nach oben

European Journal of Nuclear Medicine and Molecular Imaging

Erschienen in:

15.06.2023 | Original Article

Superiority of [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/CT to [¹⁸F]FDG PET/CT in the evaluation of thymic epithelial tumours

verfasst von: Xiuling Shen, Xin Zhou, Yuan Yao, Xiangxi Meng, Yufei Song, Zhi Yang, Nan Li

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 11/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purpose of this study is to compare the ability of [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/CT and [¹⁸F]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 [¹⁸F]FDG and [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/CT within 1 week. Clinical characteristics, CT features, and metabolic parameters (maximum standardized uptake value [SUV_max] and tumour-to-mediastinum ratio [TMR]) of subjects with different pathological types and stages were compared. The diagnostic capacities of [¹⁸F]FDG and [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/CT were compared using receiver operating characteristic (ROC) curves and McNemar’s test.

Results

Fifty-seven participants were included. [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/CT was superior to [¹⁸F]FDG PET/CT in differentiating thymomas from thymic carcinomas (TCs) (AUC: 0.99 vs. 0.90, P = 0.02). Logistic regression revealed that SUV_max-FAPI (P = 0.04) was a significant predictive factor for TCs. SUV_max-FAPI and TMR_-FAPI 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_max-FAPI (P < 0.001), TMR_-FAPI (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 [¹⁸F]FDG PET/CT, [⁶⁸Ga]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_max-FAPI and TMR_-FAPI were correlated with FAP expression (both r = 0.843, P < 0.001).

Conclusion

[⁶⁸Ga]Ga-DOTA-FAPI-04 PET/CT was superior to [¹⁸F]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

Nur mit Berechtigung zugänglich

Shin DW, Cho JH, Ha J, Jung KW. 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;17:827–37. https://doi.org/10.1016/j.jtho.2022.02.001.CrossRefPubMed

Marx A, Chan JKC, Chalabreysse L, Dacic S, Detterbeck F, French CA, et al. 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. 2022;17:200–13. https://doi.org/10.1016/j.jtho.2021.10.010.CrossRefPubMed

Marchevsky AM, Gupta R, McKenna RJ, Wick M, Moran C, Zakowski MF, et al. 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;112:2780–8. https://doi.org/10.1002/cncr.23492.CrossRefPubMed

Detterbeck FC, Nicholson AG, 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:S1710–6. https://doi.org/10.1097/JTO.0b013e31821e8cff.CrossRefPubMed

Lee HS, Kim ST, Lee J, Choi YS, Han JH, Ahn YC, et al. A single institutional experience of thymic epithelial tumours over 11 years: clinical features and outcome and implications for future management. Br J Cancer. 2007;97:22–8. https://doi.org/10.1038/sj.bjc.6603833.CrossRefPubMedPubMedCentral

Expert Panel on Thoracic I, Ackman JB, Chung JH, Walker CM, Bang TJ, Carter BW, et al. ACR appropriateness criteria(R) imaging of mediastinal masses. J Am Coll Radiol. 2021;18:S37-S51. https://doi.org/10.1016/j.jacr.2021.01.007.

Marom EM, Milito MA, Moran CA, Liu P, Correa AM, Kim ES, et al. Computed tomography findings predicting invasiveness of thymoma. J Thorac Oncol. 2011;6:1274–81. https://doi.org/10.1097/JTO.0b013e31821c4203.CrossRefPubMed

Priola AM, Priola SM, Giraudo MT, Gned D, Fornari A, Ferrero B, et al. 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 disease-free survival. Eur Radiol. 2016;26:2126–38. https://doi.org/10.1007/s00330-015-4031-6.CrossRefPubMed

Sung YM, Lee KS, Kim BT, Choi JY, Shim YM, Yi CA. ¹⁸F-FDG PET/CT of thymic epithelial tumors: usefulness for distinguishing and staging tumor subgroups. J Nucl Med. 2006;47:1628–34.PubMed

10.

Terzi A, Bertolaccini L, Rizzardi G, Luzzi L, Bianchi A, Campione A, et al. Usefulness of 18-F FDG PET/CT in the pre-treatment evaluation of thymic epithelial neoplasms. Lung Cancer. 2011;74:239–43. https://doi.org/10.1016/j.lungcan.2011.02.018.CrossRefPubMed

11.

