A 68Ga-FAPI-46 PET/CT Imaging Pitfall in Assessing Residual Gastric Cancer Early After Chemotherapy

Abstract

After neoadjuvant chemotherapy, preoperative imaging with 68Ga-FAPI-46 PET/CT showed a similar level of tracer uptake at the location of the primary tumors in 2 patients with gastric cancer. Postoperative histopathology revealed residual malignant cells only in one of the patients, whereas the elevated FAPI uptake in the other patient correlated to an inflammatory reaction and fibrosis. With this case, we would like to highlight that an increased FAPI uptake in inflammatory and fibrotic tissue early after chemotherapy may represent a potential interpretation pitfall. Further studies evaluating the clinical application of FAPI-PET in assessing residual cancer tissue are warranted.

68Ga-FAPI-04 PET for surveillance of anastomotic recurrence in postoperative patients with gastrointestinal cancer: a comparative study with 18F-FDG PET

“…Kang et al previously reported 96.1% (25/26) of anastomotic sinuses and fistulas that exhibited increased FDG uptake in patients who underwent rectal cancer surgery [30]. Furthermore, Buren et al recently described a case where an abnormal 68 Ga-FAPI-04 uptake lesion was proven to be fibrosis induced by neoadjuvant chemotherapy [31]. In addition, multiple rounds of injury to an anastomosis site leading to inflammation intertwined with fibrosis repair might partly explain the results observed with FAPI + /FDG + PET imaging in non-anastomotic recurrent patients.…”

Effect of anlotinib combined with camrelizumab on clinical efficacy and short-term prognosis in male patients with advanced gastric cancer

“…Advanced gastric cancer patients who fail to respond to firstline therapy face a high risk of relapse, progression, and ultimately, increased mortality rates [9]. In such cases, person-alized second-line treatments are administered based on prior clinical practice and patient tolerance.…”