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Comparison of [68 Ga]Ga-FAPI-04 and [18F]-FDG for the detection of primary and metastatic lesions in patients with gastric cancer: a bicentric retrospective study

Abstract

Introduction

The low sensitivity of [18F]-fluorodeoxyglucose ([18F]-FDG) for the diagnosis of gastric cancer limits its application. In this study, we aimed to investigate the potential advantage of [68 Ga]Ga-FAPI-04 over [18F]-FDG in the evaluation of gastric cancer.

Methods

This was a bicentric retrospective analysis of a prospective parent study (clinical trial: HS-KY-2020–826 (Huashan Hospital) and DF-2020–102 (Shanghai East Hospital)). Thirty-eight patients with gastric cancer (31 with adenocarcinoma and 7 with signet ring cell carcinoma) were included in this study. All of the participants underwent [68 Ga]Ga-FAPI-04 and [18F]-FDG imaging by positron emission tomography (PET)/computed tomography (CT) or PET/magnetic resonance (MR). The scans were interpreted by two experienced nuclear medicine physicians, and the maximum standardized uptake value (SUVmax) was calculated. Histopathological findings obtained from biopsy or resected surgical specimens were used as a reference for the final diagnosis.

Results

For the detection of primary gastric cancer, the sensitivities of [68 Ga]Ga-FAPI-04 PET and [18F]-FDG PET were 100% (38/38) and 82% (31/38), respectively (P = 0.016). Four cases of adenocarcinoma and three cases of signet ring cell carcinoma were missed by [18F]-FDG PET. The mean SUVmax of [68 Ga]Ga-FAPI-04 in tumours greater than 4 cm (11.0 ± 4.5) was higher than that in tumours less than 4 cm (4.5 ± 3.2) (P = 0.0015). The mean SUVmax of [68 Ga]Ga-FAPI-04 was higher in T2–4 tumours (9.7 ± 4.4) than in T1 tumours (3.1 ± 1.5) (P = 0.0002). For the detection of metastatic lesions, the sensitivities of [68 Ga]Ga-FAPI-04 PET and [18F]-FDG PET in 10 patients with regional lymph node metastasis and distant metastasis were 6/10 and 5/10, respectively.

Conclusion

In this selected cohort, [68 Ga]Ga-FAPI-04 PET had a superior detection rate than [18F]-FDG PET for primary gastric cancer. [68 Ga]Ga-FAPI-04 PET could provide better performance with regard to gastric cancer diagnosis and staging. Prospective clinical trials are warranted.

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Acknowledgements

The authors appreciate the excellent technical assistance of the staff at the PET Center, Huashan Hospital, Fudan University, and the staff at the Department of Nuclear Medicine, Shanghai East Hospital, School of Medicine, Tongji University.

Funding

This work was supported by Startup Fund of Huashan Hospital, Fudan University (2017QD081), Shanghai Municipal Key Clinical Specialty (shslczdzk03402), Shanghai Municipal Science and Technology Major Project (No. 2018SHZDZX01), and Shanghai Municipal Health Commission Fund (202040420).

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Contributions

FX, JZ, YG, and FH designed this study and organized the data collection; FX, DJ, XC, ZY, HW, XZ, XL, SR, and QH collected the data; DJ, HW, and QH processed and analysed the data; FX and DJ led the manuscript writing; and all authors reviewed and revised the manuscript.

Corresponding authors

Correspondence to Fengchun Hua or Yihui Guan or Jun Zhao or Fang Xie.

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All procedures performed in this study involving human participants were performed in accordance with the ethics standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethics standards.

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The authors declare no competing interests.

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This article is part of the Topical Collection on Oncology—Digestive tract

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Cite this article

Jiang, D., Chen, X., You, Z. et al. Comparison of [68 Ga]Ga-FAPI-04 and [18F]-FDG for the detection of primary and metastatic lesions in patients with gastric cancer: a bicentric retrospective study. Eur J Nucl Med Mol Imaging (2021). https://doi.org/10.1007/s00259-021-05441-w

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Keywords

  • Gastric adenocarcinoma
  • Signet ring cell carcinoma
  • Fibroblast activation protein
  • Cancer-associated fibroblasts
  • [68 Ga]Ga-FAPI-04
  • [18F]-FDG