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. 2025 Aug 7.
doi: 10.1007/s00259-025-07495-6. Online ahead of print.

Fibroblast activation Protein-Targeted PET/CT using [18 F]FAP-2286 for the evaluation of lung cancer: A comparative study with [18 F]FDG PET/CT

Yu Ma  1 , Guanghui Liu  1 , Bulin Du  1 , Xuefei Li  2 , Yaming Li #  3 , Xuena Li #  4
Affiliations

Fibroblast activation Protein-Targeted PET/CT using [18 F]FAP-2286 for the evaluation of lung cancer: A comparative study with [18 F]FDG PET/CT

Yu Ma et al. Eur J Nucl Med Mol Imaging. .

Abstract

Purpose: FAP-2286, which is a novel cyclic peptide that targets fibroblast activation protein (FAP), demonstrates enhanced plasma stability and improved receptor selectivity compared with small-molecule FAP inhibitors (FAPIs). Although [18 F]FAP-2286 exhibits benefits due to the favorable characteristics of fluorine-18-labeled tracers, its diagnostic performance in lung cancer remains to be fully elucidated. This study aimed to compare the diagnostic efficacy of [18 F]FAP-2286 PET/CT with that of [18 F]FDG PET/CT in lung cancer patients.

Methods: Thirty patients with suspected lung cancer (18 men and 12 women; median age: 64 years [IQR: 35-81]) underwent both [18 F]FAP-2286 and [18 F]FDG PET/CT for initial staging (n = 27) or the detection of recurrence (n = 3). Diagnostic performance was assessed using histopathology and clinical follow-up as reference standards. The quantitative analysis included the maximum standardized uptake value (SUVmax) and target-to-background ratio (TBR).

Results: Compared with [18 F]FDG, [18 F]FAP-2286 PET/CT significantly increased the TBR in primary tumors (11.60 ± 6.02 vs. 5.80 ± 3.08; P < 0.001), whereas the SUVmax was not significantly different (15.20 ± 8.25 vs. 13.81 ± 7.73; P = 0.524). Although [18 F]FAP-2286 PET/CT demonstrated a lower detection rate for metastatic lymph nodes (67.46% [85/126] vs. 86.51% [109/126]; P < 0.001), it exhibited a higher true positive rate (95.29% vs. 68.81%; P < 0.001). For distant metastases, [18 F]FAP-2286 PET/CT demonstrated superior detection of bone (98.80% vs. 72.46%) and brain lesions (100% vs. 72.73%).

Conclusion: Compared with [18 F]FDG, [18 F]FAP-2286 PET/CT demonstrates superior performance for detecting bone metastases and provides more accurate N and M staging. These findings suggest that [18 F]FAP-2286 PET/CT may serve as a valuable alternative for the comprehensive evaluation of lung cancer patients.

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Conflict of interest statement

Declarations. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki and approval was granted by the Ethics Committee of the first affiliated hospital of China Medical University. Consent to participate and publish: Informed consent was obtained from the patient included in this study. Competing interests: The authors have no interests to disclose.

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