Comparison of [68Ga]Ga-DOTA-FAPI-04 PET/CT with [18F]FDG PET/CT for Nodule Characterization and Staging in NSCLC Patients

Abstract Purpose:The aim of this study is to explore the nodule characterization and staging efficacy of [68Ga]Ga-DOTA-FAPI-04 PET/CT in non-small cell lung cancer (NSCLC) patients and to compare with that of [18F]FDG PET/CT lesion-by-lesion.Methods:Sixty-five patients with clinically diagnosed or suspected NSCLC were enrolled in this prospective study (ChiCTR2000038080). All patients received both [18F]FDG and [68Ga]Ga-DOTA-FAPI-04 PET/CT, and they were assigned into three groups by different research directions as nodule characterization, node (N) staging and metastatic (M) staging. Imaging characteristics in PET/CT of lung nodules and suspected metastatic lesions were obtained and analyzed.Results:In the nodule characterization group, [18F]FDG and [68Ga]Ga-DOTA-FAPI-04 SUVmax ≥ 2.5 was set as the predictor of NSCLC, and the diagnostic sensitivity of [68Ga]Ga-DOTA-FAPI-04 was higher than [18F]FDG (0.88 vs. 0.67). And for adenocarcinoma with partial-solid density, SUVmax of 68Ga-DOTA-FAPI-04 was higher than [18F]FDG with significant differences (4.8 ± 2.8 vs. 2.1 ± 1.1). In N staging group, lymph nodes SUVmax of [68Ga]Ga-DOTA-FAPI-04 was lower than [18F]FDG in nonmetastatic group (3.1 ± 1.3 vs. 6.1 ± 2.3) and higher than [18F]FDG (10.7 ± 4.7 vs. 6.5 ± 3.3) in metastatic group. Set 6 and 1.1 as the cut-off value for [68Ga]Ga-DOTA-FAPI-04 SUVmax and [68Ga]Ga-DOTA-FAPI-04 SUVmax/FDG SUVmax, diagnostic accuracy of metastatic lymph nodes using each criterion and their combination was 95%, 93% and 97% respectively. In multi-metastatic NSCLC patients, [68Ga]Ga-DOTA-FAPI-04 identified more lesions than [18F]FDG (206 vs. 106 lesions) and the uptake value of [68Ga]Ga-DOTA-FAPI-04 was higher too, but no patients’ staging was changed.Conclusion:Compared with [18F]FDG, [68Ga]Ga-DOTA-FAPI-04 PET/CT imaging has higher sensitivity in primary and metastatic lesion detection of NSCLC patients, it also increases the specificity of metastatic lymph nodes diagnosis.

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Primary Hepatic Actinomycosis Mimicking Hepatic Malignancy with Metastatic Lymph Nodes by F-18 FDG PET/CT

Nuclear Medicine and Molecular Imaging ◽

10.1007/s13139-015-0345-1 ◽

2015 ◽

Vol 50 (1) ◽

pp. 93-94 ◽

Cited By ~ 1

Author(s):

Eun Jung Kong

Keyword(s):

Lymph Nodes ◽

Fdg Pet ◽

Hepatic Malignancy ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Pet Ct ◽

Hepatic Actinomycosis ◽

Fdg Pet Ct

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Usefulness of partial volume effect-corrected F-18 FDG PET/CT for predicting I-131 accumulation in the metastatic lymph nodes of patients with thyroid carcinoma

Annals of Nuclear Medicine ◽

10.1007/s12149-013-0767-8 ◽

2013 ◽

Vol 27 (10) ◽

pp. 873-879 ◽

Cited By ~ 4

Author(s):

Yasuhiro Maruoka ◽

Koichiro Abe ◽

Shingo Baba ◽

Takuro Isoda ◽

Yoshiyuki Kitamura ◽

...

