The inferior performance of [68Ga]Ga-FAPI-04 PET/CT as a diagnostic and theranostic biomarker in [177Lu]Lu-DOTATATE refractory well-differentiated neuroendocrine tumors.

PURPOSE: We aimed to investigate the potential of [68Ga]Ga-FAPI-04 PET/CT as an alternative diagnostic and theranostic tool in well-differentiated NETs refractory to [177Lu]Lu-DOTATATE therapy. METHODS: Patients who received at least two cycles of [177Lu]Lu-DOTATATE therapy for metastatic NETs and progressed under treatment were included. All patients had performed [68Ga]Ga-DOTATATE and [68Ga]Ga-FAPI-04 PET/CT within 3 weeks. The number of PET-positive lesions related to NETs and tumor sites was documented. Mann-Whitney U and chi-square tests were used to compare SUVmax levels of tracers and the number of detected metastases. RESULTS: Twelve patients (7 male, 5 female) who met the eligibility criteria were included in the study. Ten patients had grade 1-2 NET of various origins, and two had paraganglioma and pheochromocytoma. One hundred ninety-eight of 230 lesions (86%) were SSTR positive with a median SUVmax of 16.6 (2.2-76.5), and 88 of 230 lesions (38.2%) were [68Ga]Ga-FAPI-04 positive with a median SUVmax of 5.1 (2.3-21). Median SUVmax level and detected number of tumors were significantly higher in [68Ga]Ga-DOTATATE PET/CT (p=<0.001). [68Ga]Ga-FAPI-04 PET/CT was completely (n:2) or almost completely (n:3) negative in 5 (42%) patients. Two (17%) patients had flip-flop SSTR/FAPI uptake in tumors. In four patients (33%), tumor uptake or the number of PET-positive lesions was inferior in [68Ga]Ga-FAPI-04 PET/CT. In only one patient (8%), tumor uptakes were higher in [68Ga]Ga-FAPI-04 PET/CT. Low-dose [177Lu]Lu-FAPI-46 dosimetry was performed on the FAPI-dominant patient; absorbed radiation doses per GBq were 1.26 Gy, 0.36 Gy, 0.32 Gy, and 0.2 Gy for kidneys, liver, spleen, and total body, respectively. The mean absorbed dose per GBq was 0.33 Gy for liver mass and 0.41 Gy for metastatic lymph nodes. CONCLUSION: Our preliminary results demonstrated that [68Ga]Ga-FAPI-04 PET/CT mainly failed in well-differentiated NETs refractory to [177Lu]Lu-DOTATATE therapy and had a limited role as an alternative diagnostic or theranostic agent. Further investigations with a larger patient population are required to determine the impact of [68Ga]Ga-FAPI-04 PET/CT on NETs.

The role of [68 Ga]Ga-FAPI-04 PET/CT in renal cell carcinoma: a preliminary study.

PURPOSE: We aimed to investigate the role of [68 Ga]Ga-FAPI-04 PET/CT and uptake patterns of primary and metastatic lesions in patients with renal cell carcinoma (RCC). METHODS: Twenty patients with a suspicious lesion considered primary renal malignancy or a history of RCC were included in our study. Two patients were excluded from further analyses due to other confirmed malignancies. Six patients were newly diagnosed, while the indication of 12 patients was restaging. All patients underwent [68 Ga]Ga-FAPI-04 and [18F]F-FDG PET/CT. SUVmax and tumor-to-background ratio (TBR) of primary (n = 7) and local recurrent lesions (n = 6) and lymph node (n = 26), lung (n = 32), bone (n = 5), and other metastases (n = 14) were compared between the two tracers. RESULTS: We detected 90 lesions in 18 patients with varying FAPI and FDG uptake values on both PET/CT. The median TBR of FAPI-PET/CT of all lesions was higher than TBR of FDG-PET/CT with statistically significance (5.6 vs. 2.1, p < 0.001). In primary and recurrent lesions, the median SUVmax, TBR, and tumor volume on FAPI-PET/CT were higher than FDG-PET/CT. The median SUVmax of lung lesions on FAPI-PET/CT was statistical significantly higher than FDG-SUVmax (3.8 vs. 1.8, p = 0.02). The median of FAPI-SUVmax on primary lesions was lower in the early stage based on TNM compared to the advanced stage. FAPI-SUVmax in 49% of all lesions were SUVmax ≥ 6, and 13% were SUVmax ≥ 10. In patient-based analyses, seven patients (39%) had at least one lesion with FAPI-SUVmax ≥ 10; 12 patients (67%) had at least one lesion with FAPI-SUVmax ≥ 6. CONCLUSION: This study showed the potential utility of [68 Ga]Ga-FAPI-04 PET/CT showing promising results in RCC. We have presumed that FAPI-PET/CT may be performed for complementary imaging modality providing prognosis and possibility of theranostic application in selected patients.

