[68Ga]Ga-FAPI-46 PET/CT for Staging Suspected/Confirmed Lung Cancer: Results on the Surgical Cohort Within a Monocentric Prospective Trial

Background/Objectives. To evaluate T&N-staging diagnostic performance of [68Ga]Ga-FAPI-46 PET/CT (FAPI) in a suspected/confirmed lung cancer surgical cohort. Methods: Patients were enrolled in a prospective monocentric trial (EudraCT: 2021-006570-23) to perform FAPI, in addition to conventional-...

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Vydáno v:Pharmaceuticals (Basel, Switzerland) Ročník 17; číslo 11; s. 1468
Hlavní autoři: Zanoni, Lucia, Fortunati, Emilia, Cuzzani, Giulia, Malizia, Claudio, Lodi, Filippo, Cabitza, Veronica Serena, Brusa, Irene, Emiliani, Stefano, Assenza, Marta, Antonacci, Filippo, Giunchi, Francesca, Degiovanni, Alessio, Ferrari, Marco, Natali, Filippo, Galasso, Thomas, Bandelli, Gian Piero, Civollani, Simona, Candoli, Piero, D’Errico, Antonietta, Solli, Piergiorgio, Fanti, Stefano, Nanni, Cristina
Médium: Journal Article
Jazyk:angličtina
Vydáno: Switzerland MDPI AG 01.11.2024
MDPI
Témata:
[68Ga]Ga-FAPI
Analysis
Biomarkers
Care and treatment
CT imaging
Diagnosis
Fibroblasts
Lung cancer
Lymphatic system
Metastasis
Methods
Nuclear medicine
Patients
PET imaging
PET/CT
Physiology
Risk factors
staging
Thoracic surgery
Tumor staging
Italy
Berlin Germany
Germany
lung cancer
[68Ga]Ga-FAPI
staging
PET/CT
ISSN:1424-8247, 1424-8247
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Shrnutí:Background/Objectives. To evaluate T&N-staging diagnostic performance of [68Ga]Ga-FAPI-46 PET/CT (FAPI) in a suspected/confirmed lung cancer surgical cohort. Methods: Patients were enrolled in a prospective monocentric trial (EudraCT: 2021-006570-23) to perform FAPI, in addition to conventional-staging-flow-chart (including [18F]F-FDG PET/CT-FDG). For the current purpose, only surgical patients were included. PET-semiquantitative parameters were measured for T&N: SUVmax, target-to-background-ratios (using mediastinal blood pool-MBP, liver-L and pulmonary-parenchyma-P). Visual and semiquantitative T&N PET/CT performances were analysed per patient and per region for both tracers, with surgical histopathology as standard-of-truth. Results: 63 FAPI scans were performed in 64 patients enrolled (26 May 2022–30 November 2023). A total of 50/63 patients underwent surgery and were included. Agreement (%) with histopathological-T&N-StagingAJCC8thEdition was slightly in favour of FAPI (T-66% vs. 58%, N-78% vs. 70%), increasing when T&N dichotomised (T-92% vs. 80%, N-78% vs. 72%). The performance of Visual-Criteria for T-per patient (n = 50) resulted higher FAPI than FDG. For N-per patient (n = 46), sensitivity and NPV were slightly lower with FAPI. Among 59 T-regions surgically examined, malignancy was excluded in 6/59 (10%). FAPI showed (vs. FDG): sensitivity 85% (vs. 72%), specificity 67% (vs. 50%), PPV 96% (vs. 93%), NPV 33% (vs. 17%), accuracy 83% (vs. 69%). Among 217 N-stations surgically assessed (overall 746 ln removed), only 15/217 (7%) resulted malignant; FAPI showed (vs. FDG): sensitivity 53% (vs. 60%), PPV 53% (vs. 26%), NPV 97% (vs. 97%), and significantly higher specificity (97% vs. 88%, p = 0.001) and accuracy (94% vs. 86%, p = 0.018). Semiquantitative-PET parameters performed similarly, better for N (p < 0.001) than for T, slightly in favour (although not significantly) of FAPI over FDG. Conclusions: In a suspected/confirmed lung cancer surgical cohort, PET/CT performances for preoperative T&Nstaging were slightly in favour of FAPI than FDG (except for suboptimal N-sensitivity), significantly better only for N (region-based) specificity and accuracy using visual assessment. The trial’s conventional follow-up is still ongoing; future analyses are pending, including non-surgical findings and theoretical impact on patient management.
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These authors contributed equally to this work.
ISSN:1424-8247
1424-8247
DOI:10.3390/ph17111468