Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 11/2022

17-05-2022 | Colorectal Cancer | Original Article

Comparison of [68 Ga]Ga-DOTA-FAPI-04 PET/CT and [18F]FDG PET/CT in colorectal cancer

Authors: Halil Kömek, Canan Can, İhsan Kaplan, Cihan Gündoğan, Ferat Kepenek, Hüseyin Karaoglan, Aykut Demirkıran, Senar Ebinç, Yunus Güzel, Ebubekir Gündeş

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 11/2022

Login to get access

Abstract

Aim

In this study, we aimed to evaluate the diagnostic sensitivity of [68 Ga]Ga-DOTA-FAPI-04 PET/CT in the evaluation of primary or recurrent tumor, and nodal, peritoneal, and distant organ metastases in patients with newly diagnosed or relapsed colorectal cancer (CRC) in comparison with [18F]FDG PET/CT.

Materials and method

Thirty-nine patients with histopathologically confirmed primary or relapsed CRC were included in our study. All patients underwent both [18F]FDG and [68 Ga]Ga-DOTA-FAPI-04 PET/CT imaging in the same week. Primary lesions, lymph nodes, and metastatic lesions were recorded on both scans. SUVmax and background values were measured from the primary and metastatic lesions; tumor-to-background ratio (TBR) was calculated and compared. The results of the operation were compared with PET findings in patients who underwent surgical treatment without neoadjuvant chemotherapy (NAC).

Results

The sensitivity and specificity of [68 Ga]Ga-DOTA-FAPI-04 PET/CT in the evaluation of primary tumors were 100%, while the sensitivity of [18F]FDG PET/CT was 100% and its specificity was 85.3%. When evaluated with surgical results in the detection of lymph nodes, [68 Ga]Ga-DOTA-FAPI-04 PET/CT had a sensitivity of 90% and a specificity of 100%, whereas [18F]FDG PET/CT had a sensitivity of 80% and a specificity of 81.8%. The sensitivity and specificity of [68 Ga]Ga-DOTA-FAPI PET/CT for peritoneal implants were 100%, and the sensitivity of [18F]FDG PET/CT was 55%. The SUVmax of primary lesions was higher with [18F]FDG (p < 0.001), while TBR was higher in [68 Ga]Ga-DOTA-FAPI PET/CT than [18F]FDG PET/CT (p: 0.008). SUVmax and TBR of the lymph nodes were significantly higher in [68 Ga]Ga-DOTA-FAPI PET/CT than [18F]FDG PET/CT (p < 0.001 for both).

