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Abstract：
BACKGROUND: This study investigates the value of fluorine 18 ([18F])-labeled fibroblast activation protein inhibitor (FAPI) for lymph node (LN) metastases in patients with stage I-IIIA non-small cell lung cancer (NSCLC).
METHODS: From November 2021 to October 2022, 53 patients with stage I-IIIA NSCLC who underwent radical resection were prospectively included. [18F]-fluorodeoxyglucose (FDG) and [18F]FAPI examinations were performed within one week. LN staging was validated using surgical and pathological findings. [18F]FDG and [18F]FAPI uptake was compared using the Wilcoxon signed-ranks test. Furthermore, the diagnostic value of nodal groups was investigated.
RESULTS: In 53 patients (median age, 64 years, range: 31-76 years), the specificity of [18F]FAPI for detecting LN metastasis was significantly higher than that of [18F]FDG (P < 0.001). High LN risk category, greater LN short-axis dimension(≥ 1.0 cm), absence of LN calcification or high-attenuation, and higher LN FDG SUVmax (≥ 10.1) were risk factors for LN metastasis(P < 0.05). The concurrence of these four risk factors accurately predicted LN metastases (Positive Predictive Value [PPV] 100%), whereas the presence of one to three risk factors was unable to accurately discriminate the nature of LNs (PPV 21.7%). Adding [18F]FAPI in this circumstance improved the diagnostic value. LNs with an [18F]FAPI SUVmax<6.2 were diagnosed as benign (Negative Predictive Value 93.8%), and LNs with an [18F]FAPI SUVmax≥6.2 without calcification or high-attenuation were diagnosed as LN metastasis (PPV 87.5%). Ultimately, the integration of [18F]FDG and [18F]FAPI PET/CT resulted in the highest accuracy for N stage (83.0%) and clinical decision revisions for 29 patients.
CONCLUSIONS: In patients with stage I-IIIA NSCLC, [18F]FAPI contributed additional valuable information to reduce LN diagnostic uncertainties after [18F]FDG PET/CT. Integrating [18F]FDG and [18F]FAPI PET/CT resulted in more precise clinical decisions.
BACKGROUND: The Chinese Clinical Trial Registry: ChiCTR2100044944 (Registered: 1 April 2021, https://www.chictr.org.cn/showprojEN.html?proj=123995 ).
METHODS: From November 2021 to October 2022, 53 patients with stage I-IIIA NSCLC who underwent radical resection were prospectively included. [18F]-fluorodeoxyglucose (FDG) and [18F]FAPI examinations were performed within one week. LN staging was validated using surgical and pathological findings. [18F]FDG and [18F]FAPI uptake was compared using the Wilcoxon signed-ranks test. Furthermore, the diagnostic value of nodal groups was investigated.
RESULTS: In 53 patients (median age, 64 years, range: 31-76 years), the specificity of [18F]FAPI for detecting LN metastasis was significantly higher than that of [18F]FDG (P < 0.001). High LN risk category, greater LN short-axis dimension(≥ 1.0 cm), absence of LN calcification or high-attenuation, and higher LN FDG SUVmax (≥ 10.1) were risk factors for LN metastasis(P < 0.05). The concurrence of these four risk factors accurately predicted LN metastases (Positive Predictive Value [PPV] 100%), whereas the presence of one to three risk factors was unable to accurately discriminate the nature of LNs (PPV 21.7%). Adding [18F]FAPI in this circumstance improved the diagnostic value. LNs with an [18F]FAPI SUVmax<6.2 were diagnosed as benign (Negative Predictive Value 93.8%), and LNs with an [18F]FAPI SUVmax≥6.2 without calcification or high-attenuation were diagnosed as LN metastasis (PPV 87.5%). Ultimately, the integration of [18F]FDG and [18F]FAPI PET/CT resulted in the highest accuracy for N stage (83.0%) and clinical decision revisions for 29 patients.
CONCLUSIONS: In patients with stage I-IIIA NSCLC, [18F]FAPI contributed additional valuable information to reduce LN diagnostic uncertainties after [18F]FDG PET/CT. Integrating [18F]FDG and [18F]FAPI PET/CT resulted in more precise clinical decisions.
