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Performance of [18F]FDG PET/CT versus FAPI PET/CT for lung cancer assessment: a systematic review and meta-analysis

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Abstract

Purpose

This article aims to compare the diagnostic performance of 18-fluorodeoxyglucose ([18F]FDG) PET/CT and fibroblast activating protein inhibitor (FAPI) PET/CT in the assessment of primary tumors, lymph nodes, and distant metastases in lung cancer patients.

Methods

A systematic search was conducted on the Cochrane Library, Embase, and PubMed/MEDLINE databases from inception until November 1, 2022. Included studies assessed the use of FAPI PET/CT and [18F]FDG PET/CT in patients with lung cancer. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the risk of bias. A random variable model was used to analyze the diagnostic tests of the two imaging modalities.

Results

The sensitivity of FAPI PET/CT in detecting primary lung cancer lesions was 0.98 (95% CI: 0.88–1.00), while the sensitivity of [18F]FDG PET/CT was 0.99 (95% CI: 0.74–1.00). For the detection of metastatic lesions (lymph node metastases and distant metastases), FAPI PET/CT had a sensitivity of 0.99 (95% CI: 0.90–1.00), while the sensitivity of [18F]FDG PET/CT was 0.77 (95% CI: 0.66–0.85). However, the specificity of the two imaging modalities could not be assessed due to the lack of sufficient information on pertinent true negatives.

Conclusion

In the diagnosis of metastatic lung cancer lesions, FAPI PET/CT demonstrated a higher sensitivity compared to [18F]FDG PET/CT. Therefore, FAPI PET/CT may be considered an alternative imaging modality for the assessment of primary lung cancer tumors, lymph node metastases, and distant metastases.

Clinical relevance statement

FAPI may be an alternative to [18F]FDG in the assessment of primary lung cancer tumors, lymph node metastases, and distant metastases, which plays a very important role in treatment.

Key Points

• This article is to compare the performance of [18F]FDG PET/CT with FAPI PET/CT in the assessment of primary tumors, lymph nodes, and distant metastases in lung cancer.

• However, FAPI PET/CT has a higher sensitivity for the diagnostic assessment of metastatic lung cancer lesions.

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Abbreviations

[18F]FDG:

18 Fluorodeoxyribose

[68 Ga]Ga-FAPI:

68-Labeled fibroblast activating protein inhibitor

95% CI:

95% Confidence intervals

CAFs:

Cancer-associated fibroblasts

FAP:

Fibroblast activating protein

LAC:

Lung adenocarcinoma

LC:

Lung cancer

NSCLC:

Nonsmall cell lung cancer

P:

Prospective

R:

Retrospective

SUVmax:

Maximum standardized uptake

TBR:

Target-to-background ratio

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Acknowledgements

This study was supported by the Luzhou Municipal People’s Government-Southwest Medical University Science and Technology Strategic Cooperation Fund.

Funding

This study has received funding by the Luzhou Municipal People’s Government-Southwest Medical University Science and Technology Strategic Cooperation Fund (No. 2020LZXNYDJ12); Sichuan Provincial Medical Research Project Program (No. S21004); Southwest Medical University Innovation and Entrepreneurship Training Program (No.S202210632248).

Author information

Authors and Affiliations

  1. Southwest Medical University, Luzhou, Sichuan, China

    Qiuya Yang, Delong Huang, YuanHang Han & Haodong Jiang

  2. Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China

    Junhao Wu

  3. Department of Hematology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China

    Haoshu Zhong

  4. Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China

    Yue Chen

  5. Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China

    Yue Chen

  6. Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, China

    Yue Chen

  7. Chengdu Sport University, Chengdu, Sichuan, China

    Gong Chen

  8. Department of Radiology, The Affiliated Hospital of Southwest Medical University, No.25, Taiping St, Luzhou, 646000, Sichuan, China

    Xiang Zhan & Ping Zhou

Authors
  1. Qiuya Yang
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Correspondence to Ping Zhou.

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Guarantor

The scientific guarantor of this publication is Ping Zhou.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Delong Huang kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was not required for this study because we statistically analyzed other people’s experiments and it was registered with PROSPERO9 (CRD42022374792; available at https://www.crd.york.ac.uk/PROSPERO).

Ethical approval

Institutional Review Board approval was not required because it was a systematic review and meta-analysis.

Study subjects or cohorts overlap

Some study subjects or cohorts have not been previously reported.

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• Performed at one institution

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Xiang Zhan and Ping Zhou are co-corresponding authors; they contributed equally to this work.

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Yang, Q., Huang, D., Wu, J. et al. Performance of [18F]FDG PET/CT versus FAPI PET/CT for lung cancer assessment: a systematic review and meta-analysis. Eur Radiol 34, 1077–1085 (2024). https://doi.org/10.1007/s00330-023-10013-7

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