ORIGINAL RESEARCH article
Front. Oncol.
Sec. Molecular and Cellular Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1605568
Comparison of [ 18 F]AlF-NOTA-FAPI-04 PET/CT and [ 18 F]FDG PET/CT for diagnosing lymph node metastasis in malignant tumors Running head: [ 18 F]AlF-NOTA-FAPI-04 vs [ 18 F]FDG PET/CT for lymph node metastasis diagnosis in malignancies
Provisionally accepted
Wanjing Zhou1,2*
jiashun dai1,2
Kai Zheng1,2xiang peng1,2yanyin zhang1,2chengzhi jiang1,2*
Yang Jian1,2*hui ye1,2*- 1Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
- 2PET/CT Center, Hunan Cancer Hospital, Changsha, Anhui Province, China
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Purpose: This study compared the diagnostic performance, semi-quantitative analysis, and staging accuracy of [ 18 F]AlF-NOTA-FAPI-04 and [ 18 F]FDG PET/CT in detecting lymph node metastases. Methods: This single-center retrospective study included 41 patients with suspected lymph node metastases who received both [ 18 F]FDG and [ 18 F]AIF-NOTA-FAPI-04 PET/CT. The study compared metastatic lymph node detection, semi-quantitative values, and N staging accuracy. Subgroup analyses were performed for lymph nodes with short-axis diameters (SAD) ≥10 mm and <10 mm. Results: 41 patients with 126 nodes were included. [ 18 F]AlF-NOTA-FAPI-04 outperformed [ 18 F]FDG in the detection of metastatic lymph nodes, achieving higher accuracy in both patient-based (92.7% vs. 70.7%, p=0.004) and node-based analyses (91.3% vs. 60.3%, p<0.001). In semi-quantitative analysis, the maximum standardized uptake value and target-to-background ratio of [ 18 F]AlF-NOTA-FAPI-04 were higher than those of [ 18 F]FDG in metastatic lymph nodes (all p < 0.001). Both tracers distinguished metastatic from benign nodes with SAD ≥ 10 mm (p<0.05).[ 18 F]AlF-NOTA-FAPI-04 PET/CT could distinguish between benign and metastatic lymph nodes with SAD < 10mm (p＜0.001), whereas [ 18 F]FDG PET/CT could not (p ＞0.05). [ 18 F]AlF-NOTA-FAPI-04 also provided more accurate N staging assessments 4 (87.8% vs. 65.9%, p = 0.006). [ 18 F]AlF-NOTA-FAPI-04 PET/CT enabled the correct diagnosis of more lymph nodes, leading to a change in the therapeutic regimen for 8 patients (19.5%) Conclusion: [ 18 F]AlF-NOTA-FAPI-04 PET/CT demonstrated superior diagnostic performance, semi-quantitative capability, and N staging accuracy compared to [ 18 F]FDG PET/CT, particularly for small metastatic lymph nodes (SAD < 10 mm), offering enhanced guidance for tumor staging.
Keywords: [ 18 F]AlF-NOTA-FAPI-04, [ 18 F]FDG, PET/CT, fibroblast activation protein (FAP), Lymph node metastases
Received: 03 Apr 2025; Accepted: 16 Jun 2025.
Copyright: © 2025 Zhou, dai, Zheng, peng, zhang, jiang, Jian and ye. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wanjing Zhou, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
chengzhi jiang, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
Yang Jian, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
hui ye, Hunan Cancer Hospital, Xiangya School of Medicine, Central South University, Changsha, China
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