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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 13/2021

01-12-2021 | Metastasis | Original Article

State-of-the-art of FAPI-PET imaging: a systematic review and meta-analysis

Authors: Martina Sollini, Margarita Kirienko, Fabrizia Gelardi, Francesco Fiz, Noemi Gozzi, Arturo Chiti

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 13/2021

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Abstract

Introduction

Fibroblast activation protein-α (FAPα) is overexpressed on cancer-associated fibroblasts in approximately 90% of epithelial neoplasms, representing an appealing target for therapeutic and molecular imaging applications. [68 Ga]Ga-labelled radiopharmaceuticals—FAP-inhibitors (FAPI)—have been developed for PET. We systematically reviewed and meta-analysed published literature to provide an overview of its clinical role.

Materials and methods

The search, limited to January 1st, 2018–March 31st, 2021, was performed on MedLine and Embase databases using all the possible combinations of terms “FAP”, “FAPI”, “PET/CT”, “positron emission tomography”, “fibroblast”, “cancer-associated fibroblasts”, “CAF”, “molecular imaging”, and “fibroblast imaging”. Study quality was assessed using the QUADAS-2 criteria. Patient-based and lesion-based pooled sensitivities/specificities of FAPI PET were computed using a random-effects model directly from the STATA “metaprop” command. Between-study statistical heterogeneity was tested (I2-statistics).

Results

Twenty-three studies were selected for systematic review. Investigations on staging or restaging head and neck cancer (n = 2, 29 patients), abdominal malignancies (n = 6, 171 patients), various cancers (n = 2, 143 patients), and radiation treatment planning (n = 4, 56 patients) were included in the meta-analysis. On patient-based analysis, pooled sensitivity was 0.99 (95% CI 0.97–1.00) with negligible heterogeneity; pooled specificity was 0.87 (95% CI 0.62–1.00), with negligible heterogeneity. On lesion-based analysis, sensitivity and specificity had high heterogeneity (I2 = 88.56% and I2 = 97.20%, respectively). Pooled sensitivity for the primary tumour was 1.00 (95% CI 0.98–1.00) with negligible heterogeneity. Pooled sensitivity/specificity of nodal metastases had high heterogeneity (I2 = 89.18% and I2 = 95.74%, respectively). Pooled sensitivity in distant metastases was good (0.93 with 95% CI 0.88–0.97) with negligible heterogeneity.

Conclusions

FAPI-PET appears promising, especially in imaging cancers unsuitable for [18F]FDG imaging, particularly primary lesions and distant metastases. However, high-level evidence is needed to define its role, specifically to identify cancer types, non-oncological diseases, and clinical settings for its applications.
Appendix
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Metadata
Title
State-of-the-art of FAPI-PET imaging: a systematic review and meta-analysis
Authors
Martina Sollini
Margarita Kirienko
Fabrizia Gelardi
Francesco Fiz
Noemi Gozzi
Arturo Chiti
Publication date
01-12-2021
Publisher
Springer Berlin Heidelberg
Keyword
Metastasis
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 13/2021
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-021-05475-0

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