First Clinical Experience of <sup>68</sup>Ga-FAPI PET/CT in Tertiary Cancer Center: Identifying Pearls and Pitfalls

First Clinical Experience of <sup>68</sup>Ga-FAPI PET/CT in Tertiary Cancer Center: Identifying Pearls and Pitfalls

<b>Background/Objectives:</b> Over the past four years, <sup>68</sup>Ga-fibroblast activation protein inhibitor (FAPI) positron emission tomography/computed tomography (PET/CT) has been established at a tertiary cancer care facility in Jordan. This retrospective study aims to...

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Main Authors: Akram Al-Ibraheem, Ahmed Saad Abdlkadir, Ula Al-Rasheed, Dhuha Al-Adhami, Feras Istatieh, Farah Anwar, Marwah Abdulrahman, Rula Amarin, Issa Mohamad, Asem Mansour
Format: Article
Language:English
Published: MDPI AG 2025-01-01
Series:Diagnostics
Subjects:
fibroblast activation protein
FAPI
PET/CT
diagnostic pitfalls
therapeutic management
management
Online Access:https://www.mdpi.com/2075-4418/15/2/218
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Summary:<b>Background/Objectives:</b> Over the past four years, <sup>68</sup>Ga-fibroblast activation protein inhibitor (FAPI) positron emission tomography/computed tomography (PET/CT) has been established at a tertiary cancer care facility in Jordan. This retrospective study aims to explore tracer uptake metrics across various epithelial neoplasms, identify diagnostic pitfalls associated with <sup>68</sup>Ga-FAPI PET/CT, and evaluate the influence of <sup>68</sup>Ga-FAPI PET/CT staging results on changes in therapeutic intent compared to gold standard molecular imaging modalities. <b>Methods:</b> A total of 48 patients with biopsy-confirmed solid tumors underwent 77 <sup>68</sup>Ga-FAPI PET/CT examinations for molecular imaging assessment, encompassing neoplasms originating from the gastrointestinal tract, head and neck, hepatobiliary system, pancreas, breast, and lung. <b>Results:</b> Notably, pancreaticobiliary tumors exhibited the highest tracer uptake, with mean maximum standardized uptake values (SUVmax) and tumor-to-background ratios (TBR) surpassing 10. A comparative sub-analysis of <sup>68</sup>Ga-FAPI PET metrics in 20 treatment-naïve patients revealed a significant correlation between <sup>68</sup>Ga-FAPI uptake metrics and tumor grade (Spearman’s rho 0.83; <i>p</i> = 0.00001). Importantly, the results from <sup>68</sup>Ga-FAPI PET/CT influenced treatment decisions in 35.5% of the cases, primarily resulting in an escalation of management plans. A total of 220 diagnostic challenges were identified across 88.3% of the scans, predominantly within the musculoskeletal system, attributed to degenerative changes (99 observations). <b>Conclusions:</b> This comprehensive analysis highlights the potential significance of <sup>68</sup>Ga-FAPI PET/CT in oncological imaging and treatment strategy, while also emphasizing the necessity for meticulous interpretation to mitigate diagnostic challenges.
ISSN:2075-4418

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