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Accurate preoperative staging with [68Ga]Ga-FAPI PET/CT for patients with oral squamous cell carcinoma: a comparison to 2-[18F]FDG PET/CT

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Abstract

Objective

To evaluate the potential value of [68Ga]Ga-labelled fibroblast activation protein inhibitor ([68Ga]Ga-FAPI) positron emission tomography/computed tomography (PET/CT) in preoperative staging for patients with oral squamous cell carcinoma (OSCC) as compared to 2-[18F]fluoro-2-deoxy-D-glucose (2-[18F]FDG) PET/CT.

Methods

Thirty-six treatment-naïve patients with OSCC who underwent 2-[18F]FDG and [68Ga]Ga-FAPI PET/CT for preoperative staging were enrolled. The maximum standardised uptake value (SUVmax) of the primary tumour and suspected cervical metastatic lymph nodes, and the tumour-to-background ratio (TBR) of the primary tumour, were measured. The accuracy of two imaging modalities for preoperative diagnosis of metastatic lymph nodes was analysed. Histopathology served as the standard of reference.

Results

Thirty-seven primary lesions of 36 patients were accurately detected by both [68Ga]Ga-FAPI and 2-[18F]FDG PET/CT. Regarding primary tumours, the SUVmax and TBR of the two imaging modalities in stage T3–T4 were significantly higher than those of stage T1–T2 (all p < 0.05). On the patient analysis, the accuracy for the evaluation of N1–N3 neck status was 52.6% (10/19) for [68Ga]Ga-FAPI PET/CT and 57.9% (11/19) for 2-[18F]FDG PET/CT. Notably, the accuracy for the evaluation of the N0 neck status between [68Ga]Ga-FAPI and 2-[18F]FDG PET/CT was 100% (17/17) and 29% (5/17), respectively. Based on the patient, neck side and neck level, [68Ga]Ga-FAPI PET/CT resulted in higher specificity and accuracy in diagnosing metastatic neck lymph nodes than 2-[18F]FDG PET/CT (all p < 0.05).

Conclusion

[68Ga]Ga-FAPI PET/CT is a promising tool for preoperative staging of OSCC, and appears to reduce the false positivity seen with 2-[18F]FDG PET/CT for the detection of neck lymph node metastases.

Key Points

• [68Ga]Ga-FAPI PET/CT is a promising tool targeting cancer-associated fibroblasts with comparable diagnostic performance to 2-[18F]FDG PET/CT for identifying the primary lesions of OSCC.

• [68Ga]Ga-FAPI PET/CT showed higher specificity and accuracy for the evaluation of neck lymph node metastases of OSCC than 2-[18F]FDG PET/CT, especially for N0 neck status.

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Abbreviations

[68Ga]Ga-FAPI:

[68Ga]Ga-labelled fibroblast activation protein inhibitor

2-[18F]FDG:

2-[18F]fluoro-2-deoxy-D-glucose

AUC:

Area under the curve

CAFs:

Cancer-associated fibroblasts

CT:

Computed tomography

FP:

False positive

GMP:

Good manufacturing practice

MRI:

Magnetic resonance imaging

OSCC:

Oral squamous cell carcinoma

PET/CT:

Positron emission tomography/computed tomography

ROC:

Receiver operating characteristic

SUVmax :

Maximum standardised uptake value

TBR:

Tumour-to-background ratio

TP:

True positive

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Acknowledgements

The authors thank the American Journal Experts for providing language help.

Funding

This study has received funding from the National Natural Science Foundation of China (NSFC) (No. 81971651, No. 82171928), Natural Science Foundation of Fujian Province (No. 2019J01454, No. 2020J05249), Fujian Provincial Health Technology Project (No. 2020GGA045, No. 2020QNA054) and Startup Fund for Scientific Research of Fujian Medical University (No. 2017XQ1099).

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Author notes

  1. Shaoming Chen and Zhenying Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China

    Shaoming Chen, Zhenying Chen, Shan Zheng, Jiaying Zhang, Chao Huang, Shaobo Yao & Weibing Miao

  2. Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China

    Gengsen Zou

  3. Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China

    Ke Zheng

  4. Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China

    Shaobo Yao & Weibing Miao

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  1. Shaoming Chen
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Correspondence to Shaobo Yao or Weibing Miao.

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Guarantor

The scientific guarantor of this publication is Weibing Miao, MD, PhD.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and Biometry

Authors Shaoming Chen, Zhenying Chen and Chao Huang kindly provided statistical advice for this manuscript.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• Performed at one institution

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Chen, S., Chen, Z., Zou, G. et al. Accurate preoperative staging with [68Ga]Ga-FAPI PET/CT for patients with oral squamous cell carcinoma: a comparison to 2-[18F]FDG PET/CT. Eur Radiol 32, 6070–6079 (2022). https://doi.org/10.1007/s00330-022-08686-7

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  • DOI: https://doi.org/10.1007/s00330-022-08686-7

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