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Research ArticleFEATURED ARTICLE OF THE MONTH

Fibroblast-Activation Protein PET and Histopathology in a Single-Center Database of 324 Patients and 21 Tumor Entities

Nader Hirmas, Rainer Hamacher, Miriam Sraieb, Marc Ingenwerth, Lukas Kessler, Kim M. Pabst, Francesco Barbato, Katharina Lueckerath, Stefan Kasper, Michael Nader, Hans-Ulrich Schildhaus, Claudia Kesch, Bastian von Tresckow, Christine Hanoun, Hubertus Hautzel, Clemens Aigner, Martin Glas, Martin Stuschke, Sherko Kümmel, Philipp Harter, Celine Lugnier, Waldemar Uhl, Marco Niedergethmann, Boris Hadaschik, Viktor Grünwald, Jens T. Siveke, Ken Herrmann and Wolfgang P. Fendler
Journal of Nuclear Medicine May 2023, 64 (5) 711-716; DOI: https://doi.org/10.2967/jnumed.122.264689
Nader Hirmas
1Department of Nuclear Medicine, University of Duisburg–Essen, and German Cancer Consortium (DKTK)–University Hospital Essen, Essen, Germany;
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Rainer Hamacher
2Department of Medical Oncology, West German Cancer Center, University of Duisburg–Essen, and DKTK–University Hospital Essen, Essen, Germany;
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Miriam Sraieb
1Department of Nuclear Medicine, University of Duisburg–Essen, and German Cancer Consortium (DKTK)–University Hospital Essen, Essen, Germany;
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Marc Ingenwerth
3Institute of Pathology, University Hospital Essen, Essen, Germany;
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Lukas Kessler
1Department of Nuclear Medicine, University of Duisburg–Essen, and German Cancer Consortium (DKTK)–University Hospital Essen, Essen, Germany;
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Kim M. Pabst
1Department of Nuclear Medicine, University of Duisburg–Essen, and German Cancer Consortium (DKTK)–University Hospital Essen, Essen, Germany;
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Francesco Barbato
1Department of Nuclear Medicine, University of Duisburg–Essen, and German Cancer Consortium (DKTK)–University Hospital Essen, Essen, Germany;
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Katharina Lueckerath
1Department of Nuclear Medicine, University of Duisburg–Essen, and German Cancer Consortium (DKTK)–University Hospital Essen, Essen, Germany;
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Stefan Kasper
2Department of Medical Oncology, West German Cancer Center, University of Duisburg–Essen, and DKTK–University Hospital Essen, Essen, Germany;
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Michael Nader
1Department of Nuclear Medicine, University of Duisburg–Essen, and German Cancer Consortium (DKTK)–University Hospital Essen, Essen, Germany;
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Hans-Ulrich Schildhaus
3Institute of Pathology, University Hospital Essen, Essen, Germany;
4Targos Molecular Pathology Inc., Kassel, Germany;
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Claudia Kesch
5Department of Urology, University of Duisburg–Essen, and DKTK–University Hospital Essen, Essen, Germany;
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Bastian von Tresckow
6Department of Hematology and Stem Cell Transplantation, University of Duisburg–Essen, and DKTK–University Hospital Essen, Essen, Germany;
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Christine Hanoun
6Department of Hematology and Stem Cell Transplantation, University of Duisburg–Essen, and DKTK–University Hospital Essen, Essen, Germany;
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Hubertus Hautzel
1Department of Nuclear Medicine, University of Duisburg–Essen, and German Cancer Consortium (DKTK)–University Hospital Essen, Essen, Germany;
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Clemens Aigner
7Department of Thoracic Surgery and Thoracic Endoscopy, University of Duisburg–Essen, and DKTK–University Hospital Essen, Essen, Germany;
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Martin Glas
8Division of Clinical Neurooncology, Department of Neurology, University of Duisburg–Essen, and DKTK–University Hospital Essen, Essen, Germany;
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Martin Stuschke
9Department of Radiation Therapy, University of Duisburg–Essen, and DKTK–University Hospital Essen, Essen, Germany;
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Sherko Kümmel
10Breast Unit, Kliniken Essen–Mitte, Essen, Germany, and Department of Gynecology with Breast Center, Charité–Universitätsmedizin Berlin, Berlin, Germany;
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Philipp Harter
11Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen–Mitte, Essen, Germany;
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Celine Lugnier
12Department of Hematology and Oncology with Palliative Care, Ruhr University Bochum, Bochum, Germany;
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Waldemar Uhl
13Department of General and Visceral Surgery, Ruhr University Bochum, Bochum, Germany;
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Marco Niedergethmann
14Clinic for General and Visceral Surgery, Alfried Krupp Hospital, Essen, Germany;
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Boris Hadaschik
5Department of Urology, University of Duisburg–Essen, and DKTK–University Hospital Essen, Essen, Germany;
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Viktor Grünwald
5Department of Urology, University of Duisburg–Essen, and DKTK–University Hospital Essen, Essen, Germany;
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Jens T. Siveke
15Bridge Institute of Experimental Tumor Therapy, West German Cancer Center, University Hospital Essen, Essen, Germany; and
16Division of Solid Tumor Translational Oncology, DKTK (Partner Site Essen) and German Cancer Research Center, Heidelberg, Germany
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Ken Herrmann
1Department of Nuclear Medicine, University of Duisburg–Essen, and German Cancer Consortium (DKTK)–University Hospital Essen, Essen, Germany;
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Wolfgang P. Fendler
1Department of Nuclear Medicine, University of Duisburg–Essen, and German Cancer Consortium (DKTK)–University Hospital Essen, Essen, Germany;
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  • FIGURE 1.
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    FIGURE 1.

