Application of 68GA-FAPI PET/CT in clinical practice – perspectives for malignant tumor imaging: A literature review

Abstract

Relevance: The incidence of malignant neoplasms of various localizations is growing worldwide and in Kazakhstan. The mortality rate from oncological diseases is also alarmingly high. To facilitate early diagnosis and optimal therapy, scientists are exploring molecular diagnostics, including PET/CT, using various markers, like 18F-fluorodeoxyglucose, widely used in oncology but lacking specificity for certain types of tumors.
The finding of Fibroblast Activation Protein (FAP) has sparked interest in FAP-targeted radiolabeled inhibitors (FAPI), which could serve as a universal marker for diagnosing different types of cancer. Various FAP markers for PET/CT are being studied, with special attention given to 68Ga-FAPI.
The study aimed to analyze the potential value of FAPI PET/CT for detecting malignant tumors.
Methods: A literature review was conducted using the MEDLINE, Embase, Scopus, PubMed, and Cochrane Central Register of Controlled Trials databases for the past decade using the following keywords: “malignant lesions,” “PET/CT,” and “FAPI.” This review analyzes 48 literature sources with A1-level evidence dedicated to the 68Ga-FAPI PET/CT diagnostic accuracy in detecting and staging malignant tumors and assessing treatment efficacy.
Results: According to the analyzed sources, the 68Ga-FAPI PET/CT sensitivity and specificity in diagnosing cancer is 95% to 100% and 62% to 100%, respectively. However, clear indications for use in clinical practice require further study of 68Ga-FAPI PET/CT diagnostic capabilities on larger cohorts and more homogeneous datasets.
Conclusion: The available literature data on FAPI PET/CT diagnostic capacity shows this marker’s potential in diagnosing oncological disorders. Information provided by 68Ga-FAPI PET/CT supplements the existing nuclear medicine methods and generally impacts the treatment strategy for each unique case.