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The performance of 68Ga-FAPI-04 PET/CT in head and neck squamous cell carcinoma: a prospective comparison with 18F-FDG PET/CT

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Abstract 

Purpose

This study was designed to compare the performance of 68Ga-FAPI-04 and 18F-FDG PET/CT for initial staging and recurrence detection of head and neck squamous cell carcinoma (HNSCC).

Methods

Prospectively, 77 patients with histologically proven or highly suspected HNSCC underwent paired 18F-FDG and 68Ga-FAPI-04 PET/CT in a week for either initial staging (n = 67) or restaging (n = 10). The diagnostic performance was compared for the two imaging approaches, especially for N staging. SUVmax, SUVmean, and target-to-background ratio (TBR) were assessed for paired positive lesions. Furthermore, change in management by 68Ga-FAPI-04 PET/CT and histopathologic FAP expression of some lesions were explored.

Results

18F-FDG and 68Ga-FAPI-04 PET/CT exhibited a comparable detection efficiency for primary tumor (100%) and recurrence (62.5%). In the twenty-nine patients receiving neck dissection, 68Ga-FAPI-04 PET/CT showed greater specificity and accuracy in evaluating preoperative N staging than 18F-FDG based on patient (p = 0.031 and p = 0.070), neck side (p = 0.002 and p = 0.006), and neck level (p < 0.001 and p < 0.001). As for distant metastasis, 68Ga-FAPI-04 PET/CT detected more positive lesions than 18F-FDG (25 vs 23) and with higher SUVmax (7.99 ± 9.04 vs 3.62 ± 2.68, p = 0.002) by lesion-based analysis. The type of neck dissection in 9 cases (9/33) was altered by 68Ga-FAPI-04. Overall, clinical management was significantly changed in 10 patients (10/61). Three patients had a follow-up 68Ga-FAPI-04 PET/CT post neoadjuvant therapy: One showed complete remission, and the others showed progression. The 68Ga-FAPI-04 uptake intensity was confirmed to be consistent with FAP expression.

Conclusion

68Ga-FAPI-04 outperforms 18F-FDG PET/CT in evaluating preoperative N staging in patients with HNSCC. Furthermore, 68Ga-FAPI-04 PET/CT also shows the potential in clinical management and monitoring response to treatment.

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Data availability

Data generated or analyzed during the study are available from the corresponding author by request.

Code availability

Not applicable.

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Acknowledgements

We appreciate Professor Qiongrong Chen (Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan University) for her crucial guidance in immunohistochemistry analysis and scoring of pathology slides. We thank Professor Xiaoli Lan (Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology) for her valuable comments on an earlier draft of the paper.

Funding

This work was partly funded by the National Natural Science Foundation of China (no. 82171986) and the Improvement Project for Theranostic Ability on Difficulty Miscellaneous Disease (number ZLYNXM202007). This work was also supported in part by the fundamental research funds for the central universities, Wuhan University (2042021kf0160), and the research fund from medical Sci-Tech innovation platform of Zhongnan Hospital, Wuhan University (PTXM2021021).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China

    Yaqun Jiang, Bing Wen, Chongjiao Li, Yueli Tian, Zhiwei Xiao, Kui Xu, Diankui Xing & Yong He

  2. Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China

    Zili Yu & Jun Jia

  3. Department of Otorhinolaryngology Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China

    Jing Huang

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  1. Yaqun Jiang
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Contributions

Y.H., J.J., and Y.J. contributed to the conception and design. All authors contributed to patient enrollment. Z.X. contributed to the preparation of 68Ga-FAPI and quality control. D.X. contributed to image acquisition. C.L., Y.T., and Y.H. contributed to the analysis and interpretation of image. Y.J. and Y.H. contributed to the statistical analysis. Y.J. drafted the initial version of the manuscript. Y.H., J.J., B.W., and Y.J. revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Jun Jia or Yong He.

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This article does not contain any experiments with animals. All procedures involving human participants were carried out 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. This study was reviewed and approved by the Medical Ethics Committee of Zhongnan Hospital, Wuhan University (No. 2021051, February 7, 2021).

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

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Jiang, Y., Wen, B., Li, C. et al. The performance of 68Ga-FAPI-04 PET/CT in head and neck squamous cell carcinoma: a prospective comparison with 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging 50, 2114–2126 (2023). https://doi.org/10.1007/s00259-023-06138-y

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