Clinical impact of FDG PET/CT in alimentary tract malignancies: an updated review

Akin, Esma A.; Qazi, Zain N.; Osman, Murat; Zeman, Robert K.

doi:10.1007/s00261-020-02447-0

Cited by 29 publications

(19 citation statements)

References 61 publications

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“…In the node-based analysis, the sensitivity, specificity, and accuracy in the diagnosis of metastatic lymph nodes were 54% (15 F-FDG uptake (14)(15)(16)(17)(18). In addition, the physiologic 18 F-FDG uptake by the gastric wall also further limits the application of 18 F-FDG PET/CT in the detection of gastric cancer.…”

Section: Diagnostic Performance Of 18 F-fdg and 68 Ga-fapi Pet/ct In mentioning

confidence: 99%

Comparison of ⁶⁸Ga-FAPI and ¹⁸F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

et al. 2021

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Background: Accurate clinical staging is crucial to managing gastrointestinal cancer, but fluorine 18 (18 F) fluorodeoxyglucose (FDG) PET/CT has limitations. Targeting fibroblast-activation protein is a newer diagnostic approach for the visualization of tumor stroma, and gallium 68 (68 Ga)-labeled fibroblast-activation protein inhibitors (FAPIs), hereafter 68 Ga-FAPIs, present a promising alternative to 18 F-FDG. Purpose: To compare the diagnostic efficacy of 68 Ga-FAPI PET/CT in primary and metastatic lesions of gastrointestinal malignancies with that of 18 F-FDG PET/CT. Materials and Methods: Images from patients with gastric, duodenal, and colorectal cancers who underwent contemporaneous 18 F-FDG and 68 Ga-FAPI PET/CT between October 2019 through June 2020 were retrospectively analyzed. 18 F-FDG and 68 Ga-FAPI uptakes were compared by using the Wilcoxon signed-rank test. The McNemar test was used to compare the diagnostic performance between the two techniques. Results: Thirty-five patients (median age, 64 years [interquartile range, 53-68 years]; 18 men) were evaluated. In treatment-naive patients (n = 19), 68 Ga-FAPI PET/CT led to upstaging of the clinical TNM stage in four (21%) patients compared with 18 F-FDG PET/CT. Tracer uptake was higher with 68 Ga-FAPI PET/CT than with 18 F-FDG PET/CT in primary lesions (gastric cancer: 12.7 vs 3.7, respectively, P = .003; colorectal cancer: 15.9 vs 7.9, P = .03), involved lymph nodes (6.7 vs 2.4, P , .001), and bone and visceral metastases (liver metastases: 9.7 vs 5.2, P , .001; peritoneal metastases: 8.4 vs 3.6, P , .001; bone metastases: 4.3 vs 2.2, P , .001; lung metastases: 4.4 vs 1.9, P = .01). In addition, the sensitivity of 68 Ga-FAPI PET/CT was higher than that of 18 F-FDG PET/CT in the detection of primary tumors (100% [19 of 19] vs 53% [10 of 19], respectively; P = .004), lymph nodes (79% [22 of 28] vs 54% [15 of 28], P , .001), and bone and visceral metastases (89% [31 of 35] vs 57% [20 of 35], P , .001). Conclusion: Gallium 68 fibroblast-activation protein inhibitor PET/CT was superior to fluorine 18 fluorodeoxyglucose PET/CT in the detection of primary and metastatic lesions in gastric, duodenal, and colorectal cancers, with higher tracer uptake in most primary and metastatic lesions. Published under a CC BY 4.0 license.

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Section: Diagnostic Performance Of 18 F-fdg and 68 Ga-fapi Pet/ct In mentioning

confidence: 99%

Comparison of ⁶⁸Ga-FAPI and ¹⁸F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

et al. 2021

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“…The sensitivity of [ 18 F]-FDG imaging for diagnosing signet ring cell carcinoma and mucinous adenocarcinoma is low (20,21) because the expression levels of glucose transporter 1 (GLUT-1) in signet ring cell carcinoma and mucinous carcinoma are relatively low (22). Indeed, the physiological uptake of [ 18 F]-FDG in the gastrointestinal tract is variable (23). In contrast, high FAP expression in matrix components of gastrointestinal tumors and metastatic tumors (9), rapid clearance by the kidney, less physiological uptake in normal organs, and high tumor-to-background ratio render [ 68 Ga]Ga-FAPI-04 more advantageous for abdominal and pelvic imaging (5,10,16,24).…”

Section: Diagnostic Efficiency Of [ 68 Ga]ga-fapi-04 and [ 18 F]-fdg ...mentioning

confidence: 99%

Comparison of Diagnostic Efficacy of [68Ga]Ga-FAPI-04 and [18F]FDG PET/CT for Staging and Restaging of Gastric Cancer

Zhang

Wang

et al. 2022

Front. Oncol.

