Assessment of thoracic tumors by FAPI PETCT: a systematic evaluation and meta-analysis

Abstract

Abstract Objective: Standard imaging techniques may not be suitable for evaluating thoracic tumor metastases, despite the high prevalence of thoracic cancers worldwide. Recent developments in PET/CT techniques using fibrogenic activating protein inhibitors (FAPI) show promise in assessing thoracic tumor metastasis. We reviewed the latest data on FAPI PET/CT for analyzing original malignancies, lymph node metastases, and remote metastases in thoracic cancers. Additionally, a meta-analysis was conducted to determine the sensitivity of FAPI PET/CT in diagnosing thoracic malignancies, including primary and non-primary foci (lymph node metastases and remote metastases) Methods: We searched the Cochrane Library, Embase, and PubMed databases from their establishment until June 23, 2023. Our screening and review included all studies that used FAPI PET/CT to examine thoracic malignancies. Three investigators conducted the filtration and full-text analysis, while two investigators collected the data. We used the QUADAS-2 tool to assess the risk of bias. A diagnostic test study was performed using a random-effects model. Results: Our systematic review and meta-analysis comprised 13 studies out of the 796 total publications we identified. These 13 articles included data from 475 patients with thoracic tumors, 475 primary thoracic tumor lesions, and 3296 metastatic thoracic tumor lesions. In order to identify primary thoracic cancers , patient-based FAPI PET/CT had a sensitivity of 0.98 (95% CI: 0.90-1.00). For the diagnosis of original thoracic tumor lesions and the diagnosis of metastatic thoracic tumor lesions, the sensitivity of lesion-based FAPI PET/CT was 0.98 (95% CI: 0.91-1.00) and 0.99 (95% CI: 0.95-1.00), respectively. Conclusion: FAPI PET/CT demonstrates superior sensitivity and specificity in diagnosing thoracic cancers. Radiologists, nuclear medicine experts, and clinicians could think about employing FAPI PET/CT to assess primary and non-primary foci (lymph node metastases and remote metastases)in thoracic cancers.