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Theranostics 2023; 13(13):4694-4710. doi:10.7150/thno.88335 This issue Cite

Research Paper

Evaluation of FAPI PET imaging in gastric cancer: a systematic review and meta-analysis

Dan Ruan¹, Liang Zhao¹, Jiayu Cai¹, Weizhi Xu¹, Long Sun¹, Jiayi Li^2,3✉, Jingjing Zhang^4,5, Xiaoyuan Chen^4,5,6✉, Haojun Chen^1,7✉

1. Department of Nuclear Medicine and Minnan PET Center, Xiamen Key Laboratory of Radiopharmaceuticals, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
2. The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350004, China.
3. Department of Medical Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, China.
4. Departments of Diagnostic Radiology, Yong Loo Lin School of Medicine and Faculty of Engineering, National University of Singapore, Singapore.
5. Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore.
6. Nanomedicine Translational Research Program, NUS Center for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore.
7. Xiamen Key Laboratory of Rare Earth Photoelectric Functional Materials, Xiamen Institute of Rare Earth Materials, Haixi Institute, Chinese Academy of Sciences, Xiamen, China.

✉ Corresponding authors: Haojun Chen, Department of Nuclear Medicine and Minnan PET Center, First Affiliated Hospital of Xiamen University, Xiamen, China, No. 55 Zhenhai Rd, The First Affiliated Hospital of Xiamen University, Xiamen 361003, China. Telephone Number: +86 18659285282; Fax Number: 0592-2139527; Email Address: leochen0821com. Jiayi Li, Department of Medical Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China, The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350004, China. Email Address: jiayi_li01com. Xiaoyuan Chen, Departments of Diagnostic Radiology, Yong Loo Lin School of Medicine and Faculty of Engineering, National University of Singapore, Singapore. Email Address: chen.shawnedu.sg. More

Abstract

Purpose: Recent studies suggest that ⁶⁸Ga-FAPI PET/CT demonstrated superiority over ¹⁸F-FDG PET/CT in the evaluation of various cancer types, especially in gastric cancer (GC). By comprehensively reviewing and analysing the differences between ⁶⁸Ga-FAPI and ¹⁸F-FDG in GC, some evidence is provided to foster the broader clinical application of FAPI PET imaging.

Methods: In this review, studies published up to July 3, 2023, that employed radionuclide labelled FAPI as a diagnostic radiotracer for PET in GC were analysed. These studies were sourced from both the PubMed and Web of Science databases. Our statistical analysis involved a bivariate meta-analysis of the diagnostic data and a meta-analysis of the quantitative metrics. These were performed using R language.

Results: The meta-analysis included 14 studies, with 527 patients, of which 358 were diagnosed with GC. Overall, ⁶⁸Ga-FAPI showed higher pooled sensitivity (0.84 [95% CI 0.67-0.94] vs. 0.46 [95% CI 0.32-0.60]), specificity (0.91 [95% CI 0.76-0.98] vs. 0.88 [95% CI 0.74-0.96]) and area under the curve (AUC) (0.92 [95% CI 0.77-0.98] vs. 0.52 [95% CI 0.38-0.86]) than ¹⁸F-FDG. The evidence showed superior pooled sensitivities of ⁶⁸Ga-FAPI PET over ¹⁸F-FDG for primary tumours, local recurrence, lymph node metastases, distant metastases, and peritoneal metastases. Furthermore, ⁶⁸Ga-FAPI PET provided higher maximum standardized uptake value (SUVmax) and tumour-to-background ratios (TBR). For bone metastases, while ⁶⁸Ga-FAPI PET demonstrated slightly lower patient-based pooled sensitivity (0.93 vs. 1.00), it significantly outperformed ¹⁸F-FDG in the lesion-based analysis (0.95 vs. 0.65). However, SUVmax (mean difference [MD] 1.79 [95% CI -3.87-7.45]) and TBR (MD 5.01 [95% CI -0.78-10.80]) of bone metastases showed no significant difference between ⁶⁸Ga-FAPI PET/CT and ¹⁸F-FDG PET/CT.

Conclusion: Compared with ¹⁸F-FDG, ⁶⁸Ga-FAPI PET imaging showed improved diagnostic accuracy in the evaluation of GC. It can be effectively applied to the early diagnosis, initial staging, and detection of recurrence/metastases of GC. ⁶⁸Ga-FAPI may have the potential of replacing ¹⁸F-FDG in GC in future applications.

Keywords: fibroblast activation protein, ⁶⁸Ga-FAPI, ¹⁸F-FDG, gastric cancer, PET/CT

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