Effect of Foot Massage on Labor Pain in Parturient Women.

Background: Massageis one of the non-pharmacologic methods used to control pain and help pregnant women cope with the pain and positively affect labor. Objective: The aim of this study was to determine the effect of foot massage in pregnant women during labor, labor pain, the duration of the delivery, interventions, postpartum bleeding and the emotional state of the mother. Design: This study was designedas a randomized controlled experimental study. Setting: The research was carried out in primipara women who cameto the clinic for childbirth in Karaman State Hospital, Turkey, between December 2016 and May 2017. Patients: Patients comprised 80 primiparous women who were randomly assigned to either the intervention (foot massage) group (n = 40) or the control group (n = 40) in accordance with the study criteria. Intervention: Routine nursing care was provided in both groups during the latent labor phase; all women signed an informed consent form. In the first phase of birth, the intervention group received a classic foot massage for 20 minutes on each foot at 3 different times, for a total of 60 minutes (cervical dilatation was 4-5 cm, 6-7 cm and 8-9 cm during this phase). Outcome Measures: Data were obtained by using an information form to gather demographic and obstetric characteristics, the labor assessment form for labor and birth records, the Visual Analog Scale (VAS) to evaluate labor pain severity, an observation-based form for emotional behavior during labor and the Labor Agentry Scale (LAS) to evaluate the emotional state of the mothers. Results: We found that the pain severity in women who received the foot massage decreased after the intervention according to their VAS scores, and they experienced less pain in the postpartum period. In addition, in the intervention group, it was observed that the second and third stages of labor were shorter, the women showed less negative behavioral responses during delivery and were satisfied with their foot massage. Conclusion: In conclusion, it was determined that foot massage could be effective and reliable intervention in the management of labor pain.

Effects of music on sleep quality and comfort levels of pregnant women.

OBJECTIVES: This pilot randomized controlled experimental study was conducted to investigate effects of music on sleep quality and comfort levels of pregnant women. METHODS: The sample of the study consisted of 70 pregnant women who met the inclusion criteria and agreed to participate in the study. The pregnant women were assigned to the music (n=35) and control groups (n=35). In the study, the musical pieces composed in Ussak mode were played for the participants in the music group. The pregnant women in the music group were first asked to empty their bladder and then listen to music for 30 min in a semi-Fowler's position with their head and shoulders raised 30°, in a quiet and dim environment, every other day for two weeks before going to sleep. The Pregnant Information Form, Prenatal Comfort Scale (PCS) and Pittsburgh Sleep Quality Index - 1 week (PSQI-1 week) were used to collect the study data. RESULTS: The analysis of the mean scores obtained from the overall PSQI-1 week by the pregnant women in the music and control groups by weeks demonstrated that there was a statistically significant difference between the music and control groups in the second week (p<0.05). There was no statistically significant difference between the two groups in terms of the mean scores they obtained from the overall PCS (p>0.05). CONCLUSIONS: Music increased the sleep quality of the pregnant women in the music group, but had no effect on their comfort levels.

Effects of Stress in Pregnancy on Prenatal Attachment, and Contributing Factors.

BACKGROUND: The mother's having good mental health during pregnancy is important for the mother's and fetus's health. Stress experienced during pregnancy can also affect prenatal attachment. In this study, it was aimed to determine the effect of the stress level of pregnant women on prenatal attachment and the factors affecting prenatal attachment. SUBJECTS: In this descriptive cross-sectional study conducted in the obstetrics outpatient clinic of a training and research hospital, 276 healthy primiparous pregnant women whose gestational age was ≥20 weeks were included. To collect the data, the Descriptive Characteristics Form, Pregnancy Stress Rating Scale (PSRS), and Prenatal Attachment Inventory (PAI) were used. RESULTS: The mean scores the participants obtained from the Pregnancy Stress Rating Scale and Prenatal Attachment Inventory were 40.13±31.22 and 46.87±16.62 respectively. A moderately statistically significant negative correlation was determined between pregnancy stress and prenatal attachment (r=-0.42, p=0.000). In the study, it was observed that pregnancy stress level of the participating pregnant women decreased as the age increased (r=-0.13, p=0.026), but that it increased as their education and income levels increased (χ2=8.150, p=0.043) - (χ2=6.785, p=0.034). The participants' attachment levels were not correlated with variables such as age, education, baby's sex and gestational age, but prenatal attachment levels of the participants who received social support while they did house hold chores were statistically significantly higher (U=7872.500, p=0.025). CONCLUSIONS: It was observed that as the prenatal attachment level of the participating pregnant women decreased, as their stress level increased, that their stress level decreased as their age increased, that that their stress level increased as the education and income levels increased, and that the prenatal attachment of the participants who received social support when they did household chores was higher. It is thought that health personnel can improve prenatal attachment by taking necessary steps to reduce the stress levels of pregnant women in this process.

