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[68 Ga]Ga-FAPI-46 PET/CT for locoregional lymph node staging in urothelial carcinoma of the bladder prior to cystectomy: initial experiences from a pilot analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年1月18日

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  • Lena M. Unterrainer,
  • Lennert Eismann,
  • Simon Lindner,
  • Franz-Josef Gildehaus,
  • Johannes Toms,
  • Jozefina Casuscelli,
  • Adrien Holzgreve,
  • Sophie C. Kunte,
  • Clemens C. Cyran,
  • Paula Menold,
  • Alexander Karl,
  • Marcus Unterrainer,
  • Stephan T. Ledderose,
  • Christian G. Stief,
  • Peter Bartenstein,
  • Alexander Kretschmer,
  • Gerald B. Schulz

摘要

Introduction

[68 Ga]Ga-FAPI-46 PET/CT is a novel hybrid imaging method that previously showed additional diagnostic value in the assessment of distant urothelial carcinoma lesions. We hypothesized that patients with bladder cancer benefit from [68 Ga]Ga-FAPI-46 PET/CT prior to radical cystectomy for locoregional lymph node staging.

Materials and methods

Eighteen patients underwent [68 Ga]Ga-FAPI-46 PET/CT for evaluation of lymph node (LN) status in predefined LN regions. Two hundred twenty-nine intraoperatively removed LN served as histopathological reference standard.

Results

Urothelial carcinoma (UC) spread was found in ten LN in seven different regions (14.3%). Hereby, [68 Ga]Ga-FAPI-46 PET/CT was positive in four out of seven regions (57.1%) and showed significantly increased FAPI uptake compared to non-pathological regions. In the remaining three out of seven (42.9%) regions, [68 Ga]Ga-FAPI-46 PET/CT was rated negative since no pathological increased FAPI uptake was detected or the proximity of the urinary tract prevented a differentiation from physiological uptake. CT was inconspicuous in these three regions. In total, two FAP-positive LN regions were found without histopathological counterpart. Overall, sensitivity, specificity, positive predictive value, and negative predictive value were 57.1%, 95.2%, 66.7%, and 93.0% for PET imaging.

Conclusion

In summary, this innovative [68 Ga]Ga-FAPI-46 PET/CT method showed high specificity and negative predictive value in patients with bladder UC with a future potential to optimize therapy planning.