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Head-to-head comparison of [18F]FDG PET and [68Ga]Ga-FAPI-04 PET in the diagnosis of gastric and pancreatic cancer: a systematic review and meta-analysis

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Abstract

Purpose

Our meta-analysis aimed to compare the positivity rates of [68Ga]Ga-FAPI-04 PET and [18F]FDG PET in gastric and pancreatic cancer.

Methods

We conducted a comprehensive search of PubMed, Embase, and Web of Science databases up to May 2023. The selected studies focused on evaluating the positivity rates of [18F]FDG PET and [68Ga]Ga-FAPI-04 PET in detecting gastric and pancreatic cancer.

Results

A total of 2,401 studies were screened and 13 articles were finally included. The positivity rates of [18F]FDG PET for primary gastric cancer, lymph node and peritoneal metastases were 0.74 [95% confidence interval (CI): 0.55–0.89], 0.49 (95% CI: 0.33–0.65) and 0.52 (95% CI: 0.37–0.67), respectively. On the other hand, [68Ga]Ga-FAPI-04 PET demonstrated significantly higher positivity rates at 0.98 (95% CI: 0.92-1.00), 0.76 (95% CI: 0.60–0.89) and 0.99 (95% CI: 0.93-1.00) (P < 0.01,P = 0.02, P < 0.01), respectively. For pancreatic cancer, [18F]FDG PET showed positivity rates of 0.93 (95% CI: 0.76-1.00) and 0.46 (95% CI: 0.23–0.69) for primary cancer and lymph node metastases, respectively. In comparison, [68Ga]Ga-FAPI-04 PET showed similar positivity rates of 1.00 (95% CI: 0.94-1.00) and 0.68 (95% CI: 0.40–0.90), (P = 0.27, 0.23). There was no significant difference in histopathological positivity rates for signet ring cell carcinoma and TNM stages I and II-IV (P = 0.96, 0.85,0.56).

Conclusion

[68Ga]Ga-FAPI-04 PET exhibited a higher positivity rate compared to [18F]FDG PET in the detection of primary gastric cancer, lymph node and peritoneal metastases. For pancreatic cancer, both [18F]FDG PET and [68Ga]Ga-FAPI-04 PET demonstrated comparable, high positivity rates for primary cancer diagnosis and lymph node metastasis detection. There is still a requirement for more extensive and forward-looking research in this field.

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References

  1. Zhang J, Tian Y, Luo Z, Qian C, Li W, Duan Y (2021) Breath volatile organic compound analysis: an emerging method for gastric cancer detection. J Breath Res. ;15(4)

  2. Kole C, Charalampakis N, Sakellariou S, Papaxoinis G, Apostolou KG, Machairas N et al (2022) Hereditary diffuse gastric Cancer: a 2022 Update. J Pers Med. ;12(12)

  3. Shaib YH, Davila JA, El-Serag HB (2006) The epidemiology of pancreatic cancer in the United States: changes below the surface. Aliment Pharmacol Ther 24(1):87–94

    Article  CAS  PubMed  Google Scholar 

  4. Appelros S, Borgström A (1999) Incidence, aetiology and mortality rate of acute pancreatitis over 10 years in a defined urban population in Sweden. Br J Surg 86(4):465–470

    Article  CAS  PubMed  Google Scholar 

  5. Chen W, Zheng R, Zeng H, Zhang S, He J (2015) Annual report on status of cancer in China, 2011. Chin J Cancer Res 27(1):2–12

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fu Z, Lu Z, Li Y, Zhang J, Zhang G, Chen X et al (2016) Cancer incidence and mortality in Shandong province, 2012. Chin J Cancer Res 28(3):263–274

    Article  PubMed  PubMed Central  Google Scholar 

  7. Basu S, Parghane RV, Suman S, Joshi A, Prabhash K, Bakshi G et al (2020) Towards personalizing treatment strategies in mCRPC: can dual-tracer PET-CT provide insights into tumor biology, guide the optimal treatment sequence, and individualize decision-making (between chemotherapy, second-generation anti-androgens and PSMA-directed radioligand therapy) early in the disease course? Eur J Nucl Med Mol Imaging 47(8):1793–1797

    Article  PubMed  Google Scholar 

  8. Jacobson O, Chen X (2013) Interrogating tumor metabolism and tumor microenvironments using molecular positron emission tomography imaging. Theranostic approaches to improve therapeutics. Pharmacol Rev 65(4):1214–1256