Conclusion

[68 Ga]Ga-DOTA-FAPI-04 PET/CT achieved much higher sensitivity and specificity in the detection of primary lesions, and especially the lymph nodes and peritoneal metastases, suggesting that it can be employed in the assessment of primary tumor and metastases in patients with CRC in routine clinical practice.
Literature
1.
Keum N, Giovannucci E. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nat Rev Gastroenterol Hepatol. 2019;16:713–32.CrossRef
2.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49.CrossRef
3.
Xi Y, Xu P. Global colorectal cancer burden in 2020 and projections to 2040. Transl Oncol. 2021;14: 101174.CrossRef
4.
Lieberman DA, Weiss DG, Bond JH, Ahnen, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans affairs cooperative study group 380. N Engl J Med. 2000;343:162–8.
5.
Kostakoglu L, Agress H Jr, Goldsmith SJ. Clinical role of FDG PET in evaluation of cancer patients. Radiographics. 2003;23:315–40.CrossRef
6.
Agarwal A, Marcus C, Xiao J, Nene P, Kachnic LA, Subramaniam RM. FDG PET/CT in the management of colorectal and anal cancers. AJR Am J Roentgenol. 2014;203:1109–19.CrossRef
7.
Kim SJ, Lee SW. Diagnostic accuracy of (18)F-FDG PET/CT for detection of peritoneal carcinomatosis; a systematic review and meta-analysis. Br J Radiol. 2018;91:20170519.CrossRef
8.
Suzuki A, Kawano T, Takahashi N, Lee J, Nakagami Y, Miyagi E, et al. Value of 18F-FDG PET in the detection of peritoneal carcinomatosis. Eur J Nucl Med Mol Imaging. 2004;31:1413–20.CrossRef
9.
Lopez-Lopez V, Cascales-Campos PA, Gil J, Frutos L, Andrade RJ, Fuster-Quinonero M, et al. Use of (18)F-FDG PET/CT in the preoperative evaluation of patients diagnosed with peritoneal carcinomatosis of ovarian origin, candidates to cytoreduction and hipec. A pending issue Eur J Radiol. 2016;85:1824–8.CrossRef
10.
Garin-Chesa P, Old LJ, Rettig WJ. Cell surface glycoprotein of reactive stromal fibroblasts as a potential antibody target in human epithelial cancers. Proc Natl Acad Sci USA. 1990;87(18):7235–9.CrossRef
11.
Hamson EJ, Keane FM, Tholen S, Schilling O, Gorrell MD. Understanding fibroblast activation protein (FAP): substrates, activities, expression and targeting for cancer therapy. Proteom Clin Appl. 2014;8:454–63.CrossRef
12.
Kalluri R. The biology and function of fibroblasts in cancer. Nat Rev Cancer. 2016;16:582–98.CrossRef
13.
Chen X, Song E. Turning foes to friends: targeting cancer-associated fibroblasts. Nat Rev Drug Discov. 2019;18:99–115.CrossRef
14.
Kratochwil C, Flechsig P, Lindner T, Abderrahim L, Altmann A, Mier W, et al. (68)Ga-FAPI PET/CT: tracer uptake in 28 different kinds of cancer. J Nucl Med. 2019;60:801–5.CrossRef
15.
Lindner T, Loktev A, Altmann A, Giesel F, Kratochwil C, Debus J, et al. Development of quinoline-based theranostic ligands for the targeting of fibroblast activation protein. J Nucl Med. 2018;59:415–22.CrossRef
16.
Chen H, Pang Y, Wu J, Zhao L, Hao B, Wu J, et al. Comparison of [68Ga]Ga-DOTA-FAPI-04 and [18F] FDG PET/CT for the diagnosis of primary and metastatic lesions in patients with various types of cancer. Eur J Nucl Med Mol Imaging. 2020;47:1820–32.CrossRef
17.
Chen H, Zhao L, Ruan D, Pang Y, Hao B, Dai Y, Wu X, Guo W, Fan C, Wu J, Huang W, Lin Q, Sun L, Wu H. Usefulness of [68Ga]Ga-DOTA-FAPI-04 PET/CT in patients presenting with inconclusive [18F]FDG PET/CT findings. Eur J Nucl Med Mol Imaging. 2021;48:73–86.CrossRef
18.
Boellaard R, Delgado-Bolton R, Oyen WJ, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54.