Detection of metastases in newly diagnosed prostate cancer by using 68Ga-PSMA PET/CT and its relationship with modified D'Amico risk classification.

PURPOSE: We aimed to investigate the diagnostic power of 68Ga-PSMA PET/CT in the detection of metastatic spread of newly diagnosed PCa, and evaluate the relationship with modified D'Amico risk classification. METHODS: We evaluated newly diagnosed PCa patients who underwent 68Ga-PSMA PET/CT prior to therapy. All images were interpreted retrospectively and areas of abnormally increased tracer uptake were documented according to PSMA-RADS version 1.0 system. Patients were divided into risk groups as low, intermediate, or high risk, according to a modification in D'Amico classification system as ISUP grade 3 tumors were included to high-risk group. 68Ga-PSMA PET/CT findings were compared among risk groups as well as PSA levels, clinical T stages, and ISUP grades. RESULTS: A total of 356 patients were included to the study with a median PSA level was 16.42 (1.29-7013) ng/ml and median Gleason score was 8 (range: 6-10). Of these, 13(3.7%), 54 (15.1%), and 289 (81.2%) were in the low-, intermediate-, and high-risk groups, respectively. Lymph node metastases were detected in 125 (35.1%) patients, and in 48 of them, metastasis was limited to pelvic lymph nodes (PLN). Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated as 71.4%, 100%, 95.9%, 100%, and 95.4%, respectively for the detection of PLN, based on histopathological results of 49 patients. Overall, any metastasis was detected in 47.7% of high-risk patients, while only PLN metastases were defined in 3.7% intermediate-risk patients and none of low-risk patients had any kind of metastasis. CONCLUSION: This study revealed that 68Ga-PSMA PET/CT should be routinely used in newly diagnosed high-risk PCa patients; whereas it seems to be of limited use for intermediate-risk group and useless for the low-risk group.

Impact of Point-Spread Function Reconstruction on 68Ga-DOTATATE PET/CT Quantitative Imaging Parameters.

OBJECTIVE. The objective of our study was to investigate the impact of point-spread function (PSF) reconstruction and lesion size on 68Ga-tetraazacyclododecanetetraacetic acid-DPhe1-Tyr3-octreotate (DOTATATE) PET/CT quantitative parameters. MATERIALS AND METHODS. A total of 38 patients with 42 68Ga-DOTATATE PET/CT studies and 125 lesions were included. Scans were reconstructed with and without PSF modulation. For each lesion, the maximum standardized uptake value (SUVmax) and peak standardized uptake value (SUVpeak), metabolic tumor volume (MTV), total lesion somatostatin avidity, and tumor somatostatin receptor expression heterogeneity using the AUC method were measured. Intraclass correlation coefficient (ICC) and Bland-Altman analyses were used to compare PSF and non-PSF values. A subgroup analysis was performed to determine the impact of lesion size. RESULTS. Of the 125 lesions, 51 were in the liver, 31 in lymph nodes, 17 in bone, eight in pancreas, four in lung, and 14 in other sites. The ICCs between PSF and non-PSF values were excellent for SUVmax, SUVpeak, MTV, and total lesion somatostatin avidity (ICC = 0.97-0.99), and the ICC was good for tumor somatostatin receptor expression heterogeneity (ICC = 0.81). Comparison of PSF with non-PSF values showed a bias (mean percentage change ± SD) of 27.5% ± 14.7% for SUVmax, 15.5% ± 9.5% for SUVpeak, -18.6% ± 37.6% for MTV, 0.8% ± 28.1% for total lesion somatostatin avidity, and -7.1% ± 11.0% for tumor somatostatin receptor expression heterogeneity. Comparison of PSF with non-PSF values for lesions less than 2 cm (n = 75) showed corresponding biases greater than those for lesions 2 cm or larger (n = 50). CONCLUSION. PSF reconstruction effected higher values for SUVmax and SUVpeak, produced decreased values for tumor somatostatin receptor expression heterogeneity, and had a variable effect on MTV and total lesion somatostatin avidity depending on lesion size.