    Mean SUVmax on 68Ga-FAPI PET for primary lesions (n = 221) (A) and hottest metastatic lesions per patient (n = 199) (B). Data points represent hottest lesions for individual patients. Data in A and B were sorted by mean SUVmax in A. Numbers of patients included for every tumor entity are given on x-axis. Red lines represent mean values. y-axis is split to account for extreme values. Primary and metastatic lesions for every tumor entity are provided in Supplemental Table 1.

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    FIGURE 2.

    Comparison of mean SUVmax for primary lesions (A) and metastatic lesions (B) between 68Ga-FAPI and 18F-FDG PET across tumor entities. Entities are arranged as presented in Figure 1. Mean and SD are presented for every bar. Two-tailed paired t test was performed. *P < 0.05. **P < 0.01. ***P < 0.001.

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    FIGURE 3.

    Comparison of mean TBRmax for primary lesions between 68Ga-FAPI and 18F-FDG PET across tumor entities, with different reference backgrounds (blood [A], liver [B], and muscle [C]). Entities are arranged as presented in Figure 1. Mean and SD are presented for every bar. Two-tailed paired t test was performed. *P < 0.05. **P < 0.01. ***P < 0.001.

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    FIGURE 4.

    Comparison of mean TBRmax for metastatic lesions between 68Ga-FAPI and 18F-FDG PET across tumor entities, with different reference backgrounds (blood [A], liver [B], and muscle [C]). Entities are arranged as presented in Figure 1. Mean and SD are presented for every bar. Two-tailed paired t test was performed. *P < 0.05. **P < 0.01. ***P < 0.001.

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    FIGURE 5.

    Correlation of 68Ga-FAPI SUVmax with overall score for FAP-immunohistochemistry samples within 3 mo from 68Ga-FAPI PET (n = 61). Overall FAP score refers to highest score assigned for tumor or stroma. r is Pearson correlation coefficient. Strength of correlation: negligible (0.00 < r ≤ ±0.29), low (±0.30 ≤ r ≤ ±0.49), moderate (±0.50 ≤ r ≤ ±0.69), or high (r ≥ ±0.70).

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    TABLE 1.

