Kuyumcu Serkan, Isik Emine Göknur, Şen Cömert, Has-Şimsek Duygu, Başaran Bora, Özkan Zeynep Gözde, Büyükkaya Fikret, Şanlı Yasemin
Faculty of Medicine, Department of Nuclear Medicine, Istanbul University, Istanbul, Turkey.
Faculty of Medicine, Department of Otolaryngology & Head and Neck Surgery, Istanbul University, Istanbul, Turkey.
Cancer Biother Radiopharm. 2025 Mar;40(2):122-129. doi: 10.1089/cbr.2024.0112. Epub 2024 Oct 28.
This study assesses fibroblast activated protein inhibitor (FAPI) targeted PET/CT imaging against [F]FDG PET/CT (FDG PET) for detecting nodal involvement in head and neck squamous cell carcinoma (HNSCC), intending to improve diagnostic precision for metastatic lymph nodes and lay the groundwork for future investigations. Patients diagnosed with HNSCC were retrospectively enrolled. All patients underwent [Ga]Ga-FAPI04 PET/CT (FAPI PET) and FDG PET within 6 d. Primary tumor, lymph nodes, and tracer uptake were visually and quantitatively compared. The metastatic lymph nodes were evaluated using patient-and lesion-based analyses, with biopsy or postoperative histopathological examination as the reference. The cohort includes 24 patients (17 men, 7 women; mean age 60 ± 11.8 years) who underwent FDG and FAPI PET for preoperative diagnostic workup or restaging due to known recurrence of HNSCC. Lesions included 24 primary tumors, 54 cervical lymph nodes, and 5 metastases. Primary tumors exhibited significant uptake on both PET modalities (median maximum standardized uptake value [SUV]: FDG 19.4 ± 11.6, FAPI 16.9 ± 4.6), with no statistically significant difference ( > 0.5). For lymph nodes, FAPI and FDG PET showed median SUV of 9.18 ± 6.77 and 9.67 ± 6.5, respectively. The patient-based analysis found FDG PET sensitivity at 88.2% and FAPI PET at 94.1%, with FAPI PET specificity significantly higher (85.7% vs. 42.8% for FDG PET). Lesion-based analysis revealed FAPI PET sensitivity and specificity at 84.2% and 93.7%, respectively, contrasting FDG PET's at 81.5% and 25%, respectively. This study underscores the efficacy of FAPI PET in detecting primary tumors in HNSCC. Furthermore, FAPI PET shows improved specificity over FDG PET for metastatic lymph nodes advocating further investigations for integrating FAPI PET into HNSCC clinical protocols for its enhanced precision in detecting metastatic lymph nodes.
本研究评估了成纤维细胞活化蛋白抑制剂（FAPI）靶向PET/CT成像与[F]FDG PET/CT（FDG PET）在检测头颈部鳞状细胞癌（HNSCC）淋巴结受累情况方面的差异，旨在提高转移性淋巴结的诊断准确性，并为未来的研究奠定基础。对诊断为HNSCC的患者进行回顾性纳入。所有患者在6天内接受了[Ga]Ga-FAPI04 PET/CT（FAPI PET）和FDG PET检查。对原发肿瘤、淋巴结及示踪剂摄取情况进行了视觉和定量比较。采用基于患者和病变的分析方法评估转移性淋巴结，并以活检或术后组织病理学检查作为参考。该队列包括24例患者（17例男性，7例女性；平均年龄60±11.8岁），因已知HNSCC复发而接受FDG和FAPI PET检查以进行术前诊断评估或再分期。病变包括24个原发肿瘤、54个颈部淋巴结和5个转移灶。原发肿瘤在两种PET检查方式上均表现出明显摄取（最大标准化摄取值[SUV]中位数：FDG为19.4±11.6，FAPI为16.9±4.6），差异无统计学意义（>0.5）。对于淋巴结，FAPI和FDG PET的SUV中位数分别为9.18±6.77和9.67±6.5。基于患者的分析发现，FDG PET的敏感性为88.2%，FAPI PET的敏感性为94.1%，FAPI PET的特异性显著更高（FDG PET为42.8%，FAPI PET为85.7%）。基于病变的分析显示，FAPI PET的敏感性和特异性分别为84.2%和93.7%，而FDG PET的敏感性和特异性分别为81.5%和25%。本研究强调了FAPI PET在检测HNSCC原发肿瘤方面的有效性。此外，FAPI PET在转移性淋巴结检测方面比FDG PET具有更高的特异性，鉴于其在检测转移性淋巴结方面具有更高的准确性，主张进一步研究将FAPI PET纳入HNSCC临床方案。