Timing and Impact of Posttreatment PET/CT After First 6 Months on Patient Management and Outcomes in Oropharyngeal Squamous Cell Carcinoma.

OBJECTIVE. The objective of this study was to investigate the impact of PET/CT on patient management and outcomes of oropharyngeal squamous cell carcinoma (OPSCC) after the first 6 months following treatment. MATERIALS AND METHODS. We retrospectively identified patients with OPSCC who underwent chemoradiation therapy and had at least 2 years of posttreatment follow-up. Patients were grouped on the basis of whether they underwent PET/CT, as a result of clinical suspicion of recurrence or routine follow-up, in the last 18 months of the 2-year posttreatment period (experimental group) or not (control group). Association between PET/CT use and change in management was tested using chi-square analysis. Survival analyses were performed with Cox and Kaplan-Meier analyses. RESULTS. In total, 149 patients underwent 294 PET/CT studies in the 2-year follow-up period. Eighty-three patients (55.7%) underwent PET/CT in the last 18 months of the 2 years. This group underwent 223 PET/CT studies, 22 (9.9%) of which were positive. Sixteen of the 22 (72.7%) changed management. Sixty-six patients (44.3%) did not undergo PET/CT in the last 18 months. This group underwent 71 PET/CT studies, six (8.5%) of which were positive. Two of the six studies (33.3%) changed management. Of first-time positive PET/CT studies in the last 18 months, five of nine (55.6%) were performed 6-12 months after treatment. PET/CT in the last 18 months was positively associated with change in management (odds ratio, 4.88; p = 0.02). Patients with positive PET/CT findings had worse overall survival (hazard ratio [HR], 31.6; p < 0.0001) and progression-free survival (HR, 40.8; p < 0.0001). CONCLUSION. PET/CT in the last 18 months of the 2-year posttreatment period impacted patient management. Most first-time positive PET/CT studies in the last 18 months of the 2 years were performed 6-12 months after treatment.

Neuroendocrine Tumor Diagnosis and Management: 68Ga-DOTATATE PET/CT.

OBJECTIVE: The purpose of this article is to provide a review of the use of 68Ga tetraazacyclododecanetetraacetic acid-DPhe1-Tyr3-octreotate (DOTATATE) PET/CT, a functional imaging modality for assessment of well-differentiated neuroendocrine tumors (NETs). It has become the preferred imaging modality for initial diagnosis, selection of patients for peptide receptor radionuclide therapy, and localization of unknown primary tumors. The National Comprehensive Cancer Network guideline has added 68Ga-DOTATATE PET/CT as an appropriate test in the management of NETs. CONCLUSION: In combination with FDG PET/CT, 68Ga-DOTATATE PET/CT can noninvasively assess tumor heterogeneity, especially in G2 and G3 NETs, for personalized management of patients.

Do circulating long non-coding RNAs (lncRNAs) (LincRNA-p21, GAS 5, HOTAIR) predict the treatment response in patients with head and neck cancer treated with chemoradiotherapy?

Long non-coding RNAs (lncRNAs) have been shown to be aberrantly expressed in head and neck cancer (HNC). The aim of the present study was to evaluate plasma levels of three lncRNA molecules (lincRNA-p21, GAS5, and HOTAIR) in the treatment response in HNC patients treated with radical chemoradiotherapy (CRT). Forty-one patients with HNC were enrolled in the study. Most of the patients had nasopharyngeal carcinoma (n = 27, 65.9 %) and locally advanced disease. Blood was drawn at baseline and treatment evaluation 4.5 months after therapy. lncRNAs in plasma were measured by semiquantitative PCR. Treatment response was evaluated according to clinical examination, RECIST and PERCIST criteria based on magnetic resonance imaging (MRI), and positron emission tomography with computed tomography (PET/CT) findings. Complete response (CR) rates were 73.2, 36.6, and 50 % for clinical investigation, PET/CT-, or MRI-based response evaluation, respectively. Predictive value of lncRNAs was investigated in patients with CR vs. those with partial response (PR)/progressive disease (PD). We found that post-treatment GAS5 levels in patients with PR/PD were significantly higher compared with patients with CR based on clinical investigation (p = 0.01). Receiver operator characteristic (ROC) analysis showed that at a cutoff value of 0.3 of GAS5, sensitivity and specificity for clinical tumor response were 82 and 77 %, respectively. Interestingly, pretreatment GAS5 levels were significantly increased in patients with PR/PD compared to those with CR upon MRI-based response evaluation (p = 0.042). In contrast to GAS5, pretreatment or post-treatment lincRNA-p21 and HOTAIR levels were not informative for treatment response. Our results suggest that circulating GAS5 could be a biomarker in predicting treatment response in HNC patients.

