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[68Ga]Ga-DOTA-FAPI-04 PET/CT in the evaluation of gastric cancer: comparison with [18F]FDG PET/CT

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Abstract

Purpose

This study aimed to compare the performance of [68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT in the evaluation of primary and metastatic lesions of gastric cancer.

Methods

Fifty-six patients with histologically proven gastric carcinomas were enrolled in this study, including 45 patients for staging and 11 patients for restaging after surgery. Each patient underwent both [18F]FDG and [68Ga]Ga-DOTA-FAPI-04 PET/CT within 1 week. The activity of tracer accumulation in lesions was assessed by maximum standardized uptake value (SUVmax) and TBR (lesions SUVmax/ascending aorta SUVmean). Histological workup served as a standard of reference. If tissue diagnosis was not applicable, the follow-up data including the results of laboratory tests and medical imaging could also serve as a reference.

Results

[68Ga]Ga-DOTA-FAPI-04 PET/CT was comparable to [18F]FDG on detecting primary tumors and lymph node (LN) metastases, whereas [68Ga]Ga-DOTA-FAPI-04 outperformed [18F]FDG in detecting peritoneal (159 vs. 47, P < 0.001) and bone metastases (64 vs. 55, P = 0.003) by the lesion-based analysis. [68Ga]Ga-DOTA-FAPI-04 showed higher SUVmax (10.3 vs. 8.1, P = 0.004) and TBR (11.6 vs. 5.8, P < 0.001) in primary tumor, and higher TBR in LN involvement (8.0 vs. 3.7, P < 0.001) and peritoneal metastases (8.1 vs. 3.2, P < 0.001), compared with [18F]FDG PET/CT. The specificity and positive predictive value of [68 Ga]Ga-DOTA-FAPI-04 were significantly higher than that of [18F]FDG (100.0% vs. 97.7%, P < 0.001; 100.0% vs. 57.1%, P = 0.001) in determining the LN status. [68Ga]Ga-DOTA-FAPI-04 was comparable to [18F]FDG in evaluating N-staging (47.1% vs. 23.5%, P = 0.282). [68Ga]Ga-DOTA-FAPI-04 PET/CT detected more positive recurrent lesions in all restaging patients and showed clearer tumor delineation. Two patients underwent follow-up [68Ga]Ga-DOTA-FAPI-04 PET/CT scans after chemotherapy, which both showed remission.

Conclusions

[68Ga]Ga-DOTA-FAPI-04 PET/CT can better evaluate primary gastric cancer and metastatic lesions in the peritoneum, abdominal LNs, and bone. Furthermore, [68Ga]Ga-DOTA-FAPI-04 PET/CT provided more information for patients with recurrent disease and had the potential in monitoring response to treatment.

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Funding

This study was funded in part by the National Natural Science Foundation of China (No.81971651), Natural Science Foundation of Fujian Province (No.2019J01454), Fujian Provincial Health Technology Project (No.2021QNA031), and Startup Fund for Scientific Research of Fujian Medical University (No.2020QH1044).

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Authors and Affiliations

  1. Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian Province, China

    Rong Lin, Zefang Lin, Zhenying Chen, Shan Zheng, Jiaying Zhang, Jie Zang & Weibing Miao

  2. Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China

    Weibing Miao

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  1. Rong Lin
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Correspondence to Jie Zang or Weibing Miao.

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

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Lin, R., Lin, Z., Chen, Z. et al. [68Ga]Ga-DOTA-FAPI-04 PET/CT in the evaluation of gastric cancer: comparison with [18F]FDG PET/CT. Eur J Nucl Med Mol Imaging 49, 2960–2971 (2022). https://doi.org/10.1007/s00259-022-05799-5

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