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@ARTICLE{Pabst:275349,
      author       = {K. M. Pabst$^*$ and M. Trajkovic-Arsic$^*$ and P. F. Y.
                      Cheung$^*$ and S. Ballke and K. Steiger and T. Bartel$^*$
                      and B. M. Schaarschmidt and A. Milosevic and R. Seifert$^*$
                      and M. Nader$^*$ and L. Kessler$^*$ and J. Siveke$^*$ and K.
                      Lueckerath$^*$ and S. Kasper$^*$ and K. Herrmann$^*$ and N.
                      Hirmas$^*$ and H. H. Schmidt and R. Hamacher$^*$ and W. P.
                      Fendler$^*$},
      title        = {{S}uperior {T}umor {D}etection for 68{G}a-{FAPI}-46
                      {V}ersus 18{F}-{FDG} {PET}/{CT} and {C}onventional {CT} in
                      {P}atients with {C}holangiocarcinoma.},
      journal      = {Journal of nuclear medicine},
      volume       = {64},
      number       = {7},
      issn         = {0097-9058},
      address      = {New York, NY},
      publisher    = {Soc.},
      reportid     = {DKFZ-2023-00718},
      pages        = {1049-1055},
      year         = {2023},
      note         = {2023 Jul;64(7):1049-1055},
      abstract     = {Management of cholangiocarcinoma is among other factors
                      critically determined by accurate staging. Here, we aimed to
                      assess the accuracy of PET/CT with the novel cancer
                      fibroblast-directed 68Gafibroblast activation protein (FAP)
                      inhibitor (FAPI)-46 tracer for cholangiocarcinoma staging
                      and management guidance. Methods: Patients with
                      cholangiocarcinoma from a prospective observational trial
                      were analyzed. 68Ga-FAPI-46 PET/CT detection efficacy was
                      compared with 18F-FDG PET/CT and conventional CT.
                      SUVmax/tumor-to-background ratio (Wilcoxon test) and
                      separately uptake for tumor grade and location (Mann-Whitney
                      U test) were compared. Immunohistochemical FAP and glucose
                      transporter 1 (GLUT1) expression of stromal and cancer cells
                      was analyzed. The impact on therapy management was
                      investigated by pre- and post-PET/CT questionnaires sent to
                      the treating physicians. Results: In total, 10 patients (6
                      with intrahepatic cholangiocarcinoma and 4 with extrahepatic
                      cholangiocarcinoma; 6 with grade 2 tumor and 4 with grade 3
                      tumor) underwent 68Ga-FAPI-46 PET/CT and conventional CT; 9
                      patients underwent additional 18F-FDG PET/CT.
                      Immunohistochemical analysis was performed on the entire
                      central tumor plain in 6 patients. Completed questionnaires
                      were returned in 8 cases. Detection rates for 68Ga- FAPI-46
                      PET/CT, 18F-FDG PET/CT, and CT were 5, 5, and 5,
                      respectively, for primary tumor; 11, 10, and 3,
                      respectively, for lymph nodes; and 6, 4, and 2,
                      respectively, for distant metastases. 68Ga-FAPI-46 versus
                      18F-FDG PET/CT SUVmax for primary tumor, lymph nodes, and
                      distant metastases was 14.5 versus 5.2 (P = 0.043), 4.7
                      versus 6.7 (P = 0.05), and 9.5 versus 5.3 (P = 0.046),
                      respectively, and tumor-to-background ratio (liver) was 12.1
                      versus 1.9 (P = 0.043) for primary tumor. Grade 3 tumors
                      demonstrated a significantly higher 68Ga-FAPI-46 uptake than
                      grade 2 tumors (SUVmax, 12.6 vs. 6.4; P = 0.009).
                      Immunohistochemical FAP expression was high on tumor stroma
                      $(~90\%$ of cells positive), whereas GLUT1 expression was
                      high on tumor cells $(~80\%$ of cells positive). Overall,
                      average expression intensity was estimated as grade 3 for
                      FAP and grade 2 for GLUT1. Positive 68Ga-FAPI-46 PET
                      findings led to a consequent biopsy workup and diagnosis of
                      cholangiocarcinoma in 1 patient. However, patient treatment
                      was not adjusted on the basis of 68Ga-FAPI-46 PET.
                      Conclusion: 68Ga-FAPI-46 demonstrated superior radiotracer
                      uptake, especially in grade 3 tumors, and lesion detection
                      in patients with cholangiocarcinoma. In line with this
                      result, immunohistochemistry demonstrated high FAP
                      expression on tumor stroma. Accuracy is under investigation
                      in an ongoing investigator-initiated trial.},
      keywords     = {18F-FDG PET/CT (Other) / 68Ga-FAPI-46 PET/CT (Other) /
                      Molecular Imaging (Other) / Oncology: Liver (Other) / PET/CT
                      (Other) / cholangiocarcinoma (Other) / conventional CT
                      (Other) / immunohistochemistry (Other)},
      cin          = {ED01},
      ddc          = {610},
      cid          = {I:(DE-He78)ED01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37024301},
      doi          = {10.2967/jnumed.122.265215},
      url          = {https://inrepo02.dkfz.de/record/275349},
}