Superiority of [Ga]Ga-DOTA-FAPI-04 PET/CT to [F]FDG PET/CT in the Evaluation of Thymic Epithelial Tumours

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2023 Jun 14

PMID 37316675

Authors

Xiuling Shen

Xin Zhou

Yuan Yao

Xiangxi Meng

Yufei Song

Zhi Yang

Nan Li

Affiliations

Soon will be listed here.

Abstract

Purpose: The purpose of this study is to compare the ability of [Ga]Ga-DOTA-FAPI-04 PET/CT and [F]FDG PET/CT to stratify the malignancy and invasiveness of thymic epithelial tumours (TETs).

Methods: From April 2021 to November 2022, participants with suspected TETs confirmed by histopathology or follow-up imaging were prospectively analysed. All participants underwent [F]FDG and [Ga]Ga-DOTA-FAPI-04 PET/CT within 1 week. Clinical characteristics, CT features, and metabolic parameters (maximum standardized uptake value [SUV] and tumour-to-mediastinum ratio [TMR]) of subjects with different pathological types and stages were compared. The diagnostic capacities of [F]FDG and [Ga]Ga-DOTA-FAPI-04 PET/CT were compared using receiver operating characteristic (ROC) curves and McNemar's test.

Results: Fifty-seven participants were included. [Ga]Ga-DOTA-FAPI-04 PET/CT was superior to [F]FDG PET/CT in differentiating thymomas from thymic carcinomas (TCs) (AUC: 0.99 vs. 0.90, P = 0.02). Logistic regression revealed that SUV (P = 0.04) was a significant predictive factor for TCs. SUV and TMR showed an excellent ability to differentiate low-risk thymomas (types A, AB, and B1), high-risk thymomas (types B2 and B3), and TCs (both P < 0.001). In thymomas, only SUV (P < 0.001), TMR (P < 0.001), and nonsmooth edges (P = 0.02) were significantly higher in the advanced-stage (Masaoka-Koga [MK] stage III/IV) group than in the early-stage group (MK stage I/II). Compared with [F]FDG PET/CT, [Ga]Ga-DOTA-FAPI-04 PET/CT showed significantly higher specificity (67% [46 of 69] vs. 93% [64 of 69], P < 0.001) in the detection of lymph node metastases and higher sensitivity (49% [19 of 39] vs. 97% [38 of 39], P < 0.001) in evaluating distant metastases. Both SUV and TMR were correlated with FAP expression (both r = 0.843, P < 0.001).

Conclusion: [Ga]Ga-DOTA-FAPI-04 PET/CT was superior to [F]FDG PET/CT in evaluating the World Health Organization (WHO) classification, MK staging, and metastatic status of TETs.

Trial Registration: ChiCTR2000038080, registration date 2020-09-09, https://www.chictr.org.cn/com/25/showproj.aspx?proj=61192.

Citing Articles

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PMID: 40069442 DOI: 10.1007/s12149-025-02022-x.

Distinguishing benign from malignant lesions with high [ Ga]Ga-FAPI-04 uptake in oncology patients: Insights from dynamic total-body [ Ga]Ga-FAPI-04 PET/CT.

Chen R, Yang X, Li L, Zhao H, Huang G, Liu J Eur J Nucl Med Mol Imaging. 2024; 52(4):1345-1353.

PMID: 39665998 DOI: 10.1007/s00259-024-07029-6.

References

Shin D, Cho J, Ha J, Jung K . Trends in Incidence and Survival of Patients With Thymic Epithelial Tumor in a High-Incidence Asian Country: Analysis of the Korean Central Cancer Registry 1999 to 2017. J Thorac Oncol. 2022; 17(6):827-837. DOI: 10.1016/j.jtho.2022.02.001. View

Marx A, Chan J, Chalabreysse L, Dacic S, Detterbeck F, French C . The 2021 WHO Classification of Tumors of the Thymus and Mediastinum: What Is New in Thymic Epithelial, Germ Cell, and Mesenchymal Tumors?. J Thorac Oncol. 2021; 17(2):200-213. DOI: 10.1016/j.jtho.2021.10.010. View

Marchevsky A, Gupta R, Mckenna R, Wick M, Moran C, Zakowski M . Evidence-based pathology and the pathologic evaluation of thymomas: the World Health Organization classification can be simplified into only 3 categories other than thymic carcinoma. Cancer. 2008; 112(12):2780-8. DOI: 10.1002/cncr.23492. View

Detterbeck F, Nicholson A, Kondo K, Van Schil P, Moran C . The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol. 2011; 6(7 Suppl 3):S1710-6. DOI: 10.1097/JTO.0b013e31821e8cff. View

Lee H, Kim S, Lee J, Choi Y, Han J, Ahn Y . A single institutional experience of thymic epithelial tumours over 11 years: clinical features and outcome and implications for future management. Br J Cancer. 2007; 97(1):22-8. PMC: 2359672. DOI: 10.1038/sj.bjc.6603833. View