Keyword(s):

Thyroid Carcinoma ◽

Lymph Nodes ◽

Fdg Pet ◽

Volume Effect ◽

Partial Volume Effect ◽

Metastatic Lymph Nodes ◽

Partial Volume ◽

Metastatic Lymph ◽

Pet Ct ◽

Fdg Pet Ct

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Preoperative Standardized Uptake Value of Metastatic Lymph Nodes Measured by 18F-FDG PET/CT Improves the Prediction of Prognosis in Gastric Cancer

Medicine ◽

10.1097/md.0000000000001037 ◽

2015 ◽

Vol 94 (26) ◽

pp. e1037 ◽

Cited By ~ 18

Author(s):

Bong-Il Song ◽

Hae Won Kim ◽

Kyoung Sook Won ◽

Seung Wan Ryu ◽

Soo Sang Sohn ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Fdg Pet ◽

Standardized Uptake Value ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Pet Ct ◽

18F Fdg ◽

Prediction Of Prognosis ◽

Fdg Pet Ct

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Comparison of 18F FDG PET / CT, MRI (DWI DCE) and MRI 18F FDG PET/CT in the detection of axillary metastatic lymph nodes in patients with newly diagnosed breast cancer

Experimental Biomedical Research ◽

10.30714/j-ebr.2021370075 ◽

2021 ◽

Vol 4 (3) ◽

pp. 206-215

Author(s):

Hasan Gundogdu ◽

Osman Kupik

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Fdg Pet ◽

Newly Diagnosed ◽

Metastatic Lymph Nodes ◽

Metastatic Lymph ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Actinomycosis Imitating Parotid Cancer With Metastatic Lymph Nodes in FDG PET/CT

Clinical Nuclear Medicine ◽

10.1097/rlu.0b013e31820a9fbf ◽

2011 ◽

Vol 36 (4) ◽

pp. 309-310 ◽

Cited By ~ 6

Author(s):

Greta S. P. Mok ◽

Frankie P. T. Choi ◽

Winnie C. W. Chu

Keyword(s):

Lymph Nodes ◽

Fdg Pet ◽

Metastatic Lymph Nodes ◽

Parotid Cancer ◽

Metastatic Lymph ◽

Pet Ct ◽

Fdg Pet Ct

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N-Staging in Large Cell Neuroendocrine Carcinoma of the Lung: Diagnostic Value of FDG PET/CT Compared to the Histopathology Reference Standard

10.21203/rs.3.rs-513428/v1 ◽

2021 ◽

Author(s):

Hubertus Hautzel ◽

Yazan Alnajdawi ◽

Wolfgang P Fendler ◽

Christoph Rischpler ◽

Kaid Darwiche ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Predictive Value ◽

Fdg Pet ◽

Interrater Reliability ◽

Glucose Turnover ◽

Glucose Transporter 1 ◽

Pet Ct ◽

Fdg Pet Ct ◽

N Staging

Abstract Background:Large cell neuroendocrine carcinomas of the lung (LCNEC) is a rare entity occurring in less than 4% of all lung cancers. Due to its low differentiation and high glucose transporter 1 (GLUT1) expression LCNEC demonstrates an increased glucose turnover. Thus, PET/CT with 2-[18F]-fluoro-deoxyglucose (FDG) is suitable for LCNEC staging. Surgery with curative intent is the treatment of choice in early stage LCNEC. Prerequisite for this is correct lymph node staging. This study aimed at evaluating the diagnostic performance of FDG PET/CT validated by histopathology following surgical resection or mediastinoscopy. N-staging interrater-reliability was assessed to test for robustness of the FDG PET/CT findings.Methods:Between 03/2014 and 12/2020 46 patients with LCNEC were included in this single center retrospective analysis. All underwent FDG PET/CT for pre-operative staging and subsequently either surgery (n=38) or mediastinoscopy (n=8). Regarding the lymph node involvement, sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for FDG PET/CT using the final histopathological N-staging (pN0 to pN3) as reference.Results:Per patient 14 ± 7 (range 4 - 32) lymph nodes were resected and histologically processed. 31/46 patients had no LCNEC spread into the lymph nodes. In 8/46 patients final stage was pN1, in 5/46 pN2 and in 2/46 pN3. FDG PET/CT diagnosed lymph node metastasis of LCNEC with a sensitivity of 93%, a specificity of 87%, an accuracy of 89%, a PPV of 78% and a NPV of 96%. Interrater-reliability was high with a strong level of agreement (κ=0.82).Conclusions:In LCNEC N-staging with FDG PET/CT demonstrates both high sensitivity and specificity, an excellent NPV but a slightly reduced PPV. Accordingly, preoperative invasive mediastinal staging may be omitted in cases with cN0 disease by FDG PET/CT. In FDG PET/CT cN1-cN3 stages histological confirmation is warranted, particularly in case of only moderate FDG uptake.

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