Sentinel lymph node biopsy and aberrant lymphatic drainage in recurrent breast cancer: Findings likely to change treatment decisions.

BACKGROUND AND OBJECTIVES: It is not clear whether sentinel lymph node biopsy (SLNB) can be applied to patients with a second breast cancer or recurrence occurring at previously treated breast. The purpose of this study was to assess the feasibility of SLNB procedure in patients with recurrent breast cancer. METHODS: Patients with non-metastatic recurrent N0 breast cancer at ipsilateral breast were included. Patients were grouped according to their initial breast, axilla, and overall surgery. Presence of drainage and its pattern as well as SLNB success rate and overall axillary involvement rates were assessed. Findings were compared. RESULTS: Out of 75 patients, mean age was 52.5 years and disease-free interval was 82 (9-312) months. Lymphatic drainage was successful in 42 (56%) patients. Drainage positivity was more frequent in patients who were previously treated with SLNB (82.6%) than in patients who underwent axillary lymph node dissection (ALND) (44.2%; P = 0,002). Aberrant lymphatic drainage was detected in 64.3% of drainage positive patients. Success rate of reoperative SLNB was 92.9%. Adjuvant treatment plan was altered in 12 (16%) patients. In 15 patients, negative SLNB prevented axillary dissection. CONCLUSIONS: Reoperative SLNB seems to be technically feasible in N0 recurrent breast cancer patients. It may further avoid unnecessary ALND and lead changes in adjuvant treatment plans. J. Surg. Oncol. 2016;114:796-802. © 2016 2016 Wiley Periodicals, Inc.

Isolated Adrenal Metastases of Castration-Resistant Prostate Cancer: Excellent Response to 177 Lu-PSMA With No Adrenal Insufficiency.

ABSTRACT: We present isolated bilateral adrenal metastases successfully treated with 177 Lu-PSMA in a 66-year-old man diagnosed with castration-resistant prostate cancer. The patient had progression under chemotherapy as depicted by 68 Ga-PSMA PET/CT showing intense bilateral PSMA uptake in the adrenal masses, and metastasis-directed therapies were considered as the first option for improving survival because the patient was oligometastatic. However, surgery and radiotherapy were not justifiable options due to the high risk of definitive adrenal insufficiency; therefore, the patient received 4 cycles of 177 Lu-PSMA treatment. 68 Ga-PSMA PET/CT showed near-complete response in bilateral adrenal metastases, and no sign of adrenal insufficiency was observed during follow-up.

Detecting Amyloid Goiter With 99mTc-PYP SPECT/CT in the Setting of Ankylosing Spondylitis: An Uncommon Involvement of AA Amyloidosis.

ABSTRACT: We present a case with systemic amyloidosis secondary to ankylosing spondylitis (AA amyloidosis), whose 99mTc PYP scintigraphy revealed amyloid deposition in the thyroid gland (amyloid goiter). Amyloidosis is characterized by extracellular accumulation of amyloid fibril proteins leading to organ malfunction. Even though AA amyloidosis can be observed in patients with systemic inflammatory diseases, it is a very rare complication in ankylosing spondylitis. SPECT/CT images showed diffuse tracer uptake in enlarged thyroid gland containing fat density areas.

Unusual Metastasis of Signet-Ring Cell Gastric Cancer That Could Not Be Detected With 18 F-FDG PET But With 68 Ga-FAPI PET/CT.

ABSTRACT: A 70-year-old man who was scheduled for surgery because of the recurrence of gastric cancer was referred to our clinic preoperatively. The patient underwent a comprehensive evaluation through 18 F-FDG and 68 Ga-FAPI ( 68 Ga-labeled FAP inhibitors) PET/CT scans. The 68 Ga-FAPI PET/CT scan was particularly valuable in this case because of its ability to detect recurrent mass lesions and identify unusual metastatic sites compared with the 18 F-FDG PET/CT scan.

