Role of 68Ga-FAPI-04 PET/CT in the Initial Staging of Esophageal Cancer

Huipan Liu; Xiao Yang; Zhouxiang You; Zhi Hu; Yue Chen

doi:10.1055/a-1984-8044

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2023; 62(01): 38-44
DOI: 10.1055/a-1984-8044

Original Article

Role of 68Ga-FAPI-04 PET/CT in the Initial Staging of Esophageal Cancer

Rolle von 68Ga-FAPI-04 PET/CT in der Erstinszenierung von Speiseröhrenkrebs

Authors

Huipan Liu

¹Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China (Ringgold ID: RIN556508)

²Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China (Ringgold ID: RIN556508)

³Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China (Ringgold ID: RIN556508)

⁴Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China (Ringgold ID: RIN74647)
Xiao Yang

⁵Department of Nuclear Medicine, The Yibin No. 2 People’s Hospital, Yibin, China
Zhouxiang You

⁶Department of Thoracic Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China (Ringgold ID: RIN556508)
Zhi Hu

⁶Department of Thoracic Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China (Ringgold ID: RIN556508)
Yue Chen

¹Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China (Ringgold ID: RIN556508)

²Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China (Ringgold ID: RIN556508)

³Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou, China (Ringgold ID: RIN556508)

⁴Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China (Ringgold ID: RIN74647)

Abstract

Aim To investigate the clinical value of 68Ga-FAPI-04 PET/CT for initial staging of esophageal cancer.

Methods A total of 44 newly diagnosed patients with esophageal cancer were included in the analysis on the basis of postoperative pathology or clinical and radiologic follow-up.

Results All primary lesions showed increased 68Ga-FAPI-04 uptake, with an SUVmax of 14.92 ± 6.91. A total of 561 lymph nodes were verified by surgery (507) or clinical and radiologic follow-up (54), of which 92 lymph nodes were diagnosed as showing metastases. Seventy-five lymph nodes with metastases showed positive findings on 68Ga-FAPI-04, with a diameter of about 1.06 ± 0.53 cm and SUVmax of 8.10±4.71. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for lymph node metastasis detection were 81.5%, 99.3%, 96.6%, 96.2%, and 96.5%, respectively.

Conclusion 68Ga-FAPI-04 PET/CT showed good diagnostic performance in detecting lymph node metastases of esophageal cancer.

Zusammenfassung

Ziel Untersuchung des klinischen Werts von 68Ga-FAPI-04-PET/CT für das initiale Staging von Speiseröhrenkrebs.

Methoden Insgesamt 44 neu diagnostizierte Patienten mit Speiseröhrenkrebs wurden in die Analyse nach postoperativer Pathologie oder klinischer und radiologischer Nachsorge eingeschlossen.

Ergebnisse Alle primären Läsionen zeigten eine erhöhte 68Ga-FAPI-04-Aufnahme mit einem SUVmax von 14,92 ± 6,91. Die Sensitivität, Spezifität, Genauigkeit, PPV und NPV für den Nachweis von Lymphknotenmetastasen betrugen 81,5 %, 99,3 %, 96,6 %, 96,2 % bzw. 96,5 %.

Schlussfolgerung 68Ga-FAPI-04 PET/CT zeigte eine gute diagnostische Leistung beim Nachweis von Lymphknotenmetastasen von Speiseröhrenkrebs.

Keywords

68Ga-FAPI-04 - PET/CT - esophageal carcinoma - lymph node metastasis - initial staging

