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[68Ga]Ga-FAPI PET/CT Improves the T Staging of Patients with Newly Diagnosed Nasopharyngeal Carcinoma: A Comparison with [18F]F-FDG

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Abstract

Purpose

This study aimed to explore the value of [68Ga]Ga-labelled fibroblast activation protein inhibitor ([68Ga]Ga-FAPI) positron emission tomography/computed tomography (PET/CT) in the initial staging of patients with newly diagnosed nasopharyngeal carcinoma (NPC), compared with 2-deoxy-2[18F]fluoro-D-glucose ([18F]F-FDG) PET/CT.

Materials and Methods

Forty-seven treatment-naïve patients with newly diagnosed NPC underwent magnetic resonance imaging (MRI), [68Ga]Ga-DOTA-FAPI-04 PET/CT and [18F]F-FDG PET/CT within 1 week. The diagnostic efficiency of all imaging modalities for evaluating primary tumour extension was compared from the two aspects of soft tissue and bony structure involvement. The accuracy of two PET/CT methods for diagnosing cervical lymph node (CLN) metastases was compared, and MRI served as the standard reference. T and N stages were assessed by MRI, [68Ga]Ga-FAPI PET/CT and [18F]F-FDG PET/CT. Immunohistochemical (IHC) staining for FAP was conducted in 22 of the patients.

Results

[68Ga]Ga-FAPI PET/CT outperformed [18F]F-FDG PET/CT in the assessment of primary tumour invasion in the cavernous sinus (10 vs. 1, p < 0.001) and bony structures (207 vs. 177, p < 0.001). Compared with MRI, [68Ga]Ga-FAPI PET/CT upgraded and underestimated T stage in 13 and 2 patients, while [18F]F-FDG PET/CT upgraded and underestimated T stage in 5 and 13 patients. However, [68Ga]Ga-FAPI PET/CT was inferior to [18F]F-FDG PET/CT in diagnosing positive CLNs based on the analyses of patients, neck sides, neck levels and individual nodes. [68Ga]Ga-FAPI PET/CT changed therapeutic schedules in 8 patients because of stage group changes. The presence of FAP with high quantity and intensity in cancer-associated fibroblasts (CAFs) was confirmed in all tumour specimens.

Conclusion

[68Ga]Ga-FAPI PET/CT outperformed [18F]F-FDG PET/CT in detecting the cavernous sinus and bony structure involvement of primary NPC tumours, suggesting its value in improving T staging and therapeutic regimen selection. However, the performance of [68Ga]Ga-FAPI PET/CT is less promising for N staging because it detected fewer positive CLNs than [18F]F-FDG PET/CT.

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Acknowledgements

The authors gratefully acknowledge all participating patients.

Funding

This study was funded in part by the National Natural Science Foundation of China (NSFC) 81971651.

Author information

Author notes

  1. Jieling Zheng and Feng Liu contributed equally to this work

Authors and Affiliations

  1. Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China

    Jieling Zheng, Feng Liu, KaiXian Lin, Jiaying Zhang, Shaobo Yao & Weibing Miao

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

    Li Zhang

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

    Nan Huang & Wanjing Zheng

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

    Shaobo Yao & Weibing Miao

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  1. Jieling Zheng
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Contributions

Jieling Zheng, Feng Liu and Weibing Miao contributed to experimental design. Jieling Zheng and Feng Liu contributed to patient recruitment. Shaobo Yao and Jiaying Zhang contributed to radiopharmaceutical preparation. Jieling Zheng, Weibing Miao, Nan Huang and Wanjing Zheng contributed to PET imaging analyses. Jieling Zheng and Kaixian Lin contributed to statistical analyses. Jieling Zheng, Kaixian Lin and Weibing Miao wrote the manuscript. Weibing Miao revised the manuscript. All authors have read and approved the manuscript. Jieling Zheng and Feng Liu contributed equally to this study.

Corresponding authors

Correspondence to Shaobo Yao or Weibing Miao.

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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. This study was approved by the ethics committee of the First Affiliated Hospital of Fujian Medical University, Fujian, and China. This study has been registered online at NIH ClinicalTrails.gov (NCT 04499365).

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Zheng, J., Liu, F., Lin, K. et al. [68Ga]Ga-FAPI PET/CT Improves the T Staging of Patients with Newly Diagnosed Nasopharyngeal Carcinoma: A Comparison with [18F]F-FDG. Mol Imaging Biol 24, 973–985 (2022). https://doi.org/10.1007/s11307-022-01748-8

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  • DOI: https://doi.org/10.1007/s11307-022-01748-8

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