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).
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This scientific guarantor of this publication is Haojun Chen, MD, PhD.
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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.
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Authors Haojun Chen and Yizhen Pang kindly provided statistical advice for this manuscript.
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Written informed consent was obtained from all subjects (patients) in this study.
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Institutional Review Board approval was obtained.
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• 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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DOI: https://doi.org/10.1007/s00330-022-09084-9