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@ARTICLE{Rhrich:289458,
author = {M. Röhrich and J. Daum and E. Gutjahr and A.-M. Spektor
and F. M. Glatting$^*$ and Y. A. Sahin and H. G. Buchholz
and J. Hoppner and C. Schroeter and E. Mavriopoulou and K.
Schlamp and M. Grott and F. Eichhorn and C. P. Heußel and
H. U. Kauczor and M. Kreuter and F. Giesel$^*$ and M.
Schreckenberger and H. Winter and U. Haberkorn$^*$},
title = {{D}iagnostic {P}otential of {S}upplemental {S}tatic and
{D}ynamic 68{G}a-{FAPI}-46 {PET} for {P}rimary
18{F}-{FDG}-{N}egative {P}ulmonary {L}esions.},
journal = {Journal of nuclear medicine},
volume = {65},
number = {6},
issn = {0097-9058},
address = {New York, NY},
publisher = {Soc.},
reportid = {DKFZ-2024-00780},
pages = {872-879},
year = {2024},
note = {#LA:E060# / 2024 Jun 3;65(6):872-879},
abstract = {PET using 68Ga-labeled fibroblast activation protein (FAP)
inhibitors (FAPIs) holds high potential for diagnostic
imaging of various malignancies, including lung cancer (LC).
However, 18F-FDG PET is still the clinical gold standard for
LC imaging. Several subtypes of LC, especially lepidic LC,
are frequently 18F-FDG PET-negative, which markedly hampers
the assessment of single pulmonary lesions suggestive of LC.
Here, we evaluated the diagnostic potential of static and
dynamic 68Ga-FAPI-46 PET in the 18F-FDG-negative pulmonary
lesions of 19 patients who underwent surgery or biopsy for
histologic diagnosis after PET imaging. For target
validation, FAP expression in lepidic LC was confirmed by
FAP immunohistochemistry. Methods: Hematoxylin and eosin
staining and FAP immunohistochemistry of 24 tissue sections
of lepidic LC from the local tissue bank were performed and
analyzed visually. Clinically, 19 patients underwent static
and dynamic 68Ga-FAPI-46 PET in addition to 18F-FDG PET
based on individual clinical indications. Static PET data of
both examinations were analyzed by determining SUVmax,
SUVmean, and tumor-to-background ratio (TBR) against the
blood pool, as well as relative parameters (68Ga-FAPI-46 in
relation to18F-FDG), of histologically confirmed LC and
benign lesions. Time-activity curves and dynamic parameters
(time to peak, slope, k 1, k 2, k 3, and k 4) were extracted
from dynamic 68Ga-FAPI-46 PET data. The sensitivity and
specificity of all parameters were analyzed by calculating
receiver-operating-characteristic curves. Results: FAP
immunohistochemistry confirmed the presence of strongly
FAP-positive cancer-associated fibroblasts in lepidic LC. LC
showed markedly elevated 68Ga-FAPI-46 uptake, higher TBRs,
and higher 68Ga-FAPI-46-to-18F-FDG ratios for all parameters
than did benign pulmonary lesions. Dynamic imaging analysis
revealed differential time-activity curves for LC and benign
pulmonary lesions: initially increasing time-activity curves
with a decent slope were typical of LC, and steadily
decreasing time-activity curve indicated benign pulmonary
lesions, as was reflected by a significantly increased time
to peak and significantly smaller absolute values of the
slope for LC. Relative 68Ga-FAPI-46-to-18F-FDG ratios
regarding SUVmax and TBR showed the highest sensitivity and
specificity for the discrimination of LC from benign
pulmonary lesions. Conclusion: 68Ga-FAPI-46 PET is a
powerful new tool for the assessment of single
18F-FDG-negative pulmonary lesions and may optimize patient
stratification in this clinical setting.},
keywords = {FAPI (Other) / PET (Other) / fibroblast activation protein
(Other) / lung cancer (Other) / pulmonary lesions (Other)},
cin = {E055 / HD01 / E060},
ddc = {610},
cid = {I:(DE-He78)E055-20160331 / I:(DE-He78)HD01-20160331 /
I:(DE-He78)E060-20160331},
pnm = {315 - Bildgebung und Radioonkologie (POF4-315)},
pid = {G:(DE-HGF)POF4-315},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:38604763},
doi = {10.2967/jnumed.123.267103},
url = {https://inrepo02.dkfz.de/record/289458},
}