Skip to main content

Advertisement

SpringerLink
Log in

The role of [68 Ga]Ga-FAPI-04 PET/CT in renal cell carcinoma: a preliminary study

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

An Editorial to this article was published on 22 December 2023

Abstract

Purpose

We aimed to investigate the role of [68 Ga]Ga-FAPI-04 PET/CT and uptake patterns of primary and metastatic lesions in patients with renal cell carcinoma (RCC).

Methods

Twenty patients with a suspicious lesion considered primary renal malignancy or a history of RCC were included in our study. Two patients were excluded from further analyses due to other confirmed malignancies. Six patients were newly diagnosed, while the indication of 12 patients was restaging. All patients underwent [68 Ga]Ga-FAPI-04 and [18F]F-FDG PET/CT. SUVmax and tumor-to-background ratio (TBR) of primary (n = 7) and local recurrent lesions (n = 6) and lymph node (n = 26), lung (n = 32), bone (n = 5), and other metastases (n = 14) were compared between the two tracers.

Results

We detected 90 lesions in 18 patients with varying FAPI and FDG uptake values on both PET/CT. The median TBR of FAPI-PET/CT of all lesions was higher than TBR of FDG-PET/CT with statistically significance (5.6 vs. 2.1, p < 0.001). In primary and recurrent lesions, the median SUVmax, TBR, and tumor volume on FAPI-PET/CT were higher than FDG-PET/CT. The median SUVmax of lung lesions on FAPI-PET/CT was statistical significantly higher than FDG-SUVmax (3.8 vs. 1.8, p = 0.02). The median of FAPI-SUVmax on primary lesions was lower in the early stage based on TNM compared to the advanced stage. FAPI-SUVmax in 49% of all lesions were SUVmax ≥ 6, and 13% were SUVmax ≥ 10. In patient-based analyses, seven patients (39%) had at least one lesion with FAPI-SUVmax ≥ 10; 12 patients (67%) had at least one lesion with FAPI-SUVmax ≥ 6.

Conclusion

This study showed the potential utility of [68 Ga]Ga-FAPI-04 PET/CT showing promising results in RCC. We have presumed that FAPI-PET/CT may be performed for complementary imaging modality providing prognosis and possibility of theranostic application in selected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Bukavina L, Bensalah K, Bray F, Carlo M, Challacombe B, Karam JA, et al. Epidemiology of renal cell carcinoma: 2022 Update. Eur Urol. 2022;82:529–42. https://doi.org/10.1016/j.eururo.2022.08.019.

    Article  PubMed  Google Scholar 

  2. Moch H, Amin MB, Berney DM, Compérat EM, Gill AJ, Hartmann A, et al. The 2022 world health organization classification of tumours of the urinary system and male genital organs-part a: renal, penile, and testicular tumours. Eur Urol. 2022;82:458–68. https://doi.org/10.1016/j.eururo.2022.06.016.

    Article  PubMed  Google Scholar 

  3. Sohlberg EM, Metzner TJ, Leppert JT. The harms of overdiagnosis and overtreatment in patients with small renal masses: a mini-review. Eur Urol Focus. 2019;5:943–5. https://doi.org/10.1016/j.euf.2019.03.006.

    Article  PubMed  Google Scholar 

  4. Ljungberg B, Albiges L, Abu-Ghanem Y, Bedke J, Capitanio U, Dabestani S, et al. European Association of Urology Guidelines on renal cell carcinoma: The 2022 Update. Eur Urol. 2022;82:399–410. https://doi.org/10.1016/j.eururo.2022.03.006.

    Article  PubMed  Google Scholar 

  5. Oflas M, Ozluk Y, Sanli O, Ozkan ZG, Kuyumcu S. 68Ga-PSMA Uptake patterns of clear cell renal carcinoma across different histopathological subtypes. Clin Nucl Med. 2022;47:e45–6. https://doi.org/10.1097/rlu.0000000000003814.

