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Purpose <p>[<sup>68</sup>Ga]Ga-FAPI-46 has shown promise for urothelial cancer (UC) detection. This study evaluates its diagnostic value versus contrast-enhanced CT (ceCT) and 2-[<sup>18</sup>F]FDG PET in the largest bi-centric cohort to date.</p> Methods <p>Patients with metastatic UC undergoing [<sup>68</sup>Ga]Ga-FAPI-46 PET at University Hospitals Munich or Essen were retrospectively reviewed. Detection rates were compared with ceCT on a regional basis (primary, lymph nodes, visceral organs, bone). SUV<sub>max</sub> and SUV<sub>mean</sub> of two index lesions were recorded. In a sub-cohort, [<sup>68</sup>Ga]Ga-FAPI-46 and 2-[<sup>18</sup>F]FDG PET were compared on a lesion basis. Clinical follow-up and/or histopathology served as reference.</p> Results <p>Thirty-four patients underwent [<sup>68</sup>Ga]Ga-FAPI-46 PET/CT and ceCT, including 10 (29%) with additional 2-[<sup>18</sup>F]FDG PET/CT. Across 98 lesions (<i>n</i> = 65 regions), [<sup>68</sup>Ga]Ga-FAPI-46 PET detected <i>n</i> = 96 (98%) and ceCT <i>n</i> = 88 (90%), with mismatch findings in eight lymph nodes (PET positive/ceCT negative) and two visceral organs (ceCT positive/PET negative). In the subgroup comparison, 78 lesions were detected in total ([<sup>68</sup>Ga]Ga-FAPI-46: <i>n</i> = 72 (92%); 2-[<sup>18</sup>F]FDG: <i>n</i> = 78 (100%)). Tumour uptake was comparable (SUV<sub>max</sub> [<sup>68</sup>Ga]Ga-FAPI-46 PET vs. 2-[<sup>18</sup>F]FDG: 10.2 (IQR, 1.9) vs. 8.0 (IQR, 3.3), <i>p</i> = 0.249), whereas [<sup>68</sup>Ga]Ga-FAPI-46 provided higher tumour-to-background ratios (Tumour-to-liver: 12.7 (IQR, 10.3) vs. 3.8 (IQR, 1.9), <i>p</i> = 0.046; tumour-to-spleen: 8.4 (IQR, 6.6) vs. 4.6 (IQR, 0.6), <i>p</i> = 0.016).</p> Conclusion <p>[<sup>68</sup>Ga]Ga-FAPI-46 PET demonstrated higher regional detection rates than ceCT in UC patients, particularly for lymph node metastases. Compared to 2-[<sup>18</sup>F]FDG, it provided superior tumour-to-background contrast but detected slightly fewer lesions. [<sup>68</sup>Ga]Ga-FAPI-46 PET may complement established imaging in selected scenarios, although its role in routine UC staging remains investigational.</p>

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Potential value of [68Ga]Ga-FAPI-46 PET in patients with metastatic urothelial carcinoma: a bi-centric analysis

  • 期刊论文

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  • 发表日期：

    2025年11月25日

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  • Kim M. Pabst,
  • Sophie C. Siegmund,
  • Adrien Holzgreve,
  • Hans P. Schmid,
  • Timo Bartel,
  • Ken Herrmann,
  • Alina T. Küper,
  • Can Aydogdu,
  • David Kersting,
  • Claudia Kesch,
  • Boris A. Hadaschik,
  • Marcus Unterrainer,
  • Christian G. Stief,
  • Clemens C. Cyran,
  • Rudolf A. Werner,
  • Wolfgang P. Fendler,
  • Jozefina Casuscelli,
  • Lena M. Unterrainer

摘要

Purpose

[68Ga]Ga-FAPI-46 has shown promise for urothelial cancer (UC) detection. This study evaluates its diagnostic value versus contrast-enhanced CT (ceCT) and 2-[18F]FDG PET in the largest bi-centric cohort to date.

Methods

Patients with metastatic UC undergoing [68Ga]Ga-FAPI-46 PET at University Hospitals Munich or Essen were retrospectively reviewed. Detection rates were compared with ceCT on a regional basis (primary, lymph nodes, visceral organs, bone). SUVmax and SUVmean of two index lesions were recorded. In a sub-cohort, [68Ga]Ga-FAPI-46 and 2-[18F]FDG PET were compared on a lesion basis. Clinical follow-up and/or histopathology served as reference.

Results

Thirty-four patients underwent [68Ga]Ga-FAPI-46 PET/CT and ceCT, including 10 (29%) with additional 2-[18F]FDG PET/CT. Across 98 lesions (n = 65 regions), [68Ga]Ga-FAPI-46 PET detected n = 96 (98%) and ceCT n = 88 (90%), with mismatch findings in eight lymph nodes (PET positive/ceCT negative) and two visceral organs (ceCT positive/PET negative). In the subgroup comparison, 78 lesions were detected in total ([68Ga]Ga-FAPI-46: n = 72 (92%); 2-[18F]FDG: n = 78 (100%)). Tumour uptake was comparable (SUVmax [68Ga]Ga-FAPI-46 PET vs. 2-[18F]FDG: 10.2 (IQR, 1.9) vs. 8.0 (IQR, 3.3), p = 0.249), whereas [68Ga]Ga-FAPI-46 provided higher tumour-to-background ratios (Tumour-to-liver: 12.7 (IQR, 10.3) vs. 3.8 (IQR, 1.9), p = 0.046; tumour-to-spleen: 8.4 (IQR, 6.6) vs. 4.6 (IQR, 0.6), p = 0.016).

Conclusion

[68Ga]Ga-FAPI-46 PET demonstrated higher regional detection rates than ceCT in UC patients, particularly for lymph node metastases. Compared to 2-[18F]FDG, it provided superior tumour-to-background contrast but detected slightly fewer lesions. [68Ga]Ga-FAPI-46 PET may complement established imaging in selected scenarios, although its role in routine UC staging remains investigational.