Abstract：
OBJECTIVE: This prospective study aims to evaluate the value of [18F]AlF-NOTA-fibroblast activation protein inhibitor (FAPI)-04 positron emission tomography-computed tomography (PET/CT) in predicting molecular subtypes of breast cancer.
METHODS: The study consecutively recruited patients suspected of having breast cancer from a single center who were prospectively enrolled from July 2023 to May 2024 and underwent [18F]AlF-NOTA-FAPI-04 PET/CT. This study compared the differences in tracer uptake among breast cancers with different adverse prognostic factors and molecular subtypes. The classification performance for each molecular subtype of breast cancer was assessed using a receiver operating characteristic (ROC) curve.
RESULTS: Fifty-three participants (mean age, 51 ± 11 years; 52 females) were evaluated. Breast cancer lesions with adverse prognostic factors showed higher tracer uptake. The five different molecular subtypes exhibited varying levels of uptake. The luminal A and luminal B (HER2-negative) subtypes had relatively low uptake, while the luminal B (HER2-positive), HER2-positive, and triple-negative subtypes had relatively high uptake. ROC analysis identified the max standardized uptake value (SUVmax) as a significant classifier (AUC = 0.912, P = 0.0005) for the luminal A subtype, with 100% sensitivity and 83% specificity. For predicting the luminal B (HER2-negative) subtype, SUVmax had an AUC of 0.770 (P = 0.0015). SUVmax, with an AUC of 0.781 (P = 0.003), was used to identify the triple-negative subtype tumors, resulting in a sensitivity of 100% and specificity of 51%. Lastly, the ROC curve showed the cut-off 15.40 (AUC = 0.921, P < 0.0001) could classify luminal A & luminal B (HER2-negative), and luminal B (HER2-positive) & HER2-positive & triple-negative, yielding a sensitivity of 94% and specificity of 79%.
CONCLUSIONS: The uptake of [18F]AlF-NOTA-FAPI-04 is significantly correlated with the molecular subtypes of breast cancer, and [18F]AlF-NOTA-FAPI-04 PET/CT is a potential tool for noninvasive identification of luminal A subtypes and guidance of FAP-targeted therapies.
METHODS: The study consecutively recruited patients suspected of having breast cancer from a single center who were prospectively enrolled from July 2023 to May 2024 and underwent [18F]AlF-NOTA-FAPI-04 PET/CT. This study compared the differences in tracer uptake among breast cancers with different adverse prognostic factors and molecular subtypes. The classification performance for each molecular subtype of breast cancer was assessed using a receiver operating characteristic (ROC) curve.
RESULTS: Fifty-three participants (mean age, 51 ± 11 years; 52 females) were evaluated. Breast cancer lesions with adverse prognostic factors showed higher tracer uptake. The five different molecular subtypes exhibited varying levels of uptake. The luminal A and luminal B (HER2-negative) subtypes had relatively low uptake, while the luminal B (HER2-positive), HER2-positive, and triple-negative subtypes had relatively high uptake. ROC analysis identified the max standardized uptake value (SUVmax) as a significant classifier (AUC = 0.912, P = 0.0005) for the luminal A subtype, with 100% sensitivity and 83% specificity. For predicting the luminal B (HER2-negative) subtype, SUVmax had an AUC of 0.770 (P = 0.0015). SUVmax, with an AUC of 0.781 (P = 0.003), was used to identify the triple-negative subtype tumors, resulting in a sensitivity of 100% and specificity of 51%. Lastly, the ROC curve showed the cut-off 15.40 (AUC = 0.921, P < 0.0001) could classify luminal A & luminal B (HER2-negative), and luminal B (HER2-positive) & HER2-positive & triple-negative, yielding a sensitivity of 94% and specificity of 79%.
CONCLUSIONS: The uptake of [18F]AlF-NOTA-FAPI-04 is significantly correlated with the molecular subtypes of breast cancer, and [18F]AlF-NOTA-FAPI-04 PET/CT is a potential tool for noninvasive identification of luminal A subtypes and guidance of FAP-targeted therapies.