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PurposeThis study aimed to compare the potential diagnostic efficacy of gallium68-fibroblast-activation protein inhibitor ([68Ga]Ga-FAPI-04) and fluorine18-fluorodeoxyglucose ([18F]-FDG) positron emission tomography-computed tomography (PET/CT) for primary tumors, lymph nodes, and distant metastatic lesions of gastric cancer (GC), and to explore the effects of [68Ga]Ga-FAPI-04 and [18F]-FDG on tumor staging and restaging in GC.MethodsThis single-center retrospective study (NCT2100044131) was conducted at the Affiliated Hospital of the Southwest Medical University between June 2020 and December 2021. Images of patients with GC who were pathologically confirmed and underwent contemporaneous [18F]-FDG and [68Ga]Ga-FAPI-04 PET/CT within 1 week were analyzed. The diagnostic efficacy of [68Ga]Ga-FAPI-04 PET/CT and [18F]-FDG PET/CT for TNM staging of GC was compared using McNemar test. The maximum standard uptake value (SUVmax) of each lesion in the two imaging types was compared using the Mann-Whitney U test.ResultsIn total, 25 patients with GC (mean age, 56 ± 12 years) were evaluated. [68Ga]Ga-FAPI-04 PET/CT exhibited higher sensitivity compared to [18F]-FDG PET/CT for detecting primary tumors (18/19 [94.74%] vs. 13/19 [68.42%], χ2 = 6.866, P < 0.01), lymph node metastasis (75/77 [97.40%] vs. 32/77 [41.56%], χ2 = 2.888, P =0.089), and distant metastases (275/283 [97.17%] vs. 122/283 [43.11%], χ2 = 11.858, P < 0.01). [68Ga]Ga-FAPI-04 accumulation was significantly higher than that of [18F]FDG in tumors (median SUVmax, 10.28 vs 3.20; U=59.00, P < 0.01), lymph node metastasis metastases (median SUVmax, 9.20 vs 3.15; U=53.50, P < 0.01), and distant metastases (median SUVmax, 8.00 vs 4.20; U=200.00, P < 0.01). Compared to [18F]-FDG PET/CT, [68Ga]Ga-FAPI-04 PET/CT resulted in new oncological findings in 14/25 patients and corrected tumor staging or restaging in 7/25 patients.ConclusionOur preliminary results regarding the impact of [68Ga]Ga-FAPI-04 PET/CT on tumor staging highlight the potential of this approach for increasing the accuracy of GC diagnosis, which may facilitate treatment decision-making.

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“…The rate of PET-CT, although not sensitive in patients with mucinous or diffuse tumours, has increased simultaneously with the improved survival. 2,29 In group 3, GC surgery was mostly performed by minimally invasive approach (84.5%). Compared with open surgery, it has oncological equivalent outcomes with numerous advantages, such as fewer complications, reduced blood loss, and shorter recovery time.…”

Section: Discussionmentioning

confidence: 99%

“…The rate of PET-CT, although not sensitive in patients with mucinous or diffuse tumours, has increased simultaneously with the improved survival. 2 , 29 …”

Section: Discussionmentioning

confidence: 99%

Implementation of Multimodality Therapy and Minimally Invasive Surgery: Short- and Long-term Outcomes of Gastric Cancer Surgery in Medium-Volume Center

Junttila

Helminen

Kairaluoma

et al. 2022

Journal of Gastrointestinal Surgery

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Background Multimodal treatment of gastric cancer includes careful preoperative staging, perioperative oncological treatment, and selective minimally invasive approach. The aim was to evaluate whether this approach improves short- and long-term outcomes in operable gastric cancer. Methods This study included 181 gastric cancer patients who underwent curative intent surgery in Central Finland Central Hospital between years 2005 and 2021 for gastric or esophagogastric junction adenocarcinoma. Those 65 patients in group 1 operated between years 2005–2010 had open surgery with possible adjuvant therapy. During the second period including 58 patients (2011–2015), perioperative chemotherapy and minimally invasive surgery were implemented. The period, when these treatments were standard practise, was years 2016–2021 including 58 patients (group 3). Outcomes were lymph node yield, major complications and 1- and 3-year survival rates. Results Median lymph node yield increased from 17 in group 1 and 20 in group 2 to 23 in group 3 (p < 0.001). Major complication rates in groups 1–3 were 12.3%, 32.8%, and 15.5% (group 1 vs. group 2, p = 0.007; group 2 vs. group 3, p = 0.018), respectively. Overall 1-year survival rates between study groups 1–3 were 78.5% vs. 69.0% vs. 90.2% (p = 0.018) and 3-year rates 44.6% vs. 44.8% vs. 68.1% (p = 0.016), respectively. For overall 3-year mortality, adjusted hazard ratio (HR) was 1.02 (95%CI 0.63–1.66) in group 2 and HR 0.37 (95%CI 0.20–0.68) in group 3 compared to group 1. Conclusions In medium-volume center, modern multimodal therapy in operable gastric cancer combined with minimally invasive surgery increased lymph node yield and improved long-term survival without increasing postoperative morbidity.

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Clinical impact of FDG PET/CT in alimentary tract malignancies: an updated review

Cited by 29 publications

References 61 publications

Comparison of ⁶⁸Ga-FAPI and ¹⁸F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

Comparison of ⁶⁸Ga-FAPI and ¹⁸F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

Comparison of Diagnostic Efficacy of [68Ga]Ga-FAPI-04 and [18F]FDG PET/CT for Staging and Restaging of Gastric Cancer

Implementation of Multimodality Therapy and Minimally Invasive Surgery: Short- and Long-term Outcomes of Gastric Cancer Surgery in Medium-Volume Center

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Clinical impact of FDG PET/CT in alimentary tract malignancies: an updated review

Cited by 29 publications

References 61 publications

Comparison of 68Ga-FAPI and 18F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

Comparison of 68Ga-FAPI and 18F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

Comparison of Diagnostic Efficacy of [68Ga]Ga-FAPI-04 and [18F]FDG PET/CT for Staging and Restaging of Gastric Cancer

Implementation of Multimodality Therapy and Minimally Invasive Surgery: Short- and Long-term Outcomes of Gastric Cancer Surgery in Medium-Volume Center

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Comparison of ⁶⁸Ga-FAPI and ¹⁸F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers

Comparison of ⁶⁸Ga-FAPI and ¹⁸F-FDG Uptake in Gastric, Duodenal, and Colorectal Cancers