[¹⁸F]FAPI-04 PET/CT for detection of recurrent breast cancer after surgery: a post hoc analysis comparing [¹⁸F]FDG PET/CT.

Authors

Hao Peng, Yu Liu, Jiucen Liang, Sha Yan, Wen Li, Zhidong Liu, Rusen Zhang, Ming Jiang, Linqi Zhang

Published in

European journal of nuclear medicine and molecular imaging. Aug 29, 2026. Epub Aug 29, 2026.

Abstract

To compare the diagnostic performance of [¹⁸F]FAPI-04 PET/CT with that of [¹⁸F]FDG PET/CT in patients with suspected recurrence of breast cancer following surgical treatment.
This is a post‑hoc analysis of data from a prospective single-center clinical trial. Patients with clinical suspicion of recurrence of breast cancer after surgery were consecutively enrolled and underwent both [¹⁸F]FDG and [¹⁸F]FAPI-04 PET/CT. Paired comparisons of sensitivity and accuracy were performed using McNemar's test. Differences in semi-quantitative parameters, including maximum standardized uptake value (SUVmax) and tumor-to-background ratio (TBR), were assessed using the Wilcoxon signed-rank test.
A total of 44 patients with 880 lesions were included, of whom 40 patients (782 lesions) were confirmed to have recurrent disease. Compared with [¹⁸F]FDG PET/CT, [¹⁸F]FAPI-04 PET/CT showed higher sensitivity and accuracy across most metastatic sites. The differences were most pronounced for lymph node, pleural, and bone metastases, with significantly higher sensitivity (98.7% vs. 62.7%, 94.0% vs. 64.2%, and 99.6% vs. 63.4%, respectively; all P < 0.001) and accuracy (93.6% vs. 54.3%, 91.5% vs. 64.3%, and 98.4% vs. 62.7%; all P < 0.001). Quantitatively, [¹⁸F]FAPI-04 demonstrated significantly higher tracer uptake than [¹⁸F]FDG across most lesion categories, with consistently elevated SUVmax and TBR values (all P < 0.001 for TBR; SUVmax differences significant except for liver lesions). These findings indicate improved lesion conspicuity and contrast with [¹⁸F]FAPI-04. Importantly, [¹⁸F]FAPI-04 PET/CT resulted in a change in clinical management in 12 of 40 patients (30%) with confirmed recurrence.
In this cohort, [¹⁸F]FAPI-04 PET/CT demonstrated higher lesion detectability than [¹⁸F]FDG PET/CT, particularly for lymph node, pleural, and bone metastases. These findings suggest that [¹⁸F]FAPI-04 PET/CT may serve as a valuable complementary imaging tool to [¹⁸F]FDG PET/CT in the post‑treatment surveillance setting, with the potential to refine patient stratification and inform therapeutic decisions.

PMID:
42667310
Bibliographic data and abstract were imported from PubMed on 30 Aug 2026.

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