19.
Foley KG, Pearson B, Riddell Z, Taylor SA. Opportunities in cancer imaging: a review of oesophageal, gastric and colorectal malignancies. Clin Radiol. 2021;76:748–76.CrossRef
20.
Fearon DT. The carcinoma-associated fibroblast expressing fibroblast activation protein and escape from immune surveillance. Cancer Immunol Res. 2014;2:187–93.CrossRef
21.
Liu F, Qi L, Liu B, Liu J, Zhang H, Che D, et al. Fibroblast activation protein overexpression and clinical implications in solid tumors: a meta-analysis. PLoS ONE. 2015;10: e0116683.CrossRef
22.
Sharma P, Singh SS, Gayana S. Fibroblast activation protein inhibitor PET/CT: a promising molecular imaging tool. Clin Nucl Med. 2021;463:e141–50.CrossRef
23.
Henry LR, Lee HO, Lee JS, et al. Clinical implications of fibroblast activation protein in patients with colon cancer. Clin Cancer Res. 2007;13:1736–41.CrossRef
24.
Henriksson ML, Edin S, Dahlin AM, et al. Colorectal cancer cells activate adjacent fibroblasts resulting in FGF1/FGFR3 signaling and increased invasion. Am J Pathol. 2011;178:1387–94.CrossRef
25.
Lotti F, Jarrar AM, Pai RK, et al. Chemotherapy activates cancer-associated fibroblasts to maintain colorectal cancer-initiating cells by IL-17A. J Exp Med. 2013;210:2851–72.CrossRef
26.
Iwasa S, Jin X, Okada K, Mitsumata M, Ooi A. Increased expression of seprase, a membrane-type serine protease, is associated with lymph node metastasis in human colorectal cancer. Cancer Lett. 2003;199:91–8.CrossRef
27.
Henry LR, Lee HO, Lee JS, Klein-Szanto A, Watts P, Ross EA, Chen WT, Cheng JD. Clinical implications of fibroblast activation protein in patients with colon cancer. Clin Cancer Res. 2007;13:1736–41.CrossRef
28.
Wikberg ML, Edin S, Lundberg IV, Van Guelpen B, Dahlin AM, Rutegård J, Stenling R, Oberg A, Palmqvist R. High intratumoral expression of fibroblast activation protein (FAP) in colon cancer is associated with poorer patient prognosis. Tumour Biol. 2013;34:1013–20.CrossRef
29.
Pang Y, Zhao L, Luo Z, Hao B, Wu H, Lin Q, et al. Comparison of 68Ga-FAPI and 18F-FDG uptake in gastric, duodenal, and colorectal cancers. Radiology. 2021;298:393–402.CrossRef
30.
Lan L, Liu H, Wang Y, Deng J, Peng D, Feng Y, Wang L, Chen Y, Qiu L. The potential utility of [68 Ga]Ga-DOTA-FAPI-04 as a novel broad-spectrum oncological and non-oncological imaging agent-comparison with [18F]FDG. Eur J Nucl Med Mol Imaging. 2022;49:963–79.CrossRef
31.
Koerber SA, Staudinger F, Kratochwil C, Adeberg S, Haefner MF, Ungerechts G, Rathke H, Winter E, Lindner T, Syed M, Bhatti IA, Herfarth K, Choyke PL, Jaeger D, Haberkorn U, Debus J, Giesel FL. The role of 68Ga-FAPI PET/CT for patients with malignancies of the lower gastrointestinal tract: first clinical experience. J Nucl Med. 2020;61:1331–6.CrossRef
32.
Moradi F, Iagaru A. Will FAPI PET/CT replace FDG PET/CT in the next decade? Counterpoint-no, not so fast! AJR Am J Roentgenol. 2021;216:307–8.CrossRef
33.
Caparelli ML, Batey JC, Tailor A, Braverman T, Barrat C. Internal hemorrhoid harboring adenocarcinoma: a case report. World J Gastrointest Oncol. 2021;13:87–91.CrossRef
34.
Giesel FL, Kratochwil C, Schlittenhardt J, Dendl K, Eiber M, Staudinger F, Kessler L, Fendler WP, Lindner T, Koerber SA, Cardinale J, Sennung D, Roehrich M, Debus J, Sathekge M, Haberkorn U, Calais J, Serfling S, Buck AL. Head-to-head intra-individual comparison of biodistribution and tumor uptake of 68Ga-FAPI and 18F-FDG PET/CT in cancer patients. Eur J Nucl Med Mol Imaging. 2021;48:4377–85.CrossRef