    Patient Characteristics (n = 324)

    VariableData
    Sex
     Male168 (52%)
     Female156 (48%)
    Median age at 68Ga-FAPI scan (y)59 (16)
    Tumor entity
     Sarcoma131 (40%)
     Pancreas67 (21%)
     Brain22 (7%)
     Lung14 (4%)
     Pleura12 (4%)
     Cholangiocellular11 (3%)
     Colorectal11 (3%)
     Prostate11 (3%)
     Head and neck9 (3%)
     Bladder8 (3%)
     Lymphoma7 (2%)
     Myeloma6 (2%)
     Ovarian4 (1%)
     Breast3 (1%)
     Duodenum2 (1%)
     Other*6 (2%)
    Tumor staging with 68Ga-FAPI scan†
     No evidence of disease19 (8%)
     Stage I26 (10%)
     Stage II29 (12%)
     Stage III25 (10%)
     Stage IV149 (60%)
    Scanning purposes
     Staging at initial diagnosis88 (27%)
     Restaging after therapy235 (73%)
    Prior therapy received
     None88 (27%)
     Surgery176 (55%)
     Chemotherapy176 (55%)
     Radiation therapy83 (26%)
     Immune therapy27 (8%)
     Hormone therapy9 (3%)
     Radionuclide therapy3 (1%)
    Median uptake time (min)
     68Ga-FAPI14 (24)
     18F-FDG67 (23)
    Median time between 68Ga-FAPI and 18F-FDG (d)0 (2)
    • ↵* Tumors of cervix (n = 1), liver (n = 1), skin (n = 1), thyroid (n = 1), and stomach (n = 1) and myoepithelial carcinoma of knee (n = 1).

    • ↵† Among 7 most common tumor entities (n = 248), excluding brain tumors as well as 9 sarcoma patients (not stageable according to AJCC-8).

    • Qualitative data are number and percentage; continuous data are median and interquartile range.

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Journal of Nuclear Medicine: 64 (5)
Journal of Nuclear Medicine
Vol. 64, Issue 5
May 1, 2023
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Fibroblast-Activation Protein PET and Histopathology in a Single-Center Database of 324 Patients and 21 Tumor Entities
Nader Hirmas, Rainer Hamacher, Miriam Sraieb, Marc Ingenwerth, Lukas Kessler, Kim M. Pabst, Francesco Barbato, Katharina Lueckerath, Stefan Kasper, Michael Nader, Hans-Ulrich Schildhaus, Claudia Kesch, Bastian von Tresckow, Christine Hanoun, Hubertus Hautzel, Clemens Aigner, Martin Glas, Martin Stuschke, Sherko Kümmel, Philipp Harter, Celine Lugnier, Waldemar Uhl, Marco Niedergethmann, Boris Hadaschik, Viktor Grünwald, Jens T. Siveke, Ken Herrmann, Wolfgang P. Fendler
Journal of Nuclear Medicine May 2023, 64 (5) 711-716; DOI: 10.2967/jnumed.122.264689

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Fibroblast-Activation Protein PET and Histopathology in a Single-Center Database of 324 Patients and 21 Tumor Entities
Nader Hirmas, Rainer Hamacher, Miriam Sraieb, Marc Ingenwerth, Lukas Kessler, Kim M. Pabst, Francesco Barbato, Katharina Lueckerath, Stefan Kasper, Michael Nader, Hans-Ulrich Schildhaus, Claudia Kesch, Bastian von Tresckow, Christine Hanoun, Hubertus Hautzel, Clemens Aigner, Martin Glas, Martin Stuschke, Sherko Kümmel, Philipp Harter, Celine Lugnier, Waldemar Uhl, Marco Niedergethmann, Boris Hadaschik, Viktor Grünwald, Jens T. Siveke, Ken Herrmann, Wolfgang P. Fendler
Journal of Nuclear Medicine May 2023, 64 (5) 711-716; DOI: 10.2967/jnumed.122.264689
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