Benveniste MF, Moran CA, Mawlawi O, Fox PS, Swisher SG, Munden RF, et al. FDG PET-CT aids in the preoperative assessment of patients with newly diagnosed thymic epithelial malignancies. J Thorac Oncol. 2013;8:502–10. https://doi.org/10.1097/JTO.0b013e3182835549.CrossRefPubMed

12.

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. 2021;69:274–81. https://doi.org/10.1007/s11748-020-01439-7.CrossRefPubMed

13.

Tatematsu T, Okuda K, Saito Y, Oda R, Sakane T, Yokota K, et al. The usefulness of fluorodeoxyglucose-positron emission tomography as a preoperative diagnostic tool for thymic epithelial tumors. Gland Surg. 2021;10:690–6. https://doi.org/10.21037/gs-20-718.

14.

Han S, Kim YI, Oh JS, Seo SY, Park MJ, Lee GD, et al. Diagnostic and prognostic values of 2-[¹⁸F]FDG PET/CT in resectable thymic epithelial tumour. Eur Radiol. 2022;32:1173–83. https://doi.org/10.1007/s00330-021-08230-z.CrossRefPubMed

15.

Chen X, Song E. Turning foes to friends: targeting cancer-associated fibroblasts. Nat Rev Drug Discov. 2019;18:99–115. https://doi.org/10.1038/s41573-018-0004-1.CrossRef

16.

Lindner T, Loktev A, Altmann A, Giesel F, Kratochwil C, Debus J, et al. Development of quinoline-based theranostic ligands for the targeting of fibroblast activation protein. J Nucl Med. 2018;59:1415–22. https://doi.org/10.2967/jnumed.118.210443.CrossRefPubMed

17.

Zhou X, Wang S, Xu X, Meng X, Zhang H, Zhang A, et al. Higher accuracy of [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/CT comparing with 2-[¹⁸F]FDG PET/CT in clinical staging of NSCLC. Eur J Nucl Med Mol Imaging. 2022;49:2983–93. https://doi.org/10.1007/s00259-022-05818-5.CrossRefPubMed

18.

Chen H, Pang Y, Wu J, Zhao L, Hao B, Wu J, et al. Comparison of [⁶⁸Ga]Ga-DOTA-FAPI-04 and [¹⁸F] 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;47:1820–32. https://doi.org/10.1007/s00259-020-04769-z.CrossRefPubMed

19.

Kratochwil C, Flechsig P, Lindner T, Abderrahim L, Altmann A, Mier W, et al. ⁶⁸Ga-FAPI PET/CT: tracer uptake in 28 different kinds of cancer. J Nucl Med. 2019;60:801–5. https://doi.org/10.2967/jnumed.119.227967.CrossRefPubMedPubMedCentral

20.

Henry LR, Lee HO, Lee JS, Klein-Szanto A, Watts P, Ross EA, et al. Clinical implications of fibroblast activation protein in patients with colon cancer. Clin Cancer Res. 2007;13:1736–41. https://doi.org/10.1158/1078-0432.Ccr-06-1746.CrossRefPubMed

21.

Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer (Oxford, England:1990). 2009;45:228–47. https://doi.org/10.1016/j.ejca.2008.10.026.

22.

Kondo K, Van Schil P, Detterbeck FC, Okumura M, Stratton K, Giroux D, et al. 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:S81–7. https://doi.org/10.1097/jto.0000000000000291.CrossRefPubMed

23.

Bayman EO, Dexter F. Multicollinearity in logistic regression models. Anesth Analg. 2021;133:362–5. https://doi.org/10.1213/ane.0000000000005593.CrossRefPubMed

24.

Obuchowski NA, McClish DK. Sample size determination for diagnostic accuracy studies involving binormal ROC curve indices. Stat Med. 1997;16:1529–42. https://doi.org/10.1002/(sici)1097-0258(19970715)16:13%3c1529::aid-sim565%3e3.0.co;2-h.CrossRefPubMed

25.

NCCN Clinical Practice Guidelines in Oncology. Thymomas and thymic carcinomas version 1.2023. https://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf. Published December 15, 2022. Accessed 17 April 2023.

26.

