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Comparison of [68Ga]Ga-FAPI and [18F]FDG uptake in patients with gastric signet-ring-cell carcinoma: a multicenter retrospective study

  • Gastrointestinal
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Abstract

Objective

In this study, we investigated the role of [68Ga]Ga-FAPI PET imaging in the detection of primary and metastatic gastric signet-ring-cell carcinoma (GSRCC) and compared with [18F]FDG PET.

Methods

This retrospective multicenter analysis included 34 patients with histologically confirmed GSRCCs from four medical centers. The maximum standard uptake value (SUVmax), tumor-to-background ratio (TBR), and diagnostic accuracy were compared between the two modalities. [18F]FDG and [68Ga]Ga-FAPI uptakes were compared by using the Wilcoxon signed-rank test. McNemar’s test was used to compare the diagnostic accuracy between the two techniques.

Results

Data were analyzed from 27 paired PET/CT and 7 paired PET/MRI scans for 34 GSRCC patients (16 men and 18 women) who had a median age of 51 years (range: 25–85 years). [68Ga]Ga-FAPI PET showed higher SUVmax and TBR values than did [18F]FDG PET in the primary tumors (SUVmax: 5.2 vs. 2.2, p = 0.001; TBR: 7.6 vs. 1.3, p < 0.001), involved lymph nodes (SUVmax: 6.8 vs. 2.5, p < 0.001; TBR: 5.8 vs. 1.3, p < 0.001), and bone and visceral metastases (SUVmax: 6.5 vs. 2.4, p < 0.001; TBR: 6.3 vs. 1.3, p < 0.001). In diagnostic performance, [68Ga]Ga-FAPI PET exhibited higher sensitivity than [18F]FDG PET for detecting primary tumors (73% [16/22] vs. 18% [4/22], p < 0.001), local recurrences (100% [7/7] vs. 29% [2/7], p = 0.071), lymph node metastases (77% [59/77] vs. 23% [18/77], p < 0.001), and distant metastases (93% [207/222] vs. 39% [86/222], p < 0.001).

Conclusion

The results from this multicenter retrospective analysis justify the clinical use of [68Ga]Ga-FAPI tracers for GSRCC diagnosis and staging.

Key Points

• [68Ga]Ga-FAPI PET/CT is a promising imaging modality for the detection of primary and metastatic disease and has implications for TNM staging in GSRCC.

• In this multicenter study of 34 patients with GSRCC, [68Ga]Ga-FAPI PET exhibited greater radiotracer uptake, tumor-to-background ratios, and diagnostic accuracy than [18F]FDG PET for detecting primary/recurrent tumors and metastatic lesions.

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Abbreviations

AJCC:

American Joint Committee on Cancer

BM:

Bone metastases

FAPIs:

Fibroblast activation protein inhibitors

FDG:

Fluorodeoxy-D-glucose

GMP:

Good manufacturing practices

GSRCC:

Gastric signet-ring-cell carcinoma

IQR:

Interquartile range

LM:

Liver metastases

LNM:

Lymph node metastases

LNs:

Lymph nodes

LR:

Local recurrence

Mets:

Metastases

PC:

Peritoneal carcinomatosis

PD:

Progressive disease

PET:

Positron emission tomography

PT:

Primary tumor

SUVmax :

Maximum standardized uptake value

TBR:

Tumor-to-background ratio

TNM staging:

Tumor, node, and metastasis staging

UCM:

Uncommon metastases

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Acknowledgements

We would like to thank all the researchers and patients at the four different institutions for their great help in this investigation.

Funding

This study has received funding from the National Natural Science Foundation of China (grant #82071963) and the Key Medical and Health Projects in Xiamen (grant #3502Z20191104).

Author information

Author notes

  1. Haojun Chen, Yizhen Pang, Junpeng Li and Fei Kang contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine & Minnan PET Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China

    Haojun Chen, Yizhen Pang, Weizhi Xu, Tinghua Meng, Qihang Shang, Hua Wu & Long Sun

  2. Department of PET Center, Huashan Hospital, Fudan University, Shanghai, China

    Junpeng Li, Yihui Guan & Fang Xie

  3. Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, China

    Fei Kang & Jing Wang

  4. Department of Nuclear Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China

    Jun Zhao

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  1. Haojun Chen
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Corresponding authors

Correspondence to Haojun Chen, Fang Xie, Jing Wang or Long Sun.

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Guarantor

This scientific guarantor of this publication is Haojun Chen, MD, PhD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Authors Haojun Chen and Yizhen Pang kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• multicenter study

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Chen, H., Pang, Y., Li, J. et al. Comparison of [68Ga]Ga-FAPI and [18F]FDG uptake in patients with gastric signet-ring-cell carcinoma: a multicenter retrospective study. Eur Radiol 33, 1329–1341 (2023). https://doi.org/10.1007/s00330-022-09084-9

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