RT Journal Article
SR Electronic
T1 Fibroblast Activation Protein–Directed Imaging Outperforms <sup>18</sup>F-FDG PET/CT in Malignant Mesothelioma: A Prospective, Single-Center, Observational Trial
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP jnumed.124.267473
DO 10.2967/jnumed.124.267473
A1 Kessler, Lukas
A1 Schwaning, Felix
A1 Metzenmacher, Martin
A1 Pabst, Kim
A1 Siveke, Jens
A1 Trajkovic-Arsic, Marija
A1 Schaarschmidt, Benedikt
A1 Wiesweg, Marcel
A1 Aigner, Clemens
A1 Plönes, Till
A1 Darwiche, Kaid
A1 Bölükbas, Servet
A1 Stuschke, Martin
A1 Umutlu, Lale
A1 Nader, Michael
A1 Theegarten, Dirk
A1 Hamacher, Rainer
A1 Eberhardt, Wilfried E.E.
A1 Schuler, Martin
A1 Herrmann, Ken
A1 Fendler, Wolfgang P.
A1 Hautzel, Hubertus
YR 2024
UL http://jnm.snmjournals.org/content/early/2024/07/03/jnumed.124.267473.abstract
AB The fibroblast activation protein (FAP) is highly expressed in tumor and stromal cells of mesothelioma and thus is an interesting imaging and therapeutic target. Previous data on PET imaging with radiolabeled FAP inhibitors (FAPIs) suggest high potential for superior tumor detection. Here, we report the data of a large malignant pleural mesothelioma cohort within a 68Ga-FAPI46 PET observational trial (NCT04571086). Methods: Of 43 eligible patients with suspected or proven malignant mesothelioma, 41 could be included in the data analysis of the 68Ga-FAPI46 PET observational trial. All patients underwent 68Ga-FAPI46 PET/CT, contrast-enhanced CT, and 18F-FDG PET/CT. The primary study endpoint was the association of 68Ga-FAPI46 PET uptake intensity and histopathologic FAP expression. Furthermore, secondary endpoints were detection rate and sensitivity, specificity, and positive and negative predictive values as compared with 18F-FDG PET/CT. Datasets were interpreted by 2 masked readers. Results: The primary endpoint was met, and the association between 68Ga-FAPI46 SUVmax or SUVpeak and histopathologic FAP expression was significant (SUVmax: r = 0.49, P = 0.037; SUVpeak: r = 0.51, P = 0.030).68Ga-FAPI46 and 18F-FDG showed similar sensitivity by histopathologic validation on a per-patient (100.0% vs. 97.3%) and per region (98.0% vs. 95.9%) basis. Per-region analysis revealed higher 68Ga-FAPI46 than 18F-FDG specificity (81.1% vs. 36.8%) and positive predictive value (87.5% vs. 66.2%). Conclusion: We confirm an association of 68Ga-FAPI46 uptake and histopathologic FAP expression in mesothelioma patients. Additionally, we report high sensitivity and superior specificity and positive predictive value for 68Ga-FAPI46 versus 18F-FDG.