{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:13:35Z","timestamp":1784297615401,"version":"3.55.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>This study compared the diagnostic performance, semi-quantitative capability, and staging accuracy of [<jats:sup>18<\/jats:sup>F]AlF-NOTA-FAPI-04 and [<jats:sup>18<\/jats:sup>F]FDG PET\/CT in detecting lymph node metastases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This single-center retrospective study included 41 patients with suspected lymph node metastases who received both [<jats:sup>18<\/jats:sup>F]FDG and [<jats:sup>18<\/jats:sup>F]AlF-NOTA-FAPI-04 PET\/CT. The study compared metastatic lymph node detection, semi-quantitative values, and N staging accuracy. Subgroup analyses were performed for lymph nodes with short-axis diameters (SADs) \u226510 and &amp;lt;10 mm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 41 patients with 126 nodes were included. [<jats:sup>18<\/jats:sup>F]AlF-NOTA-FAPI-04 outperformed [<jats:sup>18<\/jats:sup>F]FDG in the detection of metastatic lymph nodes, achieving higher accuracy in both patient-based (92.7% vs. 70.7%, <jats:italic>p<\/jats:italic> = 0.004) and node-based analyses (91.3% vs. 60.3%, <jats:italic>p<\/jats:italic> &amp;lt; 0.001). In semi-quantitative analysis, the maximum standardized uptake value and target-to-background ratio of [<jats:sup>18<\/jats:sup>F]AlF-NOTA-FAPI-04 were higher than those of [<jats:sup>18<\/jats:sup>F]FDG in metastatic lymph nodes (all <jats:italic>p<\/jats:italic> &amp;lt; 0.001). Both tracers distinguished metastatic from benign nodes with SAD \u2265 10 mm (<jats:italic>p<\/jats:italic> &amp;lt; 0.05). [<jats:sup>18<\/jats:sup>F]AlF-NOTA-FAPI-04 PET\/CT could distinguish between benign and metastatic lymph nodes with SAD &amp;lt; 10 mm (<jats:italic>p<\/jats:italic> &amp;lt; 0.001), whereas [<jats:sup>18<\/jats:sup>F]FDG PET\/CT could not (<jats:italic>p<\/jats:italic> &amp;gt; 0.05). [<jats:sup>18<\/jats:sup>F]AlF-NOTA-FAPI-04 also provided more accurate N staging assessments (87.8% vs. 65.9%, <jats:italic>p<\/jats:italic> = 0.006). [<jats:sup>18<\/jats:sup>F]AlF-NOTA-FAPI-04 PET\/CT enabled the correct diagnosis of more lymph nodes, leading to a change in the therapeutic regimen for eight patients (19.5%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>[<jats:sup>18<\/jats:sup>F]AlF-NOTA-FAPI-04 PET\/CT demonstrated superior diagnostic performance, semi-quantitative capability, and N staging accuracy compared to [<jats:sup>18<\/jats:sup>F]FDG PET\/CT, particularly for small metastatic lymph nodes (SAD &amp;lt; 10 mm), offering enhanced guidance for tumor staging.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2025.1605568","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T04:10:22Z","timestamp":1753330222000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of [18F]AlF-NOTA-FAPI-04 PET\/CT and [18F]FDG PET\/CT for diagnosing lymph node metastasis in malignant 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