    Article  PubMed  Google Scholar 

  6. Has Simsek D, Civan C, Erdem S, Sanli Y. Complementary role of 68Ga-prostate-specific membrane antigen and 18F-FDG PET/CT for evaluation of metastases and treatment response in renal cell carcinoma. Clin Nucl Med. 2021;46:579–81. https://doi.org/10.1097/rlu.0000000000003590.

    Article  PubMed  Google Scholar 

  7. Verhoeff SR, van Es SC, Boon E, van Helden E, Angus L, Elias SG, et al. Lesion detection by [(89)Zr]Zr-DFO-girentuximab and [(18)F]FDG-PET/CT in patients with newly diagnosed metastatic renal cell carcinoma. Eur J Nucl Med Mol Imaging. 2019;46:1931–9. https://doi.org/10.1007/s00259-019-04358-9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Parihar AS, Mhlanga J, Ronstrom C, Schmidt LR, Figenshau RS, Dehdashti F, et al. Diagnostic accuracy of (99m)Tc-Sestamibi SPECT/CT for characterization of solid renal masses. J Nucl Med. 2023;64:90–5. https://doi.org/10.2967/jnumed.122.264329.

    Article  CAS  PubMed  Google Scholar 

  9. Ma H, Shen G, Liu B, Yang Y, Ren P, Kuang A. Diagnostic performance of 18F-FDG PET or PET/CT in restaging renal cell carcinoma: a systematic review and meta-analysis. Nucl Med Commun. 2017;38:156–63. https://doi.org/10.1097/mnm.0000000000000618.

    Article  PubMed  Google Scholar 

  10. Takahashi M, Kume H, Koyama K, Nakagawa T, Fujimura T, Morikawa T, et al. Preoperative evaluation of renal cell carcinoma by using 18F-FDG PET/CT. Clin Nucl Med. 2015;40:936–40. https://doi.org/10.1097/rlu.0000000000000875.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Liu Y. The place of FDG PET/CT in renal cell carcinoma: value and limitations. Front Oncol. 2016;6:201. https://doi.org/10.3389/fonc.2016.00201.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kratochwil C, Flechsig P, Lindner T, Abderrahim L, Altmann A, Mier W, et al. (68)Ga-FAPI PET/CT: Tracer uptake in 28 different kinds of cancer. J Nucl Med. 2019;60:801–5. https://doi.org/10.2967/jnumed.119.227967.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kuyumcu S, Sanli Y, Subramaniam RM. Fibroblast-activated protein inhibitor PET/CT: cancer diagnosis and management. Front Oncol. 2021;11: 758958. https://doi.org/10.3389/fonc.2021.758958.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Kuyumcu S, Kovan B, Sanli Y, Buyukkaya F, Has Simsek D, Özkan ZG, et al. Safety of fibroblast activation protein-targeted radionuclide therapy by a low-dose dosimetric approach using 177Lu-FAPI04. Clin Nucl Med. 2021;46:641–6. https://doi.org/10.1097/rlu.0000000000003667.

    Article  PubMed  Google Scholar 

  15. Giesel FL, Kratochwil C, Lindner T, Marschalek MM, Loktev A, Lehnert W, et al. (68)Ga-FAPI PET/CT: biodistribution and preliminary dosimetry estimate of 2 DOTA-containing FAP-targeting agents in patients with various cancers. J Nucl Med. 2019;60:386–92. https://doi.org/10.2967/jnumed.118.215913.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Solano-Iturri JD, Errarte P, Etxezarraga MC, Echevarria E, Angulo J, López JI, et al. Altered tissue and plasma levels of fibroblast activation protein-α (FAP) in renal tumours. Cancers (Basel). 2020;12. https://doi.org/10.3390/cancers12113393.

  17. Yang J, Dong A, Zuo C. 68Ga-FAPI-04 PET/CT in solitary choroid plexus metastasis from renal cell carcinoma. Clin Nucl Med. 2022;47:885–7. https://doi.org/10.1097/rlu.0000000000004207.

