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FAPI 对Ⅰ-ⅡIA 期非小细胞肺癌淋巴结转移的诊断价值：一项前瞻性研究。

[F]FAPI adds value to [F]FDG PET/CT for diagnosing lymph node metastases in stage I-IIIA non-small cell lung cancer: a prospective study.

机构信息

Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510000, China.

Nanfang PET Center, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong Province, China.

出版信息

Cancer Imaging. 2024 Jun 3;24(1):68. doi: 10.1186/s40644-024-00701-y.

DOI:10.1186/s40644-024-00701-y

PMID:38831354

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11145785/

Abstract

BACKGROUND

This study investigates the value of fluorine 18 ([F])-labeled fibroblast activation protein inhibitor (FAPI) for lymph node (LN) metastases in patients with stage I-IIIA non-small cell lung cancer (NSCLC).

METHODS

From November 2021 to October 2022, 53 patients with stage I-IIIA NSCLC who underwent radical resection were prospectively included. [F]-fluorodeoxyglucose (FDG) and [F]FAPI examinations were performed within one week. LN staging was validated using surgical and pathological findings. [F]FDG and [F]FAPI uptake was compared using the Wilcoxon signed-ranks test. Furthermore, the diagnostic value of nodal groups was investigated.

RESULTS

In 53 patients (median age, 64 years, range: 31-76 years), the specificity of [F]FAPI for detecting LN metastasis was significantly higher than that of [F]FDG (P < 0.001). High LN risk category, greater LN short-axis dimension(≥ 1.0 cm), absence of LN calcification or high-attenuation, and higher LN FDG SUV (≥ 10.1) were risk factors for LN metastasis(P < 0.05). The concurrence of these four risk factors accurately predicted LN metastases (Positive Predictive Value [PPV] 100%), whereas the presence of one to three risk factors was unable to accurately discriminate the nature of LNs (PPV 21.7%). Adding [F]FAPI in this circumstance improved the diagnostic value. LNs with an [F]FAPI SUV<6.2 were diagnosed as benign (Negative Predictive Value 93.8%), and LNs with an [F]FAPI SUV≥6.2 without calcification or high-attenuation were diagnosed as LN metastasis (PPV 87.5%). Ultimately, the integration of [F]FDG and [F]FAPI PET/CT resulted in the highest accuracy for N stage (83.0%) and clinical decision revisions for 29 patients.

CONCLUSION

In patients with stage I-IIIA NSCLC, [F]FAPI contributed additional valuable information to reduce LN diagnostic uncertainties after [F]FDG PET/CT. Integrating [F]FDG and [F]FAPI PET/CT resulted in more precise clinical decisions.

TRIAL REGISTRATION

The Chinese Clinical Trial Registry: ChiCTR2100044944 (Registered: 1 April 2021, https://www.chictr.org.cn/showprojEN.html?proj=123995 ).

摘要

背景

本研究旨在探讨氟 18([F])-标记的成纤维细胞激活蛋白抑制剂（FAPI）在Ⅰ-Ⅲ A 期非小细胞肺癌（NSCLC）患者中用于淋巴结（LN）转移的价值。

方法

2021 年 11 月至 2022 年 10 月，前瞻性纳入 53 例接受根治性切除术的Ⅰ-Ⅲ A 期 NSCLC 患者。[F]-氟脱氧葡萄糖（FDG）和[F]FAPI 检查在一周内进行。使用手术和病理结果验证 LN 分期。采用 Wilcoxon 符号秩检验比较 LN 摄取[F]FDG 和[F]FAPI。此外，还研究了淋巴结组的诊断价值。

结果

在 53 例患者（中位年龄 64 岁，范围：31-76 岁）中，[F]FAPI 检测 LN 转移的特异性明显高于[F]FDG（P<0.001）。高 LN 风险类别、更大的 LN 短轴直径（≥1.0cm）、无 LN 钙化或高衰减以及更高的 LN FDG SUV（≥10.1）是 LN 转移的危险因素（P<0.05）。这四个危险因素的同时存在可以准确预测 LN 转移（阳性预测值 [PPV]100%），而一个至三个危险因素不能准确区分 LN 的性质（PPV 21.7%）。在此情况下加入[F]FAPI 可提高诊断价值。[F]FAPI SUV<6.2 的 LN 被诊断为良性（阴性预测值 93.8%），[F]FAPI SUV≥6.2 且无钙化或高衰减的 LN 被诊断为 LN 转移（PPV87.5%）。最终，[F]FDG 和[F]FAPI PET/CT 的整合对 29 例患者的 N 分期（83.0%）和临床决策修订具有最高的准确性。