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Gallium-68-labeled fibroblast activation protein inhibitor PET in gastrointestinal cancer: insights into diagnosis and management

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Abstract

Purpose

Gallium-68-labeled fibroblast activation protein inhibitor (68Ga-FAPI) is an emerging promising tumor tracer. This study aims to evaluate the diagnostic efficiency of 68Ga-FAPI PET in gastrointestinal cancer, and to determine its potential impact on clinical management.

Methods

Patients with malignancies were prospectively enrolled in a clinical trial to evaluate the diagnostic value of 68Ga-FAPI PET. One hundred twenty patients with gastrointestinal malignancies (121 68Ga-FAPI PET scans) between June 2020 and May 2021 were retrospectively analyzed. Initial staging of untreated patients and restaging of treated patients were evaluated. The treatment scheme promoted by imaging was determined according to NCCN guidelines. Final diagnosis and treatment reference standards were determined by a dedicated multidisciplinary team. The diagnostic performance and treatment guidance of 68Ga-FAPI PET were compared with those of conventional imaging (CI) and 18F-FDG PET.

Results

The diagnostic accuracy of 68Ga-FAPI PET was much higher than that of CI and 18F-FDG PET (95.0% vs. 65.1% and 69.0%, respectively, both p < 0.001). 68Ga-FAPI PET revised diagnosis in 30.3% and 26.2% of patients compared with CI and 18F-FDG PET. The accordance rate of 68Ga-FAPI PET-guided treatment in comparison with the reference standard was significantly higher than that of CI and 18F-FDG PET (96.7% vs. 75.2% and 76.2%, respectively, both p < 0.001). 68Ga-FAPI PET changed treatment in 22.9% and 23.8% of patients compared with CI and 18F-FDG PET.

Conclusions

68Ga-FAPI PET showed remarkable diagnostic performance in gastrointestinal cancer, resulting in more accurate staging and guidance for timely treatment revision, thereby having a critical impact on clinical management.

Trial registration

NCT04554719. Registered September 8, 2020—retrospectively registered, http://clinicaltrails.gov/show/NCT04554719

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Funding

This study was supported in part by the National Natural Science Foundation of China (Grant Nos. 82030052 and 82171985).

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Author notes

  1. Chunxia Qin and Yangmeihui Song contributed equally to this work

Authors and Affiliations

  1. Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Chunxia Qin, Yangmeihui Song, Yongkang Gai, Weiwei Ruan, Qingyao Liu, Fang Liu, Danzha Zheng & Xiaoli Lan

  2. Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China

    Chunxia Qin, Yangmeihui Song, Yongkang Gai, Weiwei Ruan, Qingyao Liu, Fang Liu, Danzha Zheng & Xiaoli Lan

  3. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Peng Zhang & Kaixiong Tao

  4. Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Hongli Liu & Tao Zhang

  5. Key Laboratory of Biological Targeted Therapy, the Ministry of Education, Wuhan, 430022, China

    Xiaoli Lan

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  1. Chunxia Qin
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Correspondence to Chunxia Qin or Xiaoli Lan.

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Ethics approval

This article does not contain any experiments with animals. All procedures involving human participants were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Clinical Research Ethics Committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (No. 20200290).

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

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Qin, C., Song, Y., Gai, Y. et al. Gallium-68-labeled fibroblast activation protein inhibitor PET in gastrointestinal cancer: insights into diagnosis and management. Eur J Nucl Med Mol Imaging 49, 4228–4240 (2022). https://doi.org/10.1007/s00259-022-05847-0

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