    Article  PubMed  Google Scholar 

  18. Civan C, Isik EG, Karadogan S, Sanli Y, Kuyumcu S. 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in metastatic papillary renal cell cancer. Clin Nucl Med. 2023. https://doi.org/10.1097/rlu.0000000000004587.

    Article  PubMed  Google Scholar 

  19. Xie F, Fu L, Zhou W. Superiority of 68Ga-FAPI-04 in delineation of soft tissue and liver metastases in chromophobe renal cell carcinoma for restaging. Clin Nucl Med. 2022;47:e758–9. https://doi.org/10.1097/rlu.0000000000004374.

    Article  PubMed  Google Scholar 

  20. Boellaard R, Delgado-Bolton R, Oyen WJ, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54. https://doi.org/10.1007/s00259-014-2961-x.

    Article  CAS  PubMed  Google Scholar 

  21. Zhong X, Guo J, Han X, Wu W, Yang R, Zhang J, et al. Synthesis and preclinical evaluation of a novel FAPI-04 dimer for cancer theranostics. Mol Pharm. 2023;20:2402–14. https://doi.org/10.1021/acs.molpharmaceut.2c00965.

    Article  CAS  PubMed  Google Scholar 

  22. Liu X, Liu H, Gao C, Zeng W. Comparison of (68)Ga-FAPI and (18)F-FDG PET/CT for the diagnosis of primary and metastatic lesions in abdominal and pelvic malignancies: a systematic review and meta-analysis. Front Oncol. 2023;13:1093861. https://doi.org/10.3389/fonc.2023.1093861.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Dong A, Yang B, Bai Y, Zuo C. 68 Ga-FAPI-04 PET/CT in a small sarcomatoid renal cell carcinoma with widespread metastases. Clin Nucl Med. 2023;48:457–9. https://doi.org/10.1097/rlu.0000000000004607.

    Article  PubMed  Google Scholar 

  24. Çermik TF, Ergül N, Yılmaz B, Mercanoğlu G. Tumor imaging with 68Ga-DOTA-FAPI-04 PET/CT: comparison with 18F-FDG PET/CT in 22 different cancer types. Clin Nucl Med. 2022;47:e333–9. https://doi.org/10.1097/rlu.0000000000004073.

    Article  PubMed  Google Scholar 

  25. Zheng S, Lin R, Chen S, Zheng J, Lin Z, Zhang Y, et al. Characterization of the benign lesions with increased (68)Ga-FAPI-04 uptake in PET/CT. Ann Nucl Med. 2021;35:1312–20. https://doi.org/10.1007/s12149-021-01673-w.

    Article  CAS  PubMed  Google Scholar 

  26. Civan C, Isik EG, Has Simsek D, Buyukkaya F, Kuyumcu S. Utility of 68 Ga-FAPI-04 PET/CT in adenoid cystic carcinoma compared with 18 F-FDG PET/CT : two case reports. Clin Nucl Med. 2023;48:e350–2. https://doi.org/10.1097/rlu.0000000000004687.

    Article  PubMed  Google Scholar 

  27. Karivedu V, Jain AL, Eluvathingal TJ, Sidana A. Role of positron emission tomography imaging in metabolically active renal cell carcinoma. Curr Urol Rep. 2019;20:56. https://doi.org/10.1007/s11934-019-0932-2.

    Article  PubMed  Google Scholar 

  28. Nakamoto Y, Ishimori T, Shimizu Y, Sano K, Togashi K. Clinical utility of (68)Ga-DOTATOC positron emission tomography/computed tomography for recurrent renal cell carcinoma. Eur J Nucl Med Mol Imaging. 2019;46:1524–30. https://doi.org/10.1007/s00259-019-04298-4.

    Article  PubMed  Google Scholar 

  29. Evangelista L, Zattoni F, Alongi P. (68)Ga-dotatoc vs. (18)F-FDG vs. radiolabelled PSMA PET/CT in renal cancer patients. Ann Transl Med. 2019;7:S150. https://doi.org/10.21037/atm.2019.06.28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Tariq A, Kwok M, Pearce A, Rhee H, Kyle S, Marsh P, et al. The role of dual tracer PSMA and FDG PET/CT in renal cell carcinoma (RCC) compared to conventional imaging: a multi-institutional case series with intra-individual comparison. Urol Oncol. 2022;40:66.e1-.e9. https://doi.org/10.1016/j.urolonc.2021.11.006.

