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

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.

• Authors: Chunxia Qin, Yangmeihui Song, Yongkang Gai, Weiwei Ruan, Qingyao Liu, Fang Liu, Danzha Zheng, Peng Zhang, Hongli Liu, Tao Zhang, Kaixiong Tao, Xiaoli Lan
• Journal: European journal of nuclear medicine and molecular imaging (Eur J Nucl Med Mol Imaging) Vol. 49 Issue 12 Pg. 4228-4240 (Oct 2022) ISSN: 1619-7089 [Electronic] Germany
• PMID: 35657428 (Publication Type: Clinical Trial, Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Chemical References

• Gallium Radioisotopes
• Membrane Proteins
• Quinolines
• Fluorodeoxyglucose F18
• Gallium-68

Topics

• Fibroblasts (metabolism, pathology)
• Fluorodeoxyglucose F18
• Gallium Radioisotopes
• Gastrointestinal Neoplasms (diagnostic imaging, pathology, therapy)
• Humans
• Membrane Proteins (metabolism)
• Positron Emission Tomography Computed Tomography (methods)
• Quinolines (pharmacology)