Diagnostic Performance of FAPI PET in Patients with Breast Cancer: A Systematic Review

Area of Science:

• Oncology
• Nuclear Medicine
• Diagnostic Imaging

Background:

• Accurate breast cancer diagnosis and response assessment are crucial for effective treatment.
• Current imaging modalities like [¹⁸F]FDG PET have limitations in lesion detection and response evaluation.
• Fibroblast activation protein inhibitor (FAPI) PET is an emerging imaging technique with potential in oncology.

Purpose of the Study:

• To evaluate the diagnostic performance of FAPI PET for lesion detection in breast cancer.
• To compare FAPI PET with [¹⁸F]FDG PET and histopathology for diagnosis and response assessment.
• To assess FAPI PET's utility in evaluating treatment response after neoadjuvant chemoimmunotherapy (NAC).

Main Methods:

• Systematic literature search of PubMed, EMBASE, Web of Science, and Cochrane Trial databases.
• Quality assessment using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool.
• Extracted data included SUVmax, tumor-to-background ratio, lesion detection, and diagnostic performance parameters.

Main Results:

• FAPI PET demonstrated higher SUVmax values and detected more lesions than [¹⁸F]FDG PET across primary tumors, lymph nodes, and distant metastases.
• In post-NAC response assessment, FAPI PET showed a sensitivity of 73%-100% and specificity of 71%-100%.
• Lower FAPI uptake was noted in low-grade, luminal A, and lobular breast cancers.

Conclusions:

• FAPI PET offers improved lesion detection for breast cancer diagnosis compared to [¹⁸F]FDG PET.
• FAPI PET exhibits considerable diagnostic performance for evaluating treatment response after NAC.
• FAPI PET shows promise as a valuable tool in breast cancer management.