Toba H, Kondo K, Sadohara Y, Otsuka H, Morimoto M, Kajiura K, et al. 18F-fluorodeoxyglucose positron emission tomography/computed tomography and the relationship between fluorodeoxyglucose uptake and the expression of hypoxia-inducible factor-1alpha, glucose transporter-1 and vascular endothelial growth factor in thymic epithelial tumours. Eur J Cardiothorac Surg. 2013;44:e105–12. https://doi.org/10.1093/ejcts/ezt263.CrossRefPubMed

27.

Nakajo M, Kajiya Y, Tani A, Yoneda S, Shirahama H, Higashi M, et al. ¹⁸FDG PET for grading malignancy in thymic epithelial tumors: significant differences in ¹⁸FDG uptake and expression of glucose transporter-1 and hexokinase II between low and high-risk tumors: preliminary study. Eur J Radiol. 2012;81:146–51. https://doi.org/10.1016/j.ejrad.2010.08.010.CrossRefPubMed

28.

Fiori ME, Di Franco S, Villanova L, Bianca P, Stassi G, De Maria R. Cancer-associated fibroblasts as abettors of tumor progression at the crossroads of EMT and therapy resistance. Mol Cancer. 2019;18:70. https://doi.org/10.1186/s12943-019-0994-2.CrossRefPubMedPubMedCentral

29.

Wu Z, Xue S, Zheng B, Ye R, Xu G, Zhang S, et al. Expression and significance of c-kit and epithelial-mesenchymal transition (EMT) molecules in thymic epithelial tumors (TETs). J Thorac Dis. 2019;11:4602–12. https://doi.org/10.21037/jtd.2019.10.56.

30.

Minami K, Jimbo N, Tanaka Y, Uchida T, Okamoto T, Shimizu N, et al. Fibrous bands associated with higher Masaoka stage and poor recurrence-free survival in patients with thymoma. Thorac Cancer. 2021;12:349–56. https://doi.org/10.1111/1759-7714.13755.CrossRefPubMed

31.

Barrio JR, Huang SC, Satyamurthy N, Scafoglio CS, Yu AS, Alavi A, et al. Does 2-FDG PET accurately reflect quantitative in vivo glucose utilization? J Nucl Med. 2020;61:931–7. https://doi.org/10.2967/jnumed.119.237446.CrossRefPubMedPubMedCentral

32.

Meyer HJ, Wienke A, Surov A. Associations between GLUT expression and SUV values derived from FDG-PET in different tumors-A systematic review and meta analysis. PLoS ONE. 2019;14:e0217781. https://doi.org/10.1371/journal.pone.0217781.

33.

Wang L, Tang G, Hu K, Liu X, Zhou W, Li H, et al. Comparison of (68)Ga-FAPI and (18)F-FDG PET/CT in the evaluation of advanced lung cancer. Radiology. 2022;303:191–9. https://doi.org/10.1148/radiol.211424.CrossRefPubMed

34.

Capobianco A, Cottone L, Monno A, Manfredi AA, Rovere-Querini P. The peritoneum: healing, immunity, and diseases. J Pathol. 2017;243:137–47. https://doi.org/10.1002/path.4942.CrossRefPubMed

Titel: Superiority of [68Ga]Ga-DOTA-FAPI-04 PET/CT to [18F]FDG PET/CT in the evaluation of thymic epithelial tumours
verfasst von: Xiuling Shen
Xin Zhou
Yuan Yao
Xiangxi Meng
Yufei Song
Zhi Yang
Nan Li
Publikationsdatum: 15.06.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 11/2023
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-023-06294-1

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Superiority of [⁶⁸Ga]Ga-DOTA-FAPI-04 PET/CT to [¹⁸F]FDG PET/CT in the evaluation of thymic epithelial tumours

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2023

Hypoxia-specific imaging in patients with lymphoma undergoing CAR-T therapy

Validation of quantitative assessment of florbetaben PET scans as an adjunct to the visual assessment across 15 software methods

Why does PSMA PET improve quality of life?

The EANM guideline on radioiodine therapy of benign thyroid disease

Prognostic value of imaging-based ATN profiles in a memory clinic cohort

ImmunoPET imaging–based pharmacokinetic profiles of an antibody and its Fab targeting endothelin A receptors on glioblastoma stem cells in a preclinical orthotopic model