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Fortunati E, Argalia G, Zanoni L, Fanti S, Ambrosini V (2022) New PET Radiotracers for the imaging of neuroendocrine neoplasms. Curr Treat Options Oncol 23(5):703–720

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ambrosini V, Kunikowska J, Baudin E, Bodei L, Bouvier C, Capdevila J et al (1990) Consensus on molecular imaging and theranostics in neuroendocrine neoplasms. European journal of cancer (Oxford, England: 2021;146:56–73

  11. Vander Heiden MG, Cantley LC, Thompson CB (2009) Understanding the Warburg effect: the metabolic requirements of cell proliferation. Sci (New York NY) 324(5930):1029–1033

    Article  CAS  Google Scholar 

  12. Zhang Z, Jia G, Pan G, Cao K, Yang Q, Meng H et al (2022) Comparison of the diagnostic efficacy of (68) Ga-FAPI-04 PET/MR and (18)F-FDG PET/CT in patients with pancreatic cancer. Eur J Nucl Med Mol Imaging 49(8):2877–2888

    Article  CAS  PubMed  Google Scholar 

  13. Pang Y, Zhao L, Shang Q, Meng T, Zhao L, Feng L et al (2022) Positron emission tomography and computed tomography with [(68)Ga]Ga-fibroblast activation protein inhibitors improves tumor detection and staging in patients with pancreatic cancer. Eur J Nucl Med Mol Imaging 49(4):1322–1337

    Article  CAS  PubMed  Google Scholar 

  14. Liu Q, Shi S, Liu S, Xu X, Hu S, Zhang J et al (2023) The added value of [(68)Ga]Ga-DOTA-FAPI-04 PET/CT in pancreatic cancer: a comparison to [(18)F]F-FDG. Eur Radiol 33(7):5007–5016

    Article  CAS  PubMed  Google Scholar 

  15. Wang X, Zhao X, Gu Y, Zhu X, Yin T, Tang Z et al (2020) Effects of Exenatide and Humalog Mix25 on Fat distribution, insulin sensitivity, and β-Cell function in normal BMI patients with type 2 diabetes and visceral adiposity. J Diabetes Res 2020:9783859

    Article  PubMed  PubMed Central  Google Scholar 

  16. Qin C, Shao F, Gai Y, Liu Q, Ruan W, Liu F et al (2022) (68)Ga-DOTA-FAPI-04 PET/MR in the evaluation of gastric carcinomas: comparison with (18)F-FDG PET/CT. J Nucl Med 63(1):81–88

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Zhao L, Pang Y, Luo Z, Fu K, Yang T, Zhao L et al (2021) Role of [(68)Ga]Ga-DOTA-FAPI-04 PET/CT in the evaluation of peritoneal carcinomatosis and comparison with [(18)F]-FDG PET/CT. Eur J Nucl Med Mol Imaging 48(6):1944–1955

    Article  CAS  PubMed  Google Scholar 

  18. Miao Y, Feng R, Guo R, Huang X, Hai W, Li J et al (2023) Utility of [(68)Ga]FAPI-04 and [(18)F]FDG dual-tracer PET/CT in the initial evaluation of gastric cancer. Eur Radiol 33(6):4355–4366

    Article  CAS  PubMed  Google Scholar 

  19. Kuten J, Levine C, Shamni O, Pelles S, Wolf I, Lahat G et al (2022) Head-to-head comparison of [(68)Ga]Ga-FAPI-04 and [(18)F]-FDG PET/CT in evaluating the extent of disease in gastric adenocarcinoma. Eur J Nucl Med Mol Imaging 49(2):743–750

    Article  CAS  PubMed  Google Scholar 

  20. Iqbal J, Wu HX, Hu N, Zhou YH, Li L, Xiao F et al (2022) Effect of glucagon-like peptide-1 receptor agonists on body weight in adults with obesity without diabetes mellitus-a systematic review and meta-analysis of randomized control trials. Obes Reviews: Official J Int Association Study Obes 23(6):e13435

    Article  CAS  Google Scholar 

  21. Gündoğan C, Kömek H, Can C, Yildirim ÖA, Kaplan İ, Erdur E et al (2022) Comparison of 18F-FDG PET/CT and 68Ga-FAPI-04 PET/CT in the staging and restaging of gastric adenocarcinoma. Nucl Med Commun 43(1):64–72

