Impact of 68Ga-FAPI-04 PET/CT on Staging and Therapeutic Management in Patients with Digestive System Tumors

Aleksander Kosmala, Sebastian E. Serfling, Wiebke Schlötelburg, Thomas Lindner, Kerstin Michalski, Andreas Schirbel, Takahiro Higuchi, Philipp E. Hartrampf, Andreas K. Buck, Alexander Weich, Rudolf A. Werner

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Purpose We aimed to determine the impact of fibroblast activation protein inhibitor (FAPI)-directed molecular imaging on staging and therapeutic management in patients affected with digestive system tumors when compared with guideline-compatible imaging (GCI). Patients and Methods Thirty-two patients with tumors of the digestive system were included: colon adenocarcinoma, 2/32 (6.3%); hepatocellular carcinoma (HCC), 6/32 (18.8%); pancreatic duct adenocarcinoma (PDAC), 6/32 (18.8%), and gastroenteropancreatic neuroendocrine neoplasms, 18/32 (56.3%). All patients underwent GCI and 68Ga-FAPI-04 PET/CT within median 4 days. Staging outcomes and subsequent treatment decisions were compared between GCI and 68Ga-FAPI-04 PET/CT. Results Compared with GCI, 68Ga-FAPI-04 PET/CT led to staging changes in 15/32 patients (46.9%). Among those, downstaging was recorded in 3/15 cases (20.0%) and upstaging in the remaining 12/15 patients (HCC, 4/12 [33.3%]; PDAC, 4/12 [33.3%]; neuroendocrine neoplasms, 3/12 [25%]; colon adenocarcinoma, 1/12 [8.3%]). Therapeutic management was impacted in 8/32 patients (25.0%), including 4 instances of major and 4 instances of minor therapeutic changes. The highest proportion of treatment modifications was observed in patients diagnosed with PDAC and HCC in 6/8 (75%). Conclusions In patients affected with digestive system tumors, 68Ga-FAPI-04 PET/CT resulted in staging changes in more than 46% and therapeutic modifications in 25% of the cases, in particular in patients with HCC and PDAC. In clinical routine, such findings may favor a more widespread adoption of FAP-directed imaging in those tumor types.

Original languageEnglish
Pages (from-to)35-42
Number of pages8
JournalClinical Nuclear Medicine
Issue number1
Publication statusPublished - Jan 1 2023
Externally publishedYes


  • Ga-FAPI
  • fibroblast activation protein
  • HCC
  • NET
  • neuroendocrine neoplasm
  • PDAC
  • staging
  • therapeutic management
  • TNM

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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