Comparison of 18F-FDG PET/CT and 68Ga-FAPI-04 PET/CT in patients with non-small cell lung cancer

Aim 

In this study, we aimed to compare the diagnostic accuracy of 18F−fluorodeoxyglucose (18F-FDG) and Gallium-68 labeled fibroblast activator protein inhibitor (68Ga-FAPI)-04 PET/CT in the tumor–node–metastasis (TNM) staging of patients with nonsmall cell lung cancer (NSCLC) and investigate whether adenocarcinoma (ADC) and squamous cell cancer (SCC) exhibit different uptake patterns on 68Ga-FAPI-04 PET/CT.

Materials and method 

Twenty-nine patients with a histopathologically-confirmed diagnosis of NSCLC, who had no history of previous radiation therapy or chemotherapy and underwent 18F-FDG PET/CT and 68Ga-FAPI-04 PET/CT imaging between January 2021 and December 2021 were included in this retrospective study. Staging was performed using the 8th edition of the TNM staging system on both 18F-FDG PET/CT and 68Ga-FAPI-04 PET/CT images. Standardized uptake value (SUV)max and tumor-to-background ratios (TBR) were calculated on primary lesions and metastases.

Results 

There was no statistically significant difference in primary lesions in terms of SUVmax and TBR values. However, 68Ga-FAPI-04 PET/CT was significantly superior to 18F-FDG PET/CT in terms of the number of lymph nodes and bone metastases revealed. The SUVmax and TBR values of lymph nodes, hepatic lesions and bone lesions were significantly higher on 68Ga-FAPI-04 PET/CT than on 18F-FDG PET/CT. 68Ga-FAPI-04 PET/CT changed the disease stage of three patients (10.9%). The diagnostic accuracy of 68Ga-FAPI-04 PET/CT was 100%, whereas the diagnostic accuracy of 18F-FDG PET/CT was 89.6% (P = 0.250).

Conclusion 

Although 68Ga-FAPI-04 PET/CT detected more lesions and higher diagnostic accuracy than 18F-FDG PET/CT in NSCLC, neither method was statistically superior to each other in terms of diagnostic accuracy in TNM staging.

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