Marom E, Milito M, Moran C, Liu P, Correa A, Kim E . Computed tomography findings predicting invasiveness of thymoma. J Thorac Oncol. 2011; 6(7):1274-81. DOI: 10.1097/JTO.0b013e31821c4203. View

Priola A, Priola S, Giraudo M, Gned D, Fornari A, Ferrero B . Diffusion-weighted magnetic resonance imaging of thymoma: ability of the Apparent Diffusion Coefficient in predicting the World Health Organization (WHO) classification and the Masaoka-Koga staging system and its prognostic significance on.... Eur Radiol. 2015; 26(7):2126-38. DOI: 10.1007/s00330-015-4031-6. View

Sung Y, Lee K, Kim B, Choi J, Shim Y, Yi C . 18F-FDG PET/CT of thymic epithelial tumors: usefulness for distinguishing and staging tumor subgroups. J Nucl Med. 2006; 47(10):1628-34. View

Terzi A, Bertolaccini L, Rizzardi G, Luzzi L, Bianchi A, Campione A . Usefulness of 18-F FDG PET/CT in the pre-treatment evaluation of thymic epithelial neoplasms. Lung Cancer. 2011; 74(2):239-43. DOI: 10.1016/j.lungcan.2011.02.018. View

10.

Benveniste M, Moran C, Mawlawi O, Fox P, Swisher S, Munden R . FDG PET-CT aids in the preoperative assessment of patients with newly diagnosed thymic epithelial malignancies. J Thorac Oncol. 2013; 8(4):502-10. PMC: 3878071. DOI: 10.1097/JTO.0b013e3182835549. View

11.

Ito T, Suzuki H, Sakairi Y, Wada H, Nakajima T, Yoshino I . 18F-FDG-PET/CT predicts grade of malignancy and invasive potential of thymic epithelial tumors. Gen Thorac Cardiovasc Surg. 2020; 69(2):274-281. DOI: 10.1007/s11748-020-01439-7. View

12.

Han S, Kim Y, Oh J, Seo S, Park M, Lee G . Diagnostic and prognostic values of 2-[F]FDG PET/CT in resectable thymic epithelial tumour. Eur Radiol. 2021; 32(2):1173-1183. DOI: 10.1007/s00330-021-08230-z. View

13.

Lindner T, Loktev A, Altmann A, Giesel F, Kratochwil C, Debus J . Development of Quinoline-Based Theranostic Ligands for the Targeting of Fibroblast Activation Protein. J Nucl Med. 2018; 59(9):1415-1422. DOI: 10.2967/jnumed.118.210443. View

14.

Zhou X, Wang S, Xu X, Meng X, Zhang H, Zhang A . Higher accuracy of [ Ga]Ga-DOTA-FAPI-04 PET/CT comparing with 2-[F]FDG PET/CT in clinical staging of NSCLC. Eur J Nucl Med Mol Imaging. 2022; 49(8):2983-2993. DOI: 10.1007/s00259-022-05818-5. View

15.

Chen H, Pang Y, Wu J, Zhao L, Hao B, Wu J . Comparison of [Ga]Ga-DOTA-FAPI-04 and [F] FDG PET/CT for the diagnosis of primary and metastatic lesions in patients with various types of cancer. Eur J Nucl Med Mol Imaging. 2020; 47(8):1820-1832. DOI: 10.1007/s00259-020-04769-z. View

16.

Kratochwil C, Flechsig P, Lindner T, Abderrahim L, Altmann A, Mier W . Ga-FAPI PET/CT: Tracer Uptake in 28 Different Kinds of Cancer. J Nucl Med. 2019; 60(6):801-805. PMC: 6581228. DOI: 10.2967/jnumed.119.227967. View

17.

Henry L, Lee H, Lee J, Klein-Szanto A, Watts P, Ross E . Clinical implications of fibroblast activation protein in patients with colon cancer. Clin Cancer Res. 2007; 13(6):1736-41. DOI: 10.1158/1078-0432.CCR-06-1746. View

18.

Kondo K, Van Schil P, Detterbeck F, Okumura M, Stratton K, Giroux D . The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposals for the N and M components for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol. 2014; 9(9 Suppl 2):S81-7. DOI: 10.1097/JTO.0000000000000291. View

19.

Bayman E, Dexter F . Multicollinearity in Logistic Regression Models. Anesth Analg. 2021; 133(2):362-365. DOI: 10.1213/ANE.0000000000005593. View

20.

Obuchowski N, McClish D . Sample size determination for diagnostic accuracy studies involving binormal ROC curve indices. Stat Med. 1997; 16(13):1529-42. DOI: 10.1002/(sici)1097-0258(19970715)16:13<1529::aid-sim565>3.0.co;2-h. View