    Article  CAS  PubMed  Google Scholar 

  31. Udovicich C, Callahan J, Bressel M, Ong WL, Perera M, Tran B, et al. Impact of prostate-specific membrane antigen positron emission tomography/computed tomography in the management of oligometastatic renal cell carcinoma. Eur Urol Open Sci. 2022;44:60–8. https://doi.org/10.1016/j.euros.2022.08.001.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Bentestuen M, Al-Obaydi N, Zacho HD. FAPI-avid nonmalignant PET/CT findings: an expedited systematic review. Semin Nucl Med. 2023. https://doi.org/10.1053/j.semnuclmed.2023.02.001.

    Article  PubMed  Google Scholar 

  33. Dong A, Yang Q, Hua M, Cheng C, Zuo C. Lipid-poor renal angiomyolipoma mimicking renal cell carcinoma on 68 Ga-FAPI-04 PET/CT. Clin Nucl Med. 2022;47:991–3. https://doi.org/10.1097/rlu.0000000000004297.

    Article  PubMed  Google Scholar 

  34. Qin C, Gai Y, Liu Q, Shao F, Lan X. Elevated 68Ga-FAPI accumulation in a recurrent angiomyolipoma. Clin Nucl Med. 2020;45:1034–5. https://doi.org/10.1097/rlu.0000000000003345.

    Article  PubMed  Google Scholar 

  35. Dell’Aprovitola N, Guarino S, Del Vecchio W, Camera L, Chiancone F, Imbimbo C, et al. Xanthogranulomatous pyelonephritis mimicking a renal cell carcinoma: a unique and challenging case. Acta Radiol Short Rep. 2014;3:2047981613513763. https://doi.org/10.1177/2047981613513763.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Joshi P, Lele V, Shah H. Fluorodeoxyglucose positron emission tomography-computed tomography findings in a case of xanthogranulomatous pyelonephritis. Indian J Nucl Med. 2013;28:49–50. https://doi.org/10.4103/0972-3919.116809.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Fendler WP, Pabst KM, Kessler L, Fragoso Costa P, Ferdinandus J, Weber M, et al. Safety and efficacy of 90Y-FAPI-46 radioligand therapy in patients with advanced sarcoma and other cancer entities. Clin Cancer Res. 2022;28:4346–53. https://doi.org/10.1158/1078-0432.Ccr-22-1432.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Hirmas N, Hamacher R, Sraieb M, Ingenwerth M, Kessler L, Pabst KM, et al. Fibroblast-activation protein PET and histopathology in a single-center database of 324 patients and 21 tumor entities. J Nucl Med. 2023;64:711–6. https://doi.org/10.2967/jnumed.122.264689.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, 34093, Fatih, Istanbul, Turkey

    Caner Civan, Serkan Kuyumcu, Duygu Has Simsek, Emine Goknur Isik, Zeynep Gozde Ozkan & Yasemin Sanli

  2. Department of Urology, Istanbul Faculty of Medicine, Istanbul University, 34093, Fatih, Istanbul, Turkey

    Oner Sanli

  3. Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, 34093, Fatih, Istanbul, Turkey

    Ozge Hurdogan

Authors
  1. Caner Civan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Serkan Kuyumcu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Duygu Has Simsek
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Oner Sanli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emine Goknur Isik
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zeynep Gozde Ozkan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ozge Hurdogan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yasemin Sanli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Caner Civan.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individuals participants included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Civan, C., Kuyumcu, S., Has Simsek, D. et al. The role of [68 Ga]Ga-FAPI-04 PET/CT in renal cell carcinoma: a preliminary study. Eur J Nucl Med Mol Imaging 51, 852–861 (2024). https://doi.org/10.1007/s00259-023-06461-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-023-06461-4

Keywords

Search

Navigation