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Comparison of the diagnostic value of [68 Ga]Ga-FAPI-04 PET/MR and [18F]FDG PET/CT in patients with T stage ≤ 2a2 uterine cervical cancer: a prospective study

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Abstract

Purpose

To compare the diagnostic value of [68 Ga]Ga-FAPI-04 PET/MR and [18F]FDG PET/CT in patients with T stage ≤ 2a2 uterine cervical cancer patients.

Methods

Patients pathologically diagnosed with cervical cancer and with a T stage ≤ T2a2 were prospectively enrolled. All patients underwent whole-body [68 Ga]Ga-FAPI-04 PET/MR and [18F]FDG PET/CT within 2 weeks, and surgical treatment was performed within 10 days after PET.

Results

Twenty-five patients were enrolled. Twenty patients underwent radical hysterectomy, among which all of them underwent pelvic lymphadenectomy, and 10 patients underwent para-aortic lymphadenectomy. Three patients received merely laparoscopic lymphadenectomy without hysterectomy. Two patients with both [18F]FDG and [68 Ga]Ga-FAPI-04 lymph node high metabolism were staged as FIGO IIIC1r, and concurrent chemoradiation therapy (CCRT) was performed. [18F]FDG and [68 Ga]Ga-FAPI-04 had equivalent detection ability on primary tumors, with a positive detection rate of 96.0%. The accuracy of T staging using [18F]FDG and [68 Ga]Ga-FAPI-04 was relatively 50% and 55.0%. Elevated and underrated staging was due to misdiagnosis of either vaginal infiltration or tumor size. In terms of lymph node metastasis detection, the specificity of [68 Ga]Ga-FAPI-04 was 100% (95% CI, 84.6% ~ 100.0%), which was significantly higher than [18F]FDG (59.1% (95% CI, 36.4% ~ 79.3%)) (p = 0.004).

Conclusion

[68 Ga]Ga-FAPI-04 PET/MR and [18F]FDG PET/CT demonstrated an equivalent detection ability on cervical cancer primary tumors. However, [68 Ga]Ga-FAPI-04 PET/MR’s diagnostic value in lymph node metastasis was significantly higher than [18F]FDG PET/CT. [68 Ga]Ga-FAPI-04 PET/MR has the potential for more accurate treatment planning, thus clarifying fertility preservation indications for early-stage young patients.

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Data availability

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

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Funding

This study was supported by the National Natural Science Foundation of China (grant number 82172601 from author Weiwei Feng), the Natural Science Foundation of Shanghai Science and Technology Commission (grant number 20ZR1433700 from author Weiwei Feng), the Shanghai Municipal Key Clinical Specialty (grant number shslczdzk03403 from author Biao Li), and the Shanghai Hospital Development Center Foundation (grant number SHDC22023201 from author Biao Li).

Author information

Author notes

  1. You Lyu and Xiaoyue Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China

    You Lyu, Hua Liu & Weiwei Feng

  2. Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China

    Xiaoyue Chen, Yun Xi & Biao Li

  3. Collaboration Innovation Center for Molecular Imaging of Precision Medicine, Ruijin Center, Shanghai, China

    Xiaoyue Chen, Yun Xi & Biao Li

Authors
  1. You Lyu
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  2. Xiaoyue Chen
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  3. Hua Liu
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  4. Yun Xi
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  5. Weiwei Feng
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  6. Biao Li
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Contributions

Weiwei Feng and Biao Li designed the study. You Lyu, Xiaoyue Chen and Weiwei Feng wrote the manuscript. Hua Liu and Weiwei Feng selected cases and performed the clinical evaluation and surgery. Xiaoyue Chen and Yun Xi operated PET/MR and PET/CT. All authors discussed the results and commented on the manuscript.

Corresponding authors

Correspondence to Weiwei Feng or Biao Li.

Ethics declarations

Ethics approval

This prospective study was approved by the ethics committee of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

PET/CT and PET/MR images demonstrated in the article were not necessary to obtain consent.

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Conflicts of interest

The authors declare no potential conflicts of interest.

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Lyu, Y., Chen, X., Liu, H. et al. Comparison of the diagnostic value of [68 Ga]Ga-FAPI-04 PET/MR and [18F]FDG PET/CT in patients with T stage ≤ 2a2 uterine cervical cancer: a prospective study. Eur J Nucl Med Mol Imaging 51, 1163–1172 (2024). https://doi.org/10.1007/s00259-023-06539-z

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  • DOI: https://doi.org/10.1007/s00259-023-06539-z

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