Full Text

References

References
1 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: a cancer journal for clinicians 2021; 71: 209-49
2 Berry MF. Esophageal cancer: staging system and guidelines for staging and treatment. Journal of thoracic disease 2014; 6 (Suppl. 03) S289-S297
3 Kratochwil C, Flechsig P, Lindner T. et al. (68)Ga-FAPI PET/CT: Tracer Uptake in 28 Different Kinds of Cancer. Journal of nuclear medicine: official publication, Society of Nuclear Medicine 2019; 60: 801-805
4 Giesel FL, Kratochwil C, Lindner T. et al. (68)Ga-FAPI PET/CT: Biodistribution and Preliminary Dosimetry Estimate of 2 DOTA-Containing FAP-Targeting Agents in Patients with Various Cancers. Journal of nuclear medicine: official publication, Society of Nuclear Medicine 2019; 60: 386-392
5 Chen H, Pang Y, Wu J. et al. Comparison of [(68)Ga]Ga-DOTA-FAPI-04 and [(18)F] FDG PET/CT for the diagnosis of primary and metastatic lesions in patients with various types of cancer. European journal of nuclear medicine and molecular imaging 2020; 47: 1820-1832
6 Koerber SA, Staudinger F, Kratochwil C. et al. The Role of (68)Ga-FAPI PET/CT for Patients with Malignancies of the Lower Gastrointestinal Tract: First Clinical Experience. Journal of nuclear medicine: official publication, Society of Nuclear Medicine 2020; 61: 1331-1336
7 Pang Y, Zhao L, Luo Z. et al. Comparison of (68)Ga-FAPI and (18)F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers. Radiology 2021; 298: 393-402
8 Ristau J, Giesel FL, Haefner MF. et al. Impact of Primary Staging with Fibroblast Activation Protein Specific Enzyme Inhibitor (FAPI)-PET/CT on Radio-Oncologic Treatment Planning of Patients with Esophageal Cancer. Molecular imaging and biology: MIB : the official publication of the Academy of Molecular Imaging 2020; 22: 1495-1500
9 Zhao L, Chen S, Chen S. et al. (68)Ga-fibroblast activation protein inhibitor PET/CT on gross tumour volume delineation for radiotherapy planning of oesophageal cancer. Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology 2021; 158: 55-61
10 Zhao L, Chen S, Lin L. et al. [(68)Ga]Ga-DOTA-FAPI-04 improves tumor staging and monitors early response to chemoradiotherapy in a patient with esophageal cancer. European journal of nuclear medicine and molecular imaging 2020; 47: 3188-3189
11 Liu Q, Shi S, Xu X. et al. The superiority of [(68)Ga]-FAPI-04 over [(18)F]-FDG PET/CT in imaging metastatic esophageal squamous cell carcinoma. European journal of nuclear medicine and molecular imaging 2021; 48: 1248-1249
12 Zhou Y, Yang X, Liu H. et al. Value of [(68)Ga]Ga-FAPI-04 imaging in the diagnosis of renal fibrosis. Eur J Nucl Med Mol Imaging 2021;
13 Liu H, Yang X, Liu L. et al. Clinical Significance of Diffusely Increased Uptake of (68)Ga-FAPI in Thyroid Gland. Frontiers in medicine 2021; 08: 782231
14 van Westreenen HL, Cobben DC, Jager PL. et al. Comparison of 18F-FLT PET and 18F-FDG PET in esophageal cancer. Journal of nuclear medicine: official publication, Society of Nuclear Medicine 2005; 46: 400-404
15 Komek H, Can C, Guzel Y. et al. (68)Ga-FAPI-04 PET/CT, a new step in breast cancer imaging: a comparative pilot study with the (18)F-FDG PET/CT. Annals of nuclear medicine 2021;
16 Wu J, Liu H, Ou L. et al. FAPI Uptake in a Vertebral Body Fracture in a Patient With Lung Cancer: A FAPI Imaging Pitfall. Clinical nuclear medicine 2021; 46: 520-522
17 Hotta M, Sonni I, Benz MR. et al. (68)Ga-FAPI-46 and (18)F-FDG PET/CT in a patient with immune-related thyroiditis induced by immune checkpoint inhibitors. European journal of nuclear medicine and molecular imaging 2021;
18 Yang X, Hu Z, You Z. et al. Mediastinal diffuse large B-cell lymphoma mimicking invasive thymoma on (68)Ga-FAPI PET/CT. Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 2021;
19 Liu H, Yang X, Liu L. et al. Incidental Detection of Sinonasal Inverted Papilloma With 68Ga-FAPI PET/CT in a Patient With Esophageal Cancer. Clin Nucl Med 2021;
20 Zhou Y, He J, Chen Y. (68)Ga-FAPI PET/CT imaging in a patient with thyroiditis. Endocrine 2021; 73: 485-486
21 Can C, Gundogan C, Guzel Y. et al. 68Ga-FAPI Uptake of Thyroiditis in a Patient With Breast Cancer. Clin Nucl Med 2021; 46: 683-685
22 Liu H, Yang X, Wang Y. et al. 68Ga-FAPI PET/CT Imaging of Graves Ophthalmopathy in a Patient With Esophageal Cancer. Clin Nucl Med 2021;
23 Qin C, Shao F, Gai Y. et al. (68)Ga-DOTA-FAPI-04 PET/MR in the evaluation of gastric carcinomas: comparison with (18)F-FDG PET/CT. Journal of nuclear medicine: official publication, Society of Nuclear Medicine 2021;
24 Yang X, You Z, Liu L. et al. The Clinical Value of 68Ga-FAPI-04 PET/CT on Detection of Lymph Node Metastasis and Staging for Esophageal Carcinoma. Research Square, Durham, North Carolina, USA. 2021