99m Tc‑FAPI‑46 Scintigraphy for Staging of Non-Small Cell Lung Carcinoma.

We describe a 71‑year‑old man with squamous cell lung carcinoma who underwent metastasis work-up with CT scan and 99m Tc‑MDP bone scintigraphy, which suggested limited extrathoracic skeletal involvement. Subsequent 99m Tc‑FAPI‑46 scintigraphy revealed a substantially greater disease burden, identifying a more extensive nodal and skeletal metastases. These findings resulted in a decisive stage migration from an initially presumed oligometastatic to a clearly polymetastatic stage IV disease, with direct implications for therapeutic intent. This case underscores the potential clinical utility of 99m Tc‑FAPI‑46 scan as a cost‑effective staging modality, particularly in settings where PET/CT is unavailable or financially prohibitive.