be consistent with FAP expression. Conclusion [68Ga]Ga-FAPI-04 outperforms [18F]FDG PET/CT in evaluating preoperative N staging in patients with HNSCC. Furthermore, [68Ga]Ga-FAPI-04 PET/CT also shows the potential in clinical management and monitoring response to treatment. Clinical Trial Registration: This prospective study was reviewed and approved by the Medical Ethics Committee of Zhongnan Hospital, Wuhan University, and was registered online at NIH ClinicalTrials.gov (NCT05034146 & NCT05030597).

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supporting

confidence: 89%

The performance of [68Ga]Ga-FAPI-04 PET/CT in head and neck squamous cell carcinoma: a prospective comparison with [18F]FDG PET/CT

Jiang

Wen

et al. 2022

Preprint

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“…In 20 of all included studies, the radiotracer activities administered intravenously to the patients are shown, depending on the body weight, which ranges from 2.59 to 5.55 MBq/kg for FDG and from 1.85 to 3.7 MBq/kg for FAP. 22,25,28,[30][31][32][33][35][36][37][38][39][40][41]44,[47][48][49][50][51] However, the mean of the median and mean radiotracer activities administered intravenously to the patients were 147.69 MBq (range, 111-259 MBq) for FAP in 9 of the included studies 23,24,26,27,29,34,43,45,46 and 271 MBq (range, 214-316 MBq) for FDG radiotracers in 6 of the studies 23,24,26,29,43,46 (Supplement Table 1, Supplemental Digital Content, http://links.lww.com/CNM/A392).…”

Section: Technical Aspects Of Pet/ct In the Included Studiesmentioning

confidence: 99%

“…The estimated pooling median SUV max of FAP was higher for primary tumors (pooling median, 12.83; 95% CI, 11.34-15.30) 22,23,[25][26][27][28][29][30][31]33,34,36,[38][39][40][42][43][44][45][46][47][48][49][50][51] than the other observed lesions such as lymph node (pooling median, 10.46; 95% CI, 8.14-10.98), 22,[24][25][26][27][28][29][30][31]36,38,39,[42][43][44][47][48][49][50][51] bone (pooling median, 9.23; 95% CI, 7.36-10.31), 22,24-28, 30,35,38,39,41-44,48-51 peritoneal (pooling median, 9.0; 95% CI, 6.71-9.92), 22,27,30,…”

Section: The Difference Of Suv Max For Positive Lesion Between Fap An...mentioning

confidence: 99%

Comparison of the Detection Performance Between FAP and FDG PET/CT in Various Cancers

et al. 2022

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Purpose: 18 F-FDG is the dominant radiotracer in oncology; however, it has limitations. Novel labeled fibroblast activation protein (FAP) radiotracers have been developed and published in several studies. Thus, this meta-analysis aimed to compare the detection rates (DRs) of FDG and FAP, based on previous studies from a systematic review. Methods: PubMed/MEDLINE and Cochrane library databases were used to perform a comprehensive and systematic search and are updated to April 30, 2022. The DR, relative risk, and the SUV max were calculated between the FAP and FDG tracers. Finally, the sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve of FAP and FDG were analyzed using gold and reference standards. Results: Thirty studies (1170 patients) were included in the meta-analysis. The relative risks of FAP DR for the primary tumor, recurrent tumor, lymph node metastasis, and distant metastasis were FDG 1.06-to 3.00-fold per patient and per lesion. For the primary tumor, FAP uptake was most intense in pancreatic cancer, followed by head and neck, cervical, colorectal, lung, gastric, and hepatocellular carcinoma, and was higher than FDG except for urological system cancer. The sensitivity (0.84-0.98), diagnostic odds ratio (19.36-358.47), and summary receiver operating characteristic curve (0.94-0.99) of FAP based on patient and lesion were better for primary tumors, LN metastasis, and distant metastasis than FDG. Conclusions: Fibroblast activation protein is an extremely potential radiotracer to replace most of the use of FDG in oncology. It is noteworthy that the FAP tracers for primary tumors had low specificity despite excellent sensitivity and had lower uptake than FDG in urological system cancer. In addition, the difference in detection between FAP and FDG for LN metastasis could not be certain in sarcoma.

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“…Ga-FAPI has higher specificity and accuracy than 18 F-FDG for evaluating OSCC neck lymph node metastases, especially for N0 neck status PET/CT [81] Superior sensitivity to 18 staging and treatment planning for HNCs [76][77][78][79]. On other hand, Chen et al found that the superiority of 68 Ga-FAPI in assessing skull base invasion and cavernous sinus involvement in patients with NPC was benefited from its low uptake in the brain [76].…”

Section: Ga-fapi Primary Tumormentioning

confidence: 99%

“…Firstly, Linz et al and Chen et al found that for OSCC patients with cervical lymph node metastasis, 68 Ga-FAPI PET/CT showed higher specificity to 18 F-FDG imaging [80,81]. This could potentially prevent overtreatment caused by false-positive nodes-indicated neck dissections.…”

Section: Ga-fapi Imagingmentioning

confidence: 99%

Advances in nuclear medicine-based molecular imaging in head and neck squamous cell carcinoma

Zhao

et al. 2022

J Transl Med

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Head and neck squamous cell carcinomas (HNSCCs) are often aggressive, making advanced disease very difficult to treat using contemporary modalities, such as surgery, radiation therapy, and chemotherapy. However, targeted therapy, e.g., cetuximab, an epidermal growth factor receptor inhibitor, has demonstrated survival benefit in HNSCC patients with locoregional failure or distant metastasis. Molecular imaging aims at various biomarkers used in targeted therapy, and nuclear medicine-based molecular imaging is a real-time and non-invasive modality with the potential to identify tumor in an earlier and more treatable stage, before anatomic-based imaging reveals diseases. The objective of this comprehensive review is to summarize recent advances in nuclear medicine-based molecular imaging for HNSCC focusing on several commonly radiolabeled biomarkers. The preclinical and clinical applications of these candidate imaging strategies are divided into three categories: those targeting tumor cells, tumor microenvironment, and tumor angiogenesis. This review endeavors to expand the knowledge of molecular biology of HNSCC and help realizing diagnostic potential of molecular imaging in clinical nuclear medicine.

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Accurate preoperative staging with [68Ga]Ga-FAPI PET/CT for patients with oral squamous cell carcinoma: a comparison to 2-[18F]FDG PET/CT

Cited by 22 publications

References 36 publications

The performance of [68Ga]Ga-FAPI-04 PET/CT in head and neck squamous cell carcinoma: a prospective comparison with [18F]FDG PET/CT

The performance of [68Ga]Ga-FAPI-04 PET/CT in head and neck squamous cell carcinoma: a prospective comparison with [18F]FDG PET/CT

Comparison of the Detection Performance Between FAP and FDG PET/CT in Various Cancers

Advances in nuclear medicine-based molecular imaging in head and neck squamous cell carcinoma

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