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Purpose <p>To evaluate the diagnostic accuracy and clinical impact of fibroblast activation protein (FAP)-targeted PET/CT imaging in primary and metastatic breast cancer and compare the results with those of standard-of-care imaging (SCI) and [<sup>18</sup>F]FDG PET/CT.</p> Methods <p>We prospectively analyzed patients with diagnosed or suspected breast cancer who underwent concomitant FAP-targeted PET/CT (radiotracers including either [<sup>68</sup>Ga]Ga-FAPI-46 or [<sup>18</sup>F]FAPI-42) and [<sup>18</sup>F]FDG PET/CT scans from June 2020 to January 2024 at two medical centers. Breast ultrasound (US) imaging was performed in all treatment-naïve patients as SCI. The SUVmax, tumor-to-background ratio (TBR), lesion detection rate, and tumor-node-metastasis (TNM) classifications between FAP-targeted and [<sup>18</sup>F]FDG PET/CT were evaluated and compared.</p> Results <p>Sixty-one female patients (median age, 52 y; range, 28–82 y) were included. Among them, 23 patients underwent evaluation for a definitive diagnosis of suspected breast lesions, 15 underwent initial staging, and 23 were evaluated for the detection of recurrence. The sensitivities of breast US, [<sup>18</sup>F]FDG, and FAP-targeted PET/CT for detecting primary breast tumors were 82%, 79%, and 100%, respectively. Regarding the diagnosis of recurrent/metastatic lesions, the lesion-based detection rate of FAP-targeted PET/CT was significantly higher than that of [<sup>18</sup>F]FDG, which included local and regional recurrence, neck lymph node (LN), abdomen LN, bone, and liver metastases. Compared with [<sup>18</sup>F]FDG PET/CT, FAP-targeted PET/CT altered thirteen patients’ TNM staging/restaging (13/59, 22%) and nine patients’ clinical management (9/59, 15%). Compared to SCI, FAPI changed fourteen patients’ TNM staging/re-staging (14/59, 24%) and eleven patients’ therapeutic regimens(11/59, 19%). There was no significant association between FAPI-derived SUVmax and receptor status/histologic type in both primary and metastatic lesions.</p> Conclusion <p>FAP-targeted PET/CT was superior to [<sup>18</sup>F]FDG in diagnosing primary and metastatic breast cancer, with higher radiotracer uptake and TBR, especially in the detection of primary/recurrent tumors, abdominal LN metastases, liver, and bone metastases. FAP-targeted PET/CT is superior to [<sup>18</sup>F]FDG and SCI in TNM staging and may improve tumor staging, recurrence detection, and implementation of necessary treatment modifications.</p>

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FAP-targeted PET/CT imaging in patients with breast cancer from a prospective bi-center study: insights into diagnosis and clinic management

  • 期刊论文

  • 发表日期：

    2025年1月30日

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  • Wei Guo,
  • Weizhi Xu,
  • Tinghua Meng,
  • Chunlei Fan,
  • Hao Fu,
  • Yizhen Pang,
  • Liang Zhao,
  • Long Sun,
  • Jingxiong Huang,
  • Yanjun Mi,
  • Xinlu Wang,
  • Haojun Chen

摘要

Purpose

To evaluate the diagnostic accuracy and clinical impact of fibroblast activation protein (FAP)-targeted PET/CT imaging in primary and metastatic breast cancer and compare the results with those of standard-of-care imaging (SCI) and [18F]FDG PET/CT.

Methods

We prospectively analyzed patients with diagnosed or suspected breast cancer who underwent concomitant FAP-targeted PET/CT (radiotracers including either [68Ga]Ga-FAPI-46 or [18F]FAPI-42) and [18F]FDG PET/CT scans from June 2020 to January 2024 at two medical centers. Breast ultrasound (US) imaging was performed in all treatment-naïve patients as SCI. The SUVmax, tumor-to-background ratio (TBR), lesion detection rate, and tumor-node-metastasis (TNM) classifications between FAP-targeted and [18F]FDG PET/CT were evaluated and compared.

Results

Sixty-one female patients (median age, 52 y; range, 28–82 y) were included. Among them, 23 patients underwent evaluation for a definitive diagnosis of suspected breast lesions, 15 underwent initial staging, and 23 were evaluated for the detection of recurrence. The sensitivities of breast US, [18F]FDG, and FAP-targeted PET/CT for detecting primary breast tumors were 82%, 79%, and 100%, respectively. Regarding the diagnosis of recurrent/metastatic lesions, the lesion-based detection rate of FAP-targeted PET/CT was significantly higher than that of [18F]FDG, which included local and regional recurrence, neck lymph node (LN), abdomen LN, bone, and liver metastases. Compared with [18F]FDG PET/CT, FAP-targeted PET/CT altered thirteen patients’ TNM staging/restaging (13/59, 22%) and nine patients’ clinical management (9/59, 15%). Compared to SCI, FAPI changed fourteen patients’ TNM staging/re-staging (14/59, 24%) and eleven patients’ therapeutic regimens(11/59, 19%). There was no significant association between FAPI-derived SUVmax and receptor status/histologic type in both primary and metastatic lesions.

Conclusion

FAP-targeted PET/CT was superior to [18F]FDG in diagnosing primary and metastatic breast cancer, with higher radiotracer uptake and TBR, especially in the detection of primary/recurrent tumors, abdominal LN metastases, liver, and bone metastases. FAP-targeted PET/CT is superior to [18F]FDG and SCI in TNM staging and may improve tumor staging, recurrence detection, and implementation of necessary treatment modifications.