ArticleFrontiers in nuclear medicine2026
Prognostic impact of discordant lesions on [
Article in Frontiers in nuclear medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: On dual-tracer positron emission tomography/computed tomography (PET/CT) with 2-deoxy-2-[¹⁸F]fluoro-D-glucose ([¹⁸F]FDG) and fibroblast activation protein inhibitor ([⁶⁸Ga]Ga-FAPI-04), discordant lesions (FDG+/FAPI-) in aggressive neuroendocrine neoplasms (NENs) are linked to shorter progression-free survival (PFS). This study evaluated the prognostic value of such lesions in comparison to histological fibroblast activation protein (FAP) expression from a clinically obtained biopsy and their impact on PFS. Methods: 23 patients with aggressive NENs underwent both [¹⁸F]FDG and [⁶⁸Ga]Ga-FAPI-04 PET/CT as well as biopsy within a short period of time. PET parameters [standardized uptake values (SUV): SUVmax, SUVmean, SUVpeak] were measured, as were tumor volume (TV), and total lesion uptake (TLU = TV × SUVmean). FDG+/FAPI- lesions were identified. FAP expression was assessed immunohistochemically using the immunoreactive score (IRS-FAP). Correlations between PET metrics, IRS-FAP, and FDG+/FAPI- lesions were analyzed. Cox regression and log-rank test were used to evaluate associations with PFS. Results: IRS-FAP correlated significantly with TV ([¹⁸F]FDG: p=0.0165; [⁶⁸Ga]Ga-FAPI-04: Conclusions: FAP expression on immunohistochemistry obtained from a single biopsy site does not predict discordant PET/CT findings. In contrast, the presence of FDG+/FAPI- lesions is a strong prognostic factor for reduced PFS. Thus, dual-tracer PET/CT may offer superior risk stratification compared to single-lesion histological FAP assessment in aggressive NENs.
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