PT  - JOURNAL ARTICLE
AU  - Hirmas, Nader
AU  - Hamacher, Rainer
AU  - Sraieb, Miriam
AU  - Kessler, Lukas
AU  - Pabst, Kim M.
AU  - Barbato, Francesco
AU  - Lanzafame, Helena
AU  - Kasper, Stefan
AU  - Nader, Michael
AU  - Kesch, Claudia
AU  - von Tresckow, Bastian
AU  - Hautzel, Hubertus
AU  - Aigner, Clemens
AU  - Glas, Martin
AU  - Stuschke, Martin
AU  - Kümmel, Sherko
AU  - Harter, Philipp
AU  - Lugnier, Celine
AU  - Uhl, Waldemar
AU  - Hadaschik, Boris
AU  - Grünwald, Viktor
AU  - Siveke, Jens T.
AU  - Herrmann, Ken
AU  - Fendler, Wolfgang P.
TI  - Diagnostic Accuracy of <sup>68</sup>Ga-FAPI Versus <sup>18</sup>F-FDG PET in Patients with Various Malignancies
AID  - 10.2967/jnumed.123.266652
DP  - 2024 Feb 08
TA  - Journal of Nuclear Medicine
PG  - jnumed.123.266652
4099  - http://jnm.snmjournals.org/content/early/2024/02/08/jnumed.123.266652.short
4100  - http://jnm.snmjournals.org/content/early/2024/02/08/jnumed.123.266652.full
AB  - To assess the diagnostic accuracy of 68Ga-labeled fibroblast activation protein inhibitor (FAPI) and 18F-labeled FDG PET for the detection of various tumors, we performed a head-to-head comparison of both imaging modalities across a range of tumor entities as part of our ongoing 68Ga-FAPI PET observational trial. Methods: The study included 115 patients with 8 tumor entities who received imaging with 68Ga-FAPI for tumor staging or restaging between October 2018 and March 2022. Of those, 103 patients received concomitant imaging with 68Ga-FAPI and 18F-FDG PET and had adequate lesion validation for accuracy analysis. Each scan was evaluated for the detection of primary tumor, lymph nodes, and visceral and bone metastases. True or false positivity and negativity to detected lesions was assigned on the basis of histopathology from biopsies or surgical excision, as well as imaging validation. Results: 68Ga-FAPI PET revealed higher accuracy than 18F-FDG PET in the detection of colorectal cancer (n = 14; per-patient, 85.7% vs. 78.6%; per-region, 95.6% vs. 91.1%) and prostate cancer (n = 22; per-patient, 100% vs. 90.9%; per-region, 96.4% vs. 92.7%). 68Ga-FAPI PET and 18F-FDG PET had comparable per-patient accuracy in detecting breast cancer (n = 16, 100% for both) and head and neck cancers (n = 10, 90% for both modalities). 68Ga-FAPI PET had lower per-patient accuracy than 18F-FDG PET in cancers of the bladder (n = 12, 75% vs. 100%) and kidney (n = 10, 80% vs. 90%), as well as lymphoma (n = 9, 88.9% vs. 100%) and myeloma (n = 10, 80% vs. 90%). Conclusion: 68Ga-FAPI PET demonstrated higher diagnostic accuracy than 18F-FDG PET in the diagnosis of colorectal cancer and prostate cancer, as well as comparable diagnostic performance for cancers of the breast and head and neck. Accuracy and impact on management will be further assessed in an ongoing prospective interventional trial (NCT05160051).