    Article  PubMed  Google Scholar 

  22. Chen H, Pang Y, Li J, Kang F, Xu W, Meng T et al (2023) Comparison of [(68)Ga]Ga-FAPI and [(18)F]FDG uptake in patients with gastric signet-ring-cell carcinoma: a multicenter retrospective study. Eur Radiol 33(2):1329–1341

    Article  CAS  PubMed  Google Scholar 

  23. Lee ES, Paeng JC, Park CM, Chang W, Lee WW, Kang KW et al (2013) Metabolic characteristics of Castleman disease on 18F-FDG PET in relation to clinical implication. Clin Nucl Med 38(5):339–342

    Article  PubMed  Google Scholar 

  24. Lin R, Lin Z, Chen Z, Zheng S, Zhang J, Zang J et al (2022) [(68)Ga]Ga-DOTA-FAPI-04 PET/CT in the evaluation of gastric cancer: comparison with [(18)F]FDG PET/CT. Eur J Nucl Med Mol Imaging 49(8):2960–2971

    Article  CAS  PubMed  Google Scholar 

  25. Wang Y, Luo W, Li Y (2023) [(68)Ga]Ga-FAPI-04 PET MRI/CT in the evaluation of gastric carcinomas compared with [(18)F]-FDG PET MRI/CT: a meta-analysis. Eur J Med Res 28(1):34

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jiang D, Chen X, You Z, Wang H, Zhang X, Li X et al (2022) 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 49(2):732–742

    Article  CAS  PubMed  Google Scholar 

  27. Pang Y, Zhao L, Luo Z, Hao B, Wu H, Lin Q et al (2021) Comparison of 68Ga-FAPI and 18F-FDG uptake in gastric, duodenal, and colorectal cancers. Radiology 298(2):393–402

    Article  PubMed  Google Scholar 

  28. Huang D, Wu J, Zhong H, Li Y, Han Y, He Y et al (2023) [(68)Ga]Ga-FAPI PET for the evaluation of digestive system tumors: systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 50(3):908–920

    Article  PubMed  Google Scholar 

  29. Yun M (2014) Imaging of gastric Cancer metabolism using 18 F-FDG PET/CT. J Gastric Cancer 14(1):1–6

    Article  PubMed  PubMed Central  Google Scholar 

  30. Rosenbaum SJ, Stergar H, Antoch G, Veit P, Bockisch A, Kühl H (2006) Staging and follow-up of gastrointestinal tumors with PET/CT. Abdom Imaging 31(1):25–35

    Article  CAS  PubMed  Google Scholar 

  31. Stahl A, Ott K, Weber W, Becker K, Link T, Siewert J-R et al (2003) FDG PET imaging of locally advanced gastric carcinomas: correlation with endoscopic and histopathological findings. Eur J Nucl Med Mol Imaging 30(2):288–295

    Article  CAS  PubMed  Google Scholar 

  32. Esteves FP, Schuster DM, Halkar RK (2006) Gastrointestinal tract malignancies and Positron Emission Tomography: an overview. Semin Nucl Med 36(2):169–181

    Article  PubMed  Google Scholar 

  33. Akin EA, Qazi ZN, Osman M, Zeman RK (2020) Clinical impact of FDG PET/CT in alimentary tract malignancies: an updated review. Abdom Radiol 45(4):1018–1035

    Article  Google Scholar 

  34. Giesel FL, Kratochwil C, Schlittenhardt J, Dendl K, Eiber M, Staudinger F et al (2021) Head-to-head intra-individual comparison of biodistribution and tumor uptake of (68)Ga-FAPI and (18)F-FDG PET/CT in cancer patients. Eur J Nucl Med Mol Imaging 48(13):4377–4385

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Quanzhou First Hospital Affifiliated to Fujian Medical University, Quanzhou, 362000, China

    Wanrun Xie, Bo Li, Zhenzhen Hong & Yi Zhang

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  1. Wanrun Xie
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Correspondence to Yi Zhang.

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Xie, W., Li, B., Hong, Z. et al. Head-to-head comparison of [18F]FDG PET and [68Ga]Ga-FAPI-04 PET in the diagnosis of gastric and pancreatic cancer: a systematic review and meta-analysis. Clin Transl Imaging (2024). https://doi.org/10.1007/s40336-024-00633-4

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