Diagnostic Performance of FAPI PET/CT for the Detection of Lymph Node Metastases in Lung Cancer Patients: A Meta-analysis.

OBJECTIVE

To evaluate the diagnostic performance of fibroblast activation protein inhibitors (FAPI) PET/CT for the detection of lymph node (LN) metastases in lung cancer patients.

METHODS

The PubMed and Embase databases were searched to identify relevant articles published through July 2024. We included studies reporting the diagnostic accuracy of FAPI PET/CT in detecting LN metastases in lung cancer patients. A head-to-head comparison of FAPI PET/CT and fluorodeoxyglucose (FDG) PET/CT was made among available studies. The pooled sensitivity, specificity, and area under the summary receiver-operating characteristics curve (AUC) were determined by using bivariate random-effects model.

RESULTS

Seven studies with 409 patients were eligible. The pooled sensitivity, specificity, and AUC value for FAPI PET/CT in detecting LN metastases in lung cancer patients were 88% (95% CI, 78-93%), 94% (95% CI, 89-96%), and 0.97 (95% CI, 0.95-0.98), respectively. Six studies provided head-to-head comparison data, and the pooled sensitivity, specificity, and AUC value were 89% (95% CI 80-95%), 94% (95% CI 89-97%), and 0.97 (95% CI 0.95-0.98) for FAPI PET/CT versus 78% (95% CI 64-87%), 66% (95% CI 33-88%), and 0.80 (95% CI 0.76-0.83) for FDG PET/CT. Fagan nomogram indicated that when the pre-test probability was set at 26%, the negative post-test probability for a FAPI PET/CT scan could decrease to 4%.

CONCLUSIONS

FAPI PET/CT shows excellent diagnostic accuracy for the detection of LN metastases in lung cancer patients, and is superior to standard-of-care FDG PET/CT. The outstanding ruling-out performance of FAPI PET/CT for LN metastases indicates that it holds the potential to reduce invasive diagnostic procedures.