Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China.
Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China.
Mol Imaging Biol. 2022 Dec;24(6):973-985. doi: 10.1007/s11307-022-01748-8. Epub 2022 Aug 9.
This study aimed to explore the value of [Ga]Ga-labelled fibroblast activation protein inhibitor ([Ga]Ga-FAPI) positron emission tomography/computed tomography (PET/CT) in the initial staging of patients with newly diagnosed nasopharyngeal carcinoma (NPC), compared with 2-deoxy-2[F]fluoro-D-glucose ([F]F-FDG) PET/CT.
Forty-seven treatment-naïve patients with newly diagnosed NPC underwent magnetic resonance imaging (MRI), [Ga]Ga-DOTA-FAPI-04 PET/CT and [F]F-FDG PET/CT within 1 week. The diagnostic efficiency of all imaging modalities for evaluating primary tumour extension was compared from the two aspects of soft tissue and bony structure involvement. The accuracy of two PET/CT methods for diagnosing cervical lymph node (CLN) metastases was compared, and MRI served as the standard reference. T and N stages were assessed by MRI, [Ga]Ga-FAPI PET/CT and [F]F-FDG PET/CT. Immunohistochemical (IHC) staining for FAP was conducted in 22 of the patients.
[Ga]Ga-FAPI PET/CT outperformed [F]F-FDG PET/CT in the assessment of primary tumour invasion in the cavernous sinus (10 vs. 1, p < 0.001) and bony structures (207 vs. 177, p < 0.001). Compared with MRI, [Ga]Ga-FAPI PET/CT upgraded and underestimated T stage in 13 and 2 patients, while [F]F-FDG PET/CT upgraded and underestimated T stage in 5 and 13 patients. However, [Ga]Ga-FAPI PET/CT was inferior to [F]F-FDG PET/CT in diagnosing positive CLNs based on the analyses of patients, neck sides, neck levels and individual nodes. [Ga]Ga-FAPI PET/CT changed therapeutic schedules in 8 patients because of stage group changes. The presence of FAP with high quantity and intensity in cancer-associated fibroblasts (CAFs) was confirmed in all tumour specimens.
[Ga]Ga-FAPI PET/CT outperformed [F]F-FDG PET/CT in detecting the cavernous sinus and bony structure involvement of primary NPC tumours, suggesting its value in improving T staging and therapeutic regimen selection. However, the performance of [Ga]Ga-FAPI PET/CT is less promising for N staging because it detected fewer positive CLNs than [F]F-FDG PET/CT.
本研究旨在探讨[Ga]Ga 标记的成纤维细胞激活蛋白抑制剂([Ga]Ga-FAPI)正电子发射断层扫描/计算机断层扫描(PET/CT)在初诊鼻咽癌(NPC)患者初始分期中的价值，并与 2-脱氧-2[F]氟-D-葡萄糖([F]F-FDG) PET/CT 进行比较。
47 例初治的新诊断 NPC 患者在 1 周内接受了磁共振成像(MRI)、[Ga]Ga-DOTA-FAPI-04 PET/CT 和[F]F-FDG PET/CT 检查。从软组织和骨结构受累两个方面比较了所有影像学方法对评估原发肿瘤延伸的诊断效率。比较了两种 PET/CT 方法对诊断颈部淋巴结（CLN）转移的准确性，以 MRI 为标准参考。MRI、[Ga]Ga-FAPI PET/CT 和[F]F-FDG PET/CT 评估 T 期和 N 期。对 22 例患者进行了 FAP 的免疫组织化学（IHC）染色。
[Ga]Ga-FAPI PET/CT 在评估海绵窦（10 例 vs. 1 例，p<0.001）和骨结构（207 例 vs. 177 例，p<0.001）的原发肿瘤侵犯方面优于[F]F-FDG PET/CT。与 MRI 相比，[Ga]Ga-FAPI PET/CT 在 13 例和 2 例患者中升级了 T 分期，低估了 T 分期，而[F]F-FDG PET/CT 在 5 例和 13 例患者中升级了 T 分期，低估了 T 分期。然而，基于对患者、颈部侧位、颈部水平和单个淋巴结的分析，[Ga]Ga-FAPI PET/CT 在诊断阳性 CLN 方面逊于[F]F-FDG PET/CT。[Ga]Ga-FAPI PET/CT 改变了 8 例患者的治疗方案，因为分期组发生了变化。所有肿瘤标本中均证实了癌相关成纤维细胞（CAF）中存在高数量和高强度的 FAP。
[Ga]Ga-FAPI PET/CT 在检测原发性 NPC 肿瘤的海绵窦和骨结构受累方面优于[F]F-FDG PET/CT，提示其在提高 T 分期和治疗方案选择方面的价值。然而，[Ga]Ga-FAPI PET/CT 对 N 期的检测效果不太理想，因为它检测到的阳性 CLN 比[F]F-FDG PET/CT 少。
