Initial Evaluation of [18F]FAPI-74 PET for Various Histopathologically Confirmed Cancers and Benign Lesions

Sep 24, 2026

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Initial evaluation of [18F]FAPI-74 PET assessed diagnostic performance in patients with various histopathologically confirmed cancers or suspected malignancies, comparing lesion uptake and detected lesions with nonmalignant findings and with [18F]FDG PET. Thirty-one patients were enrolled across lung, breast, gastric, pancreatic, other cancers, and benign tumors. [18F]FAPI-74 showed higher uptake in primary cancers than nonmalignant lesions and demonstrated significantly higher uptake versus [18F]FDG in primary tumors, lymph node metastases, and other metastases. Results support [18F]FAPI-74 as a promising diagnostic modality for tumor staging and characterization before treatment.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Methods

Patient cohort and imaging protocol

Lesion comparison strategy

Results

Uptake in primary lesions and nonmalignant lesions

Comparison with [18F]FDG PET

Conclusion

Initial Evaluation of [ 18F]FAPI-74 PET for Various Histopathologically Confirmed Cancers and Benign Lesions Tadashi Watabe 1,2, Sadahiro Naka3, Mitsuaki Tatsumi4, Takashi Kamiya4, Toru Kimura5, Yasushi Shintani5, Kaori Abe6, Tomohiro Miyake6, Kenzo Shimazu6, Shogo Kobayashi7, Yukinori Kurokawa7, Hidetoshi Eguchi7, Yuichiro Doki7, Hidenori Inohara8, Hiroki Kato 1,2, Yuriko Mori9, Jens Cardinale9, and Frederik L. Giesel2,9 1Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan; 2Institute for Radiation Sciences, Osaka University, Osaka, Japan; 3Department of Pharmacy, Osaka University Hospital, Osaka, Japan; 4Department of Radiology, Osaka University Hospital, Osaka, Japan; 5Department of Thoracic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan; 6Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan; 7Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan; 8Department of Otorhinolaryngology–Head and Neck Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan; and 9Department of Nuclear Medicine, University Hospital Duesseldorf, Heinrich Heine University, Duesseldorf, Germany The 18F-labeled ﬁbroblast activation protein inhibitor (FAPI) [18F]FAPI- 74 has the beneﬁt of a higher synthetic yield and better image resolution than 68Ga-labeled FAPI. We preliminarily evaluated the diagnostic performance of [18F]FAPI-74 PET in patients with various histopathologically conﬁrmed cancers or suspected malignancies. Methods: We enrolled 31 patients (17 men and 14 women) with lung cancer (n 5 7), breast cancer (n 5 5), gastric cancer (n 5 5), pancreatic cancer (n 5 3), other cancers (n 5 5), and benign tumors (n 5 6). Twenty-seven of the 31 patients were treatment-naïve or preoperative, whereas recurrence was suspected in the remaining 4 patients. Histopathologic conﬁrmation was obtained for the primary lesions of 29 of the 31 patients. In the remaining 2 patients, the ﬁnal diagnosis was based on the clinical course. [18F]FAPI-74 PET scanning was performed 60min after the intravenous injection of [18F]FAPI-74 (240631 MBq) . The [18F]FAPI-74 PET images were compared between the primary or local recurrent lesions of malignant tumors (n 5 21) and nonmalignant lesions (n 5 8: type-B1 thymomas, granuloma, solitary ﬁbrous tumor, and postoperative or posttherapeutic changes) . The uptake and number of detected lesions on [18F]FAPI-74 PET were also compared with those on [18F]FDG PET for available patients (n 5 19) . Results: [18F]FAPI-74 PET showed higher uptake in primary lesions of various cancers than in nonmalignant lesions (median SUVmax,9.39 [range, 1.83–25.28] vs. 3.49 [range, 2.21–15.58]; P 5 0.053), but some of the nonmalignant lesions showed high uptake. [18F]FAPI-74 PET also showed signiﬁcantly higher uptake than [18F]FDG PET (median SUVmax,9 .44 [range, 2.50–25.28] vs. 5.45 [range, 1.22–15.06] in primary lesions [P 5 0.010], 8.86 [range, 3.51–23.33] vs. 3.84 [range, 1.01–9.75] in lymph node metastases [P 5 0.002], and 6.39 [range, 0.55–12.78] vs. 1.88 [range, 0.73–8.35] in other metastases [P 5 0.046], respectively) . In 6 patients, [18F]FAPI-74 PET detected more metastatic lesions than [18F]FDG PET. Conclusion: [18F]FAPI-74 PET showed higher uptake and detection rates in primary and metastatic lesions than did [18F]FDG PET. [18F]FAPI-74 PET is a promising novel diagnostic modality for various tumors, especially for precise staging before Received Jan. 22, 2023; revision accepted Mar. 14, 2023 . For correspondence or reprints, contact Tadashi Watabe (watabe.tadashi. [med@osaka-u.ac.jp](med@osaka-u.ac.jp)) . Published online Jun. 2, 2023 . Immediate Open Access: Creative Commons Attribution 4.0 International License (CC BY) allows users to share and adapt with attribution, excluding materials credited to previous publications. License:

FAQs

What was the purpose of this study of [18F]FAPI-74 PET?

To preliminarily evaluate the diagnostic performance of [18F]FAPI-74 PET in patients with various histopathologically confirmed cancers or suspected malignancies, including comparisons to nonmalignant lesions and to [18F]FDG PET.

How were patients assigned for analysis in this evaluation?

Thirty-one patients with lung, breast, gastric, pancreatic, and other cancers, plus benign tumors were enrolled. Histopathologic confirmation was available for primary lesions in 29 patients, while the remaining 2 were diagnosed based on clinical course.

How did [18F]FAPI-74 PET perform compared with [18F]FDG PET?

[18F]FAPI-74 PET showed significantly higher uptake than [18F]FDG PET in primary lesions and metastases, and in 6 patients it detected more metastatic lesions than [18F]FDG PET.

Sep 24, 2026

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