在诊断 I-IIIA 期非小细胞肺癌淋巴结转移时，[18F]FAPI 可为[18F]FDG PET/CT 增添价值：一项前瞻性研究。

IF 3.5 2区医学 Q2 ONCOLOGY

Cancer Imaging Pub Date : 2024-06-03 DOI:10.1186/s40644-024-00701-y

Youcai Li, Yin Zhang, Zhihua Guo, Peng Hou, Jie Lv, Miao Ke, Shaoyu Liu, Siwen Li, Weiqiang Yin, Jianxing He, Xinlu Wang

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引用次数: 0

摘要

背景：本研究探讨了氟18（[18F]）标记的成纤维细胞活化蛋白抑制剂（FAPI）对I-IIIA期非小细胞肺癌（NSCLC）患者淋巴结（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-IIIA期NSCLC患者。一周内进行[18F]-氟脱氧葡萄糖（FDG）和[18F]FAPI检查。根据手术和病理结果对 LN 分期进行验证。[18F]FDG和[18F]FAPI摄取量的比较采用Wilcoxon符号秩检验。此外，还研究了结节分组的诊断价值：在 53 例患者（中位年龄：64 岁，范围：31-76 岁）中，[18F]FAPI 检测 LN 转移的特异性明显高于[18F]FDG（P 最大值（≥ 10.1）是 LN 转移的危险因素），在这种情况下，[18F]FAPI 提高了诊断价值。[18F]FAPI SUVmax18F]FAPI SUVmax≥6.2 且无钙化或高衰减的 LN 被诊断为 LN 转移（PPV 87.5%）。最终，整合[18F]FDG和[18F]FAPI PET/CT后，N分期的准确率最高（83.0%），29例患者的临床决策得到修正：结论：对于 I-IIIA 期 NSCLC 患者，[18F]FAPI 可提供更多有价值的信息，减少[18F]FDG PET/CT 后 LN 诊断的不确定性。将[18F]FDG和[18F]FAPI PET/CT结合在一起能做出更精确的临床决定：中国临床试验注册中心：ChiCTR2100044944（注册时间：2021年4月1日，https://www.chictr.org.cn/showprojEN.html?proj=123995 ）。

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[¹⁸F]FAPI adds value to [¹⁸F]FDG PET/CT for diagnosing lymph node metastases in stage I-IIIA non-small cell lung cancer: a prospective study.

Background: This study investigates the value of fluorine 18 ([¹⁸F])-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. [¹⁸F]-fluorodeoxyglucose (FDG) and [¹⁸F]FAPI examinations were performed within one week. LN staging was validated using surgical and pathological findings. [¹⁸F]FDG and [¹⁸F]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 [¹⁸F]FAPI for detecting LN metastasis was significantly higher than that of [¹⁸F]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_max (≥ 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 [¹⁸F]FAPI in this circumstance improved the diagnostic value. LNs with an [¹⁸F]FAPI SUV_max<6.2 were diagnosed as benign (Negative Predictive Value 93.8%), and LNs with an [¹⁸F]FAPI SUV_max≥6.2 without calcification or high-attenuation were diagnosed as LN metastasis (PPV 87.5%). Ultimately, the integration of [¹⁸F]FDG and [¹⁸F]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, [¹⁸F]FAPI contributed additional valuable information to reduce LN diagnostic uncertainties after [¹⁸F]FDG PET/CT. Integrating [¹⁸F]FDG and [¹⁸F]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 ).

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来源期刊

Cancer Imaging ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

7.00

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Cancer Imaging is an open access, peer-reviewed journal publishing original articles, reviews and editorials written by expert international radiologists working in oncology. The journal encompasses CT, MR, PET, ultrasound, radionuclide and multimodal imaging in all kinds of malignant tumours, plus new developments, techniques and innovations. Topics of interest include: Breast Imaging Chest Complications of treatment Ear, Nose & Throat Gastrointestinal Hepatobiliary & Pancreatic Imaging biomarkers Interventional Lymphoma Measurement of tumour response Molecular functional imaging Musculoskeletal Neuro oncology Nuclear Medicine Paediatric.