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. 2022 Dec 8:12:1047010.
doi: 10.3389/fonc.2022.1047010. eCollection 2022.

Prospective comparison of 68Ga-FAPI-04 and 18F-FDG PET/CT for tumor staging in nasopharyngeal carcinoma

Haoyuan Ding  1   2   3   4 , Juan Liang  5 , Lin Qiu  2   3   4 , Tingting Xu  2   3   4 , Liang Cai  2   3   4 , Qiang Wan  2   3   4 , Li Wang  2   3   4 , Ya Liu  2   3   4 , Yue Chen  1   2   3   4
Affiliations

Prospective comparison of 68Ga-FAPI-04 and 18F-FDG PET/CT for tumor staging in nasopharyngeal carcinoma

Haoyuan Ding et al. Front Oncol. .

Abstract

Purpose: To explore the difference in the effectiveness of gallium-68 fibroblast activation protein inhibitor (68Ga-FAPI-04) PET/CT and fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT for the initial staging of patients with nasopharyngeal carcinoma (NPC).

Methods: The Affiliated Hospital of Southwest Medical University hosted this single-center prospective investigation (Clinical Trials registration No.ChiCTR2100044131) between March 2020 and September 2021. Within a week, all subjects underwent MR scans, 68Ga-FAPI-04 PET/CT, and 18F-FDG PET/CT in order. The effectiveness of medical staging employing 68Ga-FAPI-04 and 18F-FDG PET/CT was compared.

Results: Twenty-eight patients with primary NPC were evaluated (mean age53 ± 11 years). 68Ga-FAPI-04 PET/CT indicated an elevated recognition rate for diagnosing primary tumors (28/28 [100%] vs. 27/28 [96%]) and lymph node metastases (263/285 [92%] vs. 228/285 [80%]), but a lower detection rate for distant metastases (5/7 [71%] vs. 7/7 [100%]) compared with 18F-FDG PET/CT. A significant association between the maximum standard uptake value (SUVmax) of 18F-FDG PET and 68Ga-FAPI-04 PET was found in the primary cancers (r = 0.691, p < 0.001). In comparison to 18F-FDG PET/CT, 68Ga-FAPI-04 PET/CT upstaged the T stage in five patients while downstaging the N stage in seven patients. 68Ga-FAPI-04 PET/CT corrected the overall staging of five patients on18F-FDG PET/CT.

Conclusion: 68Ga-FAPI-04 PET/CT is preferable to 18F-FDG PET/CT for NPC staging in terms of the detection efficiency for primary tumors and lymph node metastasis. This is especially true when evaluating the primary cancer and any spread to contiguous tissues. It is possible to improve the staging assessment of NPC by using 68Ga-FAPI-04 PET/CT in conjunction with 18F-FDG PET/CT.

Keywords: 18F-FDG; 68Ga-FAPI-04; PET/CT; nasopharyngeal carcinoma; tumor staging.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
A 49-year-old man with nonkeratinizing differentiated carcinoma. 68Ga-FAPI-04 PET/CT showed intensive 68Ga-FAPI-04 uptake in the posterior nasopharyngeal wall (A, dotted arrow, SUVmax 3.8), 18F-FDG PET/CT showed no abnormal 18F-FDG uptake in the primary tumor (B, dotted arrow). Moreover, 68Ga-FAPI-04 PET/CT reveals higher tracer uptake than 18F-FDG PET/CT in the left supraclavicular lymph node (A, thick arrow, SUVmax 9.4 vs. B, thick arrow, SUVmax 3.8), but the tracer uptake of left cervical (level III) lymph nodes was lower than that of 18F-FDG PET/CT (A, thin arrow, SUVmax, 4.5–11.0 vs. B, thin arrow, SUVmax, 17.7–19.4).
Figure 2
Figure 2
A 45-year-old man with nonkeratinizing differentiated carcinoma. Intense 68Ga-FAPI-04 uptake was observed in the left temporal lobe (A, dotted arrow), suggesting intracranial invasion, but 18F-FDG PET/CT (B) showed no abnormal intracranial 18F-FDG uptake. Moreover, intense 68Ga-FAPI-04 uptake was observed in the occipital and right temporal bone (A, solid arrow), while 18F-FDG PET/CT only showed low tracer uptake in the right temporal bone (B, solid arrow), which was confirmed by MRI (C, solid arrow). 68Ga-FAPI-04 PET/CT revealed more extensive lesions on intracranial and skull base invasion than 18F-FDG PET/CT.
Figure 3
Figure 3
A 57-year-old man with nonkeratinizing undifferentiated carcinoma. An increase 18F-FDG uptake was observed in the bilateral cervical (level II) lymph nodes (B, arrow, SUVmax 3.3–4.2). However, no abnormal 68Ga-FAPI-04 uptake was observed in the cervical lymph nodes (A, arrow). Ultrasound-guided biopsy of the right level II lymph node revealed proliferating lymphoid cells with no signs of metastatic disease. Finally, it was confirmed by follow-up that all the suspected metastatic lymph nodes were reactive.
Figure 4
Figure 4
A 48-year-old man with nonkeratinizing undifferentiated carcinoma.68Ga-FAPI-04 (A) and 18F-FDG PET/CT (B) revealed an abnormal nodule in the left lower lobe (A, red arrow, SUVmax 4.9 vs. B, red arrow, SUVmax 8.2). However, the nodule in the left upper lobe showed abnormal uptake on 18F-FDG PET/CT (B, blue arrow), but not on 68Ga-FAPI-04 PET/CT (A, blue arrow). In addition, both 68Ga-FAPI-04 (A, green arrow) and 18F-FDG PET/CT (B, green arrow) revealed abnormal activity in the right femur. Follow-up CT after two cycles of induction chemotherapy showed a reduction in the volume of pulmonary metastases (C, red and blue arrow). Meanwhile, the bone metastasis of the right femur revealed a repair response after treatment, showing osteosclerotic nodule on follow-up CT (C, green arrow).
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References

    1. Chen YP, Chan A, Le QT, Blanchard P, Sun Y, Ma J. Nasopharyngeal carcinoma. Lancet (2019) 394(10192):64–80. doi: 10.1016/S0140-6736(19)30956-0 - DOI - PubMed
    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. . Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin (2021) 71(3):209–49. doi: 10.3322/caac.21660 - DOI - PubMed
    1. Wu HB, Wang QS, Wang MF, Zhen X, Zhou WL, Li HS. Preliminary study of 11C-choline PET/CT for T staging of locally advanced nasopharyngeal carcinoma: comparison with 18F-FDG PET/CT. J Nucl Med (2011) 52(3):341–6. doi: 10.2967/jnumed.110.081190 - DOI - PubMed
    1. Chiesa F, De Paoli F. Distant metastases from nasopharyngeal cancer. ORL J Otorhinolaryngol Relat Spec (2001) 63(4):214–6. doi: 10.1159/000055743 - DOI - PubMed
    1. Lee AW, Ma BB, Ng WT, Chan AT. Management of nasopharyngeal carcinoma: Current practice and future perspective. J Clin Oncol (2015) 33(29):3356–64. doi: 10.1200/JCO.2015.60.9347 - DOI - PubMed

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