Influence of Early Versus Delayed Hepatic Artery Perfusion Scan on 90Y Selective Internal Radiation Therapy Planning.

Purpose: This study evaluated the effect of an increase in the time interval between hepatic intra-arterial injection of 99mTc-macroaggregated albumin (MAA) and hepatic artery perfusion scintigraphy (HAPS) on the lung shunt fraction (LSF) and perfused volume (PV) calculations in the treatment planning of selective internal radiation therapy (SIRT). Methods: The authors enrolled 51 HAPS sessions from 40 patients diagnosed with primary or metastatic liver malignancy. All patients underwent scan at the first and fourth hour after hepatic arterial injection of 99mTc-MAA. Based on single-photon emission computed tomography images, LSF values were measured from each patient's first and fourth hour images. PV1 and PV4 were also calculated based on three-dimensional images using 5% and 10% cutoff threshold values and compared with each other. Results: The authors found that the median of LSF4 was statistically significantly higher than LSF1 (3.05 vs. 4.14, p ≤ 0.01). There was no statistically significant difference between PV1 and PV4 on the 10% (p = 0.72) thresholds. Conclusions: LSF values can be overestimated in case of delayed HAPS, potentially leading to treatment cancellation due to incorrectly high results in patients who could benefit from SIRT. Threshold-based PV values do not significantly change over time; nevertheless, keeping the short interval time would be safer.

The Role of [18F]FDG PET/CT in the Characterization of Thymic Epithelial Tumors at Initial Stage.

Purpose: The aim of this study was to evaluate the potential role of [18F]FDG positron emission tomography/computed tomography (PET/CT) in the characterization of thymic epithelial tumors (TETs). Materials and Methods: A total of 73 patients who underwent preoperative [18F]FDG PET/CT were included in this study. Visual total score (VTS), maximum standard uptake values (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and heterogeneity index (HI) parameters were analyzed to investigate the prediction of histopathologic grade and advanced stage. Results: The cohort included 26 patients with low-grade thymoma (LGT), 36 patients with high-grade thymoma (HGT), and 11 patients with thymic carcinoma (TC). Ninety-one percent of TC had VTS >2, whereas 31% of LGT and 75% of HGT had VTS >2. SUVmax, MTV, and TLG were statistically significantly higher in the TC group than in both thymoma and HGT. Using the cutoff value of 7.25 for SUVmax, TC was differentiated from thymomas with 91% sensitivity and 74% specificity. TC had significantly lower HI values than thymomas. HI parameters showed good diagnostic ability to differentiate TC from thymoma and TC from HGT. SUVmax, MTV, and TLG were significantly higher in advanced-stage disease than in early-stage disease. Conclusions: Visual and quantitative parameters can reliably predict both advanced disease and the grade of primary tumor in TETs. Therefore, as a promising metabolic imaging method, [18F]FDG PET/CT makes important contributions to preoperative evaluation in routine clinical practice.

Gastro-Enteric-Pancreatic Neuroendocrine Tumor Treatment: 177Lu-DOTATATE.

177Lu-DOTA-TATE therapy is a highly effective therapy in metastatic, well-differentiated, somatostatin receptor-positive GEP-neuroendocrine tumors (NETs) with mostly tolerable adverse effects. Guidelines generally refer to peptide receptor radionuclide therapy as a second-line therapy after SSA in gastroenteric and second- or third-line therapy in pancreatic NETs to improve survival rates and quality of life. Although we do not have sufficient data, 177Lu-DOTA-TATE therapy may also have a role in high-grade NET therapy, mostly in combination with other treatments such as chemotherapy.

68 Ga-FAPI-04 PET/CT and 18 F-FDG PET/CT in Metastatic Papillary Renal Cell Cancer.

ABSTRACT: Papillary renal cell cancer is a rare malignancy with limited treatment options in the advanced stage of the disease. We present the case of a 62-year-old man with progressive left-sided papillary renal cell carcinoma who underwent 68 Ga-FAPI (fibroblast activated protein inhibitor)-04 and 18 F-FDG PET/CT imaging. 68 Ga-FAPI-04 PET/CT demonstrated variable FAP expression in all metastatic lesions detected by 18 F-FDG PET/CT, including multiple lymph nodes, bone, and thyroid. This case highlights that FAP-targeted imaging can be a promising modality for diagnostic and theranostic use in papillary renal cell carcinoma.