BACKGROUND: The Chinese Clinical Trial Registry: ChiCTR2100044944 (Registered: 1 April 2021, https://www.chictr.org.cn/showprojEN.html?proj=123995 ).
摘要：
背景：这项研究调查了氟18（[18F]）标记的成纤维细胞激活蛋白抑制剂（FAPI）对I-IIIA期非小细胞肺癌（NSCLC）患者淋巴结（LN）转移的价值。
方法：从2021年11月至2022年10月，前瞻性纳入53例I-IIIA期非小细胞肺癌根治术患者。在一周内进行[18F]-氟脱氧葡萄糖(FDG)和[18F]FAPI检查。使用手术和病理结果验证LN分期。使用Wilcoxon符号秩检验比较[18F]FDG和[18F]FAPI摄取。此外，研究了淋巴结组的诊断价值.
结果：在53例患者中（中位年龄，64年,范围：31-76岁），[18F]FAPI检测LN转移的特异性明显高于[18F]FDG（P<0.001）。高LN风险类别,LN短轴尺寸越大(≥1.0cm),没有LN钙化或高衰减，较高的LNFDGSUVmax（≥10.1）是LN转移的危险因素（P<0.05）。这四个危险因素的并发性准确预测了LN转移（阳性预测值[PPV]100％），而1~3个危险因素的存在无法准确区分LN的性质(PPV21.7%).在这种情况下添加[18F]FAPI提高了诊断价值。[18F]FAPISUVmax<6.2的LN被诊断为良性（阴性预测值93.8％），[18F]FAPISUVmax≥6.2无钙化或高衰减的LN被诊断为LN转移(PPV87.5%)。最终,[18F]FDG和[18F]FAPIPET/CT的整合导致29例患者的N分期(83.0%)和临床决策修订的最高准确度.
结论：在I-IIIA期非小细胞肺癌患者中，[18F]FAPI为减少[18F]FDGPET/CT后的LN诊断不确定性提供了更多有价值的信息。整合[18F]FDG和[18F]FAPIPET/CT导致更精确的临床决策。
背景：中国临床试验注册：ChiCTR2100044944（注册：2021年4月1日，https：//www.chictr.org.cn/showprojEN.html?proj=123995)。
方法：从2021年11月至2022年10月，前瞻性纳入53例I-IIIA期非小细胞肺癌根治术患者。在一周内进行[18F]-氟脱氧葡萄糖(FDG)和[18F]FAPI检查。使用手术和病理结果验证LN分期。使用Wilcoxon符号秩检验比较[18F]FDG和[18F]FAPI摄取。此外，研究了淋巴结组的诊断价值.
结果：在53例患者中（中位年龄，64年,范围：31-76岁），[18F]FAPI检测LN转移的特异性明显高于[18F]FDG（P<0.001）。高LN风险类别,LN短轴尺寸越大(≥1.0cm),没有LN钙化或高衰减，较高的LNFDGSUVmax（≥10.1）是LN转移的危险因素（P<0.05）。这四个危险因素的并发性准确预测了LN转移（阳性预测值[PPV]100％），而1~3个危险因素的存在无法准确区分LN的性质(PPV21.7%).在这种情况下添加[18F]FAPI提高了诊断价值。[18F]FAPISUVmax<6.2的LN被诊断为良性（阴性预测值93.8％），[18F]FAPISUVmax≥6.2无钙化或高衰减的LN被诊断为LN转移(PPV87.5%)。最终,[18F]FDG和[18F]FAPIPET/CT的整合导致29例患者的N分期(83.0%)和临床决策修订的最高准确度.
结论：在I-IIIA期非小细胞肺癌患者中，[18F]FAPI为减少[18F]FDGPET/CT后的LN诊断不确定性提供了更多有价值的信息。整合[18F]FDG和[18F]FAPIPET/CT导致更精确的临床决策。
背景：中国临床试验注册：ChiCTR2100044944（注册：2021年4月1日，https：//www.chictr.org.cn/showprojEN.html?proj=123995)。
