{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T05:02:53Z","timestamp":1777006973030,"version":"3.51.4"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Accurate staging is critical for breast cancer management. While [\n                      <jats:sup>18<\/jats:sup>\n                      F]FDG PET\/CT is the standard for metabolic imaging, it has limitations in detecting tumors with low glucose metabolism and small regional metastases. Fibroblast activation protein inhibitor (FAPI) PET\/CT targets cancer-associated fibroblasts and offers a novel diagnostic avenue.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>\n                      A female patient presented with left-sided inflammatory breast cancer. Conventional [\n                      <jats:sup>18<\/jats:sup>\n                      F]FDG PET\/CT showed uptake in the left breast but missed regional spread and contralateral disease. Conversely, a supplemental [\n                      <jats:sup>18<\/jats:sup>\n                      F]AlF-NOTA-FAPI-04 PET\/CT revealed intense uptake in the left breast (SUVmax 19.45) and detected occult metastases in the left axillary (SUVmax 15.12) and supraclavicular lymph nodes (SUVmax 14.83). Crucially, it also identified a high-uptake lesion in the right breast (SUVmax 15.06), which biopsy confirmed as DCIS, upstaging the diagnosis to synchronous bilateral breast cancer. Following neoadjuvant chemotherapy, follow-up FAPI PET\/CT demonstrated that uptake in the supraclavicular and axillary nodes dropped to background levels, predicting a complete response (CR). Postoperative pathology confirmed CR in the lymph nodes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the superior sensitivity of FAPI PET\/CT over FDG PET\/CT in detecting low-metabolic malignancies like DCIS and accurately staging regional nodal involvement (including supraclavicular nodes). FAPI PET\/CT played a decisional role in upstaging the patient and monitoring neoadjuvant therapy response.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1816302","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T04:31:25Z","timestamp":1777005085000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: FAPI PET\/CT detected occult contralateral DCIS and supraclavicular metastasis, guiding neoadjuvant therapy in synchronous bilateral breast cancer"],"prefix":"10.3389","volume":"16","author":[{"given":"Lin","family":"Cong","sequence":"first","affiliation":[{"name":"Department of Breast Surgery, China-Japan Union Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiqi","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, China-Japan Union Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yilin","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, China-Japan Union Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Breast Surgery, China-Japan Union Hospital of Jilin University","place":["Changchun, 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