35.
Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier AM. Epidemiology and management of liver metastases from colorectal cancer. Ann Surg. 2006;244:254–9.CrossRef
36.
Şahin E, Elboğa U, Çelen YZ, Sever ÖN, Çayırlı YB, Çimen U. Comparison of 68Ga-DOTA-FAPI and 18FDG PET/CT imaging modalities in the detection of liver metastases in patients with gastrointestinal system cancer. Eur J Radiol. 2021;142: 109867.CrossRef
37.
Gündoğan C, Kömek H, Can C, Yildirim ÖA, Kaplan İ, Erdur E, Poyraz K, Güzel Y, Oruç Z, Çakabay B. Comparison of 18F-FDG PET/CT and 68Ga-FAPI-04 PET/CT in the staging and restaging of gastric adenocarcinoma. Nucl Med Commun. 2022;43:64–72.CrossRef
38.
Shimada H, Okazumi S, Koyama M, Murakami K. Japanese Gastric Cancer Association Task Force for Research Promotion: clinical utility of (1)(8)F-fluoro-2-deoxyglucose positron emission tomography in gastric cancer. A systematic review of the literature. Gastric Cancer. 2011;14:13–21.
39.
Rubini G, Altini C, Notaristefano A, Merenda N, Rubini D, Ianora AA, et al. Role of 18F-FDG PET/CT in diagnosing peritoneal carcinomatosis in the restaging of patient with ovarian cancer as compared to contrast enhanced CT and tumor marker Ca-125. Rev Esp Med Nucl Imagen Mol. 2014;33:22–7.PubMed
40.
Calais J, Mona CE. Will FAPI PET/CT replace FDG PET/CT in the next decade? Point-an important diagnostic, phenotypic, and biomarker role. AJR Am J Roentgenol. 2021;216:305–6.CrossRef
41.
Chang MC, Chen JH, Liang JA, Huang WS, Cheng KY, Kao CH. PET or PET/CT for detection of peritoneal carcinomatosis: a meta-analysis. Clin Nucl Med. 2013;38:623–9.CrossRef
42.
Turlakow A, YeungHW, Salmon AS, MacapinlacHA, LarsonSM. Peritoneal carcinomatosis: role of (18)F-FDG PET. J Nucl Med. 2003;44:1407–12
43.
Zhao L, Pang Y, Luo Z, Fu K, Yang T, Zhao L, et al. Role of [68Ga]Ga-DOTA-FAPI-04 PET/CT in the evaluation of peritoneal carcinomatosis and comparison with [18F]-FDG PET/CT. Eur J Nucl Med Mol Imaging. 2021;48:1944–55.CrossRef
44.
Wu J, Wang Y, Liao T, Rao Z, Gong W, Ou L, Chen Y, Zhang C. Comparison of the relative diagnostic performance of [68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT for the detection of bone metastasis in patients with different cancers. Front Oncol. 2021;11: 737827.CrossRef
Metadata
Title
Comparison of [68 Ga]Ga-DOTA-FAPI-04 PET/CT and [18F]FDG PET/CT in colorectal cancer
Authors
Halil Kömek
Canan Can
İhsan Kaplan
Cihan Gündoğan
Ferat Kepenek
Hüseyin Karaoglan
Aykut Demirkıran
Senar Ebinç
Yunus Güzel
Ebubekir Gündeş
Publication date
17-05-2022
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 11/2022
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-022-05839-0

Other articles of this Issue 11/2022

European Journal of Nuclear Medicine and Molecular Imaging 11/2022 Go to the issue

Original Article

Imaging the fetal nonhuman primate brain with SV2A positron emission tomography (PET)

Original Article

[68 Ga]Ga-FAPI-46 PET for non-invasive detection of pulmonary fibrosis disease activity

Image of the Month

Neglected giant benign phyllode tumor of the breast

Correction

Correction to: In vitro dose effect relationships of actinium‑225‑ and lutetium‑177‑labeled PSMA‑I&T

Editorial

2-[18F]-FDG PET for imaging brain involvement in patients with long COVID: perspective of the EANM Neuroimaging Committee

Original Article

Fibrin-targeting molecular MRI in inflammatory CNS disorders