Comparison of ⁶⁸Ga-FAPI and ¹⁸F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers.

Abstract

Background Accurate clinical staging is crucial to managing gastrointestinal cancer, but fluorine 18 (¹⁸F) fluorodeoxyglucose (FDG) PET/CT has limitations. Targeting fibroblast-activation protein is a newer diagnostic approach for the visualization of tumor stroma, and gallium 68 (⁶⁸Ga)-labeled fibroblast-activation protein inhibitors (FAPIs), hereafter ⁶⁸Ga-FAPIs, present a promising alternative to ¹⁸F-FDG. Purpose To compare the diagnostic efficacy of ⁶⁸Ga-FAPI PET/CT in primary and metastatic lesions of gastrointestinal malignancies with that of ¹⁸F-FDG PET/CT. Materials and Methods Images from patients with gastric, duodenal, and colorectal cancers who underwent contemporaneous ¹⁸F-FDG and ⁶⁸Ga-FAPI PET/CT between October 2019 through June 2020 were retrospectively analyzed. ¹⁸F-FDG and ⁶⁸Ga-FAPI uptakes were compared by using the Wilcoxon signed-rank test. The McNemar test was used to compare the diagnostic performance between the two techniques. Results Thirty-five patients (median age, 64 years [interquartile range, 53-68 years]; 18 men) were evaluated. In treatment-naive patients (<i>n</i> = 19), ⁶⁸Ga-FAPI PET/CT led to upstaging of the clinical TNM stage in four (21%) patients compared with ¹⁸F-FDG PET/CT. Tracer uptake was higher with ⁶⁸Ga-FAPI PET/CT than with ¹⁸F-FDG PET/CT in primary lesions (gastric cancer: 12.7 vs 3.7, respectively, <i>P</i> = .003; colorectal cancer: 15.9 vs 7.9, <i>P</i> = .03), involved lymph nodes (6.7 vs 2.4, <i>P</i> < .001), and bone and visceral metastases (liver metastases: 9.7 vs 5.2, <i>P</i> < .001; peritoneal metastases: 8.4 vs 3.6, <i>P</i> < .001; bone metastases: 4.3 vs 2.2, <i>P</i> < .001; lung metastases: 4.4 vs 1.9, <i>P</i> = .01). In addition, the sensitivity of ⁶⁸Ga-FAPI PET/CT was higher than that of ¹⁸F-FDG PET/CT in the detection of primary tumors (100% [19 of 19] vs 53% [10 of 19], respectively; <i>P</i> = .004), lymph nodes (79% [22 of 28] vs 54% [15 of 28], <i>P</i> < .001), and bone and visceral metastases (89% [31 of 35] vs 57% [20 of 35], <i>P</i> < .001). Conclusion Gallium 68 fibroblast-activation protein inhibitor PET/CT was superior to fluorine 18 fluorodeoxyglucose PET/CT in the detection of primary and metastatic lesions in gastric, duodenal, and colorectal cancers, with higher tracer uptake in most primary and metastatic lesions. Published under a CC BY 4.0 license.