Application of FDG Combined With FAPI PET Dual Imaging in the Diagnosis and Staging of Oropharyngeal and Laryngeal Cancer

According to statistics, in 2020, new head and neck malignancies in the world accounted for 4.9% (931931 cases) of malignant tumors in the whole body, and the new death cases were 467125, accounting for 4.7% of malignant tumors in the whole body. The high incidence rate and mortality brought great burden to the medical system. In addition, due to various types of head and neck cancer, hidden location, impact on function and quality of life, and low overall survival rate, this type of disease has seriously threatened human health and social development. The incidence of oropharyngeal cancer and laryngeal cancer is more subtle. Traditional examination methods include CT(computer tomography), MR(magnetic resonance), and laryngoscopy, but they cannot make accurate judgments on the systemic TNM(primary tumor, regional nodes, metastasis) staging of oropharyngeal cancer and laryngeal cancer. 18F-FDG(18F-2-fluoro-2-deoxy-D-glucose fluorodeoxyglucose) PET/CT examination can better diagnose and stage compared to traditional examination methods. However, due to the interference of more inflammatory lesions or physiological uptake in the pharynx, the false positive rate of 18F-FDG PET/CT examination is significantly increased, 18F-FAPI(18F-fibroblast activation protein inhibitors) is a novel broad-spectrum tumor imaging agent that can be specifically uptake by fibroblasts in the tumor microenvironment, and has lower physiological uptake and acute inflammatory lesion uptake in the larynx. 18F-FAPI PET/CT examination can more accurately stage tumors throughout the body than 18F-FDG PET/CT examination. Combined with PET/MR local scanning, it will further improve the accuracy of T and N staging of local tumors. Therefore, It is of great significance for clinical diagnosis and treatment to effectively and reliably determine the systemic TNM staging of oropharyngeal and laryngeal cancer through non-invasive methods.

Sex

All

Minimum age

18 Years

Inclusion Criteria:

1. Patients with high clinical suspicion of oropharyngeal and laryngeal cancer: CT and MR examinations reveal space occupying lesions in the oropharynx and laryngopharynx, with high suspicion of laryngeal cancer;
2. Recently diagnosed patients: patients who have recently been diagnosed with oropharyngeal cancer and laryngeal cancer, have not undergone surgical resection but are willing to undergo surgery;
3. Patients who have been diagnosed with oropharyngeal and laryngeal cancer and have undergone concurrent radiotherapy, chemotherapy, or immunotherapy, and are preparing to undergo preoperative staging in the near future;
4. Patients with high suspicion of oropharyngeal and laryngeal cancer through imaging examination, and later confirmed by pathology as non oropharyngeal or laryngeal cancer;
5. Patient age ≥ 18 years old;
6. The patient voluntarily participates and signs an informed consent form.

Exclusion Criteria:

1. Patients who refuse to undergo surgery;
2. Patients highly suspected of lymphoma or metastasis in clinical or imaging studies;
3. Patients with multiple neck metastases identified through imaging examination that cannot be surgically treated;
4. Patients with malignant tumors in other parts of the body found through imaging examination that cannot be operated on;
5. Pregnancy or lactation period;
6. The imaging quality is poor and cannot be used for diagnosis and evaluation;
7. Patients with contraindications for MR examination.

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• DERIVEDXia R, Wang X, Cheng J, Li X, Sun J, Zeng Q, Hu D, You J, Xiong Y, Chen X. Head-to-head comparison of [18F]FAPI-42 and [18F]FDG PET/CT in the evaluation of laryngeal squamous cell carcinoma. Eur J Nucl Med Mol Imaging. 2025 Jul;52(9):3101-3113. doi: 10.1007/s00259-025-07180-8. Epub 2025 Mar 8. PMID 40055207