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Comparative Study
. 2025 Sep 1;50(9):840-846.
doi: 10.1097/RLU.0000000000005973. Epub 2025 May 14.

Diagnostic Performances of Radiolabeled FAPI PET/CT for Lymph Node Staging in Head and Neck Cancer Patients: Comparison With 18 F-FDG PET/CT

Yun Seong Kim  1   2 , Seong-Jang Kim  2   3   4
Affiliations
Comparative Study

Diagnostic Performances of Radiolabeled FAPI PET/CT for Lymph Node Staging in Head and Neck Cancer Patients: Comparison With 18 F-FDG PET/CT

Yun Seong Kim et al. Clin Nucl Med. .

Abstract

Objective: The purpose of the current study was to compare the diagnostic performances of radiolabeled FAPI and 18 F-FDG PET/CT for the detection of lymph node (LN) metastasis in head and neck cancer (HNC) patients.

Methods: The PubMed, Cochrane database, and EMBASE database, from the earliest available date of indexing through December 31, 2024, were searched for studies comparing diagnostic performances of radiolabeled FAPI and 18 F-FDG PET/CT for the detection of metastatic LN in HNC patients. We estimated pooled sensitivities and specificities across studies.

Results: Across 8 studies (14 results), the pooled sensitivity of FAPI PET/CT was 0.89 and the pooled specificity was 0.93. The pooled sensitivity of 18 F-FDG PET/CT was 0.91 and the pooled specificity was 0.50. On patient-based analysis, the estimated sensitivity and specificity of FAPI were 0.96 and 0.96, and those of 18 F-FDG were 0.95 and 0.34, respectively. On lesion-based analysis, the estimated sensitivity and specificity of FAPI were 0.84 and 0.94, and those of 18 F-FDG were 0.86 and 0.78, respectively. On neck side-based analysis, the estimated sensitivity and specificity of FAPI were 0.88 and 0.79, and those of 18 F-FDG were 0.91 and 0.29, respectively.

Conclusions: Radiolabeled FAPI showed a good diagnostic performance for the detection of metastatic LN in HNC patients. Also, 18 F-FDG PET/CT revealed low specificity for LN staging in HNC patients. Future large multicenter research with more patients would be necessary to provide a more comprehensive overview of the usefulness of radiolabeled FAPI for LN staging in HNC patients.

Keywords: FAPI; PET/CT; head and neck cancer; lymph node.

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Conflict of interest statement

Conflicts of interest and sources of funding: none declared.

References

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    1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin. 2021;71:7–33.
    1. Leemans CR, Tiwari R, Nauta JJ, et al. Regional lymph node involvement and its significance in the development of distant metastases in head and neck carcinoma. Cancer. 1993;71:452–456.
    1. Castelijns JA, van den Brekel MW. Imaging of lymphadenopathy in the neck. Eur Radiol. 2002;12:727–738.
    1. Blodgett TM, Meltzer CC, Townsend DW. PET/CT: form and function. Radiology. 2007;242:360–365.

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