Department of Medicine, Dunedin School of Medicine, University of Otago Medical School, Dunedin, New Zealand.
Surgical Outcomes Research Centre, Department of Surgical Sciences, University of Otago Medical School, Dunedin, New Zealand.
J Nucl Med. 2023 Aug;64(8):1218-1224. doi: 10.2967/jnumed.123.265471. Epub 2023 Jun 8.
Fibroblast-activation protein is a promising target for oncologic molecular imaging. Studies show that fibroblast activation protein inhibitor (FAPI) radiotracers are accurate diagnostics with favorable tumor-to-background ratios across various cancers. Therefore, we performed a systematic review and metaanalysis to assess the diagnostic performance of FAPI PET/CT in comparison with [F]FDG PET/CT, the most widely used radiotracer in oncology. We conducted a systematic search in MEDLINE, Embase, Scopus, PubMed, Cochrane Central Register of Controlled Trials, relevant trial registries, and bibliographies. The search consisted of combinations of terms for 3 topics: neoplasia, PET/CT, and FAPI. Two authors independently screened retrieved articles using predefined inclusion and exclusion criteria and extracted the data. Study quality was assessed using the criteria of QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2). For each study, the sensitivity, specificity, and 95% CIs were calculated to determine diagnostic accuracy for primary, nodal, and metastatic lesions. A random-effects metaanalysis was used for pooling the data, and heterogeneity was assessed (I index). Thirty-nine studies (1,259 patients) investigating the use of FAPI PET/CT were included. On a patient-based analysis, pooled sensitivity was 0.99 (95% CI, 0.97-1.0) for the detection of primary lesions. Pooled sensitivity for nodal and distant metastases was 0.91 (95% CI, 0.81-0.96) and 0.99 (95% CI, 0.96-1.0), respectively. On a paired analysis between FAPI and [F]FDG PET/CT, FAPI had a higher sensitivity in the detection of primary, nodal, and metastatic lesions (all < 0.001). The differences in sensitivities between FAPI and [F]FDG were statistically significant. In terms of heterogeneity, analyses on primary lesions were moderately affected, distant metastatic lesions were highly affected, and the nodal metastatic analyses had negligible heterogeneity. The diagnostic performance of FAPI PET/CT is superior to that of [F]FDG in the detection of primary, nodal, and distant metastases. However, further studies are needed to better evaluate its utility and indication in specific cancer types and clinical settings.
成纤维细胞激活蛋白是肿瘤分子成像有前途的靶点。研究表明，成纤维细胞激活蛋白抑制剂 (FAPI) 放射性示踪剂是准确的诊断方法，在各种癌症中具有良好的肿瘤与背景比值。因此，我们进行了系统评价和荟萃分析，以评估 FAPI PET/CT 与 [F]FDG PET/CT（肿瘤学中最广泛使用的放射性示踪剂）相比的诊断性能。我们在 MEDLINE、Embase、Scopus、PubMed、Cochrane 对照试验中心注册库、相关试验登记处和参考文献中进行了系统搜索。搜索由 3 个主题的术语组合组成：肿瘤、PET/CT 和 FAPI。两位作者独立使用预定义的纳入和排除标准筛选检索到的文章，并提取数据。使用 QUADAS-2（诊断准确性研究的质量评估 2）标准评估研究质量。对于每项研究，计算了灵敏度、特异性和 95%CI，以确定原发性、淋巴结和转移性病变的诊断准确性。使用随机效应荟萃分析对数据进行合并，并评估了异质性（I 指数）。纳入了 39 项研究（1259 名患者），研究了 FAPI PET/CT 的使用情况。基于患者的分析，原发性病变检测的汇总敏感性为 0.99（95%CI，0.97-1.0）。淋巴结和远处转移的汇总敏感性分别为 0.91（95%CI，0.81-0.96）和 0.99（95%CI，0.96-1.0）。在 FAPI 和 [F]FDG PET/CT 之间的配对分析中，FAPI 在检测原发性、淋巴结和转移性病变方面的敏感性更高（均 <0.001）。FAPI 和 [F]FDG 之间的敏感性差异具有统计学意义。在异质性方面，原发性病变的分析受到中度影响，远处转移病变受到高度影响，淋巴结转移分析的异质性可忽略不计。FAPI PET/CT 在检测原发性、淋巴结和远处转移方面的诊断性能优于 [F]FDG。然而，需要进一步的研究来更好地评估其在特定癌症类型和临床环境中的效用和适应症。
