Comparison of Diagnostic Efficacy of [68Ga]Ga-FAPI-04 and [18F]FDG PET/CT for Staging and Restaging of Gastric Cancer

Shumao Zhang; Wei Wang; Tingting Xu; Haoyuan Ding; Yi Li; Huipan Liu; Yinxue Huang; Lin Liu; Tao Du; Yan Zhao; Yue Chen; Lin Qiu

doi:10.3389/fonc.2022.925100

Comparison of Diagnostic Efficacy of [⁶⁸Ga]Ga-FAPI-04 and [¹⁸F]FDG PET/CT for Staging and Restaging of Gastric Cancer

Front Oncol. 2022 Jul 1:12:925100. doi: 10.3389/fonc.2022.925100. eCollection 2022.

Authors

Shumao Zhang^{1

2

3}, Wei Wang^{1

2

3}, Tingting Xu^{1

2

3}, Haoyuan Ding^{1

2

3}, Yi Li^{1

2

3}, Huipan Liu^{1

2

3}, Yinxue Huang^{4

5}, Lin Liu^{1

2

3}, Tao Du^{1

2

3}, Yan Zhao^{1

2

3}, Yue Chen^{1

2

3}, Lin Qiu^{1

2

3}

Affiliations

¹ Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
² Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.
³ Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China.
⁴ Department of Geriatric Psychiatry, The Fourth People's Hospital of Chengdu, Chengdu, China.
⁵ Department of Geriatric Psychiatry, The Clinical Hospital of Chengdu Brain Science Institute, Ministry of Education (MOE) Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.

Abstract

Purpose: This study aimed to compare the potential diagnostic efficacy of gallium68-fibroblast-activation protein inhibitor ([⁶⁸Ga]Ga-FAPI-04) and fluorine18-fluorodeoxyglucose ([¹⁸F]-FDG) positron emission tomography-computed tomography (PET/CT) for primary tumors, lymph nodes, and distant metastatic lesions of gastric cancer (GC), and to explore the effects of [⁶⁸Ga]Ga-FAPI-04 and [¹⁸F]-FDG on tumor staging and restaging in GC.

Methods: This single-center retrospective study (NCT2100044131) was conducted at the Affiliated Hospital of the Southwest Medical University between June 2020 and December 2021. Images of patients with GC who were pathologically confirmed and underwent contemporaneous [¹⁸F]-FDG and [⁶⁸Ga]Ga-FAPI-04 PET/CT within 1 week were analyzed. The diagnostic efficacy of [⁶⁸Ga]Ga-FAPI-04 PET/CT and [¹⁸F]-FDG PET/CT for TNM staging of GC was compared using McNemar test. The maximum standard uptake value (SUVmax) of each lesion in the two imaging types was compared using the Mann-Whitney U test.

Results: In total, 25 patients with GC (mean age, 56 ± 12 years) were evaluated. [⁶⁸Ga]Ga-FAPI-04 PET/CT exhibited higher sensitivity compared to [¹⁸F]-FDG PET/CT for detecting primary tumors (18/19 [94.74%] vs. 13/19 [68.42%], χ2 = 6.866, P < 0.01), lymph node metastasis (75/77 [97.40%] vs. 32/77 [41.56%], χ2 = 2.888, P =0.089), and distant metastases (275/283 [97.17%] vs. 122/283 [43.11%], χ2 = 11.858, P < 0.01). [⁶⁸Ga]Ga-FAPI-04 accumulation was significantly higher than that of [¹⁸F]FDG in tumors (median SUVmax, 10.28 vs 3.20; U=59.00, P < 0.01), lymph node metastasis metastases (median SUVmax, 9.20 vs 3.15; U=53.50, P < 0.01), and distant metastases (median SUVmax, 8.00 vs 4.20; U=200.00, P < 0.01). Compared to [¹⁸F]-FDG PET/CT, [⁶⁸Ga]Ga-FAPI-04 PET/CT resulted in new oncological findings in 14/25 patients and corrected tumor staging or restaging in 7/25 patients.

Conclusion: Our preliminary results regarding the impact of [⁶⁸Ga]Ga-FAPI-04 PET/CT on tumor staging highlight the potential of this approach for increasing the accuracy of GC diagnosis, which may facilitate treatment decision-making.

Keywords: PET/CT; [18F]-FDG; [68Ga]Ga-FAPI-04; gastric cancer; tumor staging.