摘要：
目的：这项前瞻性研究旨在评估[18F]AlF-NOTA-成纤维细胞活化蛋白抑制剂（FAPI）-04正电子发射断层扫描-计算机断层扫描（PET/CT）在预测乳腺癌分子亚型中的价值。
方法：该研究从2023年7月至2024年5月前瞻性纳入的单中心连续招募了怀疑患有乳腺癌的患者，并接受了[18F]AlF-NOTA-FAPI-04PET/CT检查。这项研究比较了具有不同不良预后因素和分子亚型的乳腺癌中示踪剂摄取的差异。使用受试者工作特征（ROC）曲线评估每种乳腺癌分子亚型的分类性能。
结果：53名参与者(平均年龄，51±11岁；52名女性）进行了评估。具有不良预后因素的乳腺癌病变显示出更高的示踪剂摄取。五种不同的分子亚型表现出不同的摄取水平。管腔A和管腔B（HER2阴性）亚型的摄取相对较低，而管腔B（HER2阳性），HER2阳性,和三阴性亚型具有相对较高的摄取。ROC分析确定最大标准化摄取值(SUVmax)作为腔A型亚型的显著分类器(AUC=0.912,P=0.0005),具有100%的灵敏度和83%的特异性。为了预测腔B（HER2阴性）亚型，SUVmax的AUC为0.770(P=0.0015)。SUVmax,AUC为0.781（P=0.003），用于识别三阴性亚型肿瘤，导致100%的灵敏度和51%的特异性。最后,ROC曲线显示截止值15.40（AUC=0.921，P<0.0001）可以对腔A和腔B（HER2阴性）进行分类，和管腔B（HER2阳性）和HER2阳性和三阴性，产生94%的灵敏度和79%的特异性。
结论：[18F]AlF-NOTA-FAPI-04的摄取与乳腺癌的分子亚型显著相关，和[18F]AlF-NOTA-FAPI-04PET/CT是用于非侵入性识别腔A亚型和指导FAP靶向治疗的潜在工具。
方法：该研究从2023年7月至2024年5月前瞻性纳入的单中心连续招募了怀疑患有乳腺癌的患者，并接受了[18F]AlF-NOTA-FAPI-04PET/CT检查。这项研究比较了具有不同不良预后因素和分子亚型的乳腺癌中示踪剂摄取的差异。使用受试者工作特征（ROC）曲线评估每种乳腺癌分子亚型的分类性能。
结果：53名参与者(平均年龄，51±11岁；52名女性）进行了评估。具有不良预后因素的乳腺癌病变显示出更高的示踪剂摄取。五种不同的分子亚型表现出不同的摄取水平。管腔A和管腔B（HER2阴性）亚型的摄取相对较低，而管腔B（HER2阳性），HER2阳性,和三阴性亚型具有相对较高的摄取。ROC分析确定最大标准化摄取值(SUVmax)作为腔A型亚型的显著分类器(AUC=0.912,P=0.0005),具有100%的灵敏度和83%的特异性。为了预测腔B（HER2阴性）亚型，SUVmax的AUC为0.770(P=0.0015)。SUVmax,AUC为0.781（P=0.003），用于识别三阴性亚型肿瘤，导致100%的灵敏度和51%的特异性。最后,ROC曲线显示截止值15.40（AUC=0.921，P<0.0001）可以对腔A和腔B（HER2阴性）进行分类，和管腔B（HER2阳性）和HER2阳性和三阴性，产生94%的灵敏度和79%的特异性。
结论：[18F]AlF-NOTA-FAPI-04的摄取与乳腺癌的分子亚型显著相关，和[18F]AlF-NOTA-FAPI-04PET/CT是用于非侵入性识别腔A亚型和指导FAP靶向治疗的潜在工具。
