TABLE 2.
Staging and Management Comparison Between Conventional Imaging and 68Ga-FAPI-04 PET/CT
| Patient | Diagnosis | Guideline-Appropriate Imaging Modalities and Staging | 68Ga-FAPI-04 PET-Based Staging | Additional Findings on 68Ga-FAPI-04 PET | Staging Change | Management Change |
|---|---|---|---|---|---|---|
| 1 | PDAC | CT: T0 N0 M0 | T1 N0 M1 (PER) | Peritoneal carcinosis; local recurrence | Up | Major |
| 2 | PDAC | CT: T0 N2 M1 (HEP) | T0 N2 M1 (HEP, OSS) | Bone metastases | Up | Minor |
| 3 | PDAC | CT: T4 N0 M1 (PER) | T4 N0 M1 (PER, OSS, HEP) | Bone and liver metastases | Up | Minor |
| 4 | PDAC | CT: T0 N0 M1 (HEP, OSS) | T0 N0 M1 (HEP, OSS, LYM) | Distant lymph node metastases | Up | — |
| 5 | PDAC | CT/MRI: T3 N0 M0 | T3 N0 M0 | — | — | — |
| 6 | PDAC | CT: T3 N0 M0 | T3 N0 M0 | — | — | — |
| 7* | HCC | CT/MRI: no evidence of tumor | B: multinodular hepatic | Hepatic local recurrence (multinodular liver lesions) | Up | Major |
| 8* | HCC | CT/MRI: no evidence of tumor | A: oligonodular hepatic | Bifocal hepatic local recurrence | Up | Major |
| 9* | HCC | CT/MRI: C: extrahepatic (LYM) | C: extrahepatic (LYM, OSS) | Bone metastases | Up | Minor |
| 10* | HCC | CT: C: extrahepatic (PUL, SPLE, LYM) | C: oligonodular hepatic + Extrahepatic (PUL, SPLE, LYM) | Hepatic local recurrence | Up | — |
| 11* | HCC | CT/MRI: C: extrahepatic (TISS) | C: extrahepatic (TISS) | — | — | — |
| 12* | HCC | CT/MRI: B: multinodular | B: multinodular | — | — | — |
| 13 | CAC | CT: Tx N2 M1 (LYM) | Tx N2 M1 (LYM) | Visible primary in transverse colon | Up | Major |
| 14 | CAC | CT: T0 N0 M0 | T0 N0 M0 | — | — | — |
| 15 | GIT-NET G2 | SSTR-PET: T2 N1 M1 (HEP) | T2 N1 M1 (HEP) | — | — | — |
| 16 | GIT-NET G2 | SSTR-PET: T0 N0 M1 (HEP, PER) | T0 N0 M1 (PER, PER) | — | — | — |
| 17 | GIT-NET G2 | SSTR-PET: Tx N2 M1 (HEP) | Tx N2 M1 (HEP) | — | — | — |
| 18 | P-NET G3 | FDG PET: T3 N0 M0 | T3 N0 M1 (HEP) | Visible hepatic metastasis | Up | — |
| 19 | P-NET G3 | FDG PET: Tx N1 M1 (HEP, OSS, LYM) | T2 N1 M1 (HEP, OSS, LYM) | Visible pancreatic primary | Up | — |
| 20 | P-NET G3 | FDG PET: T0 N1 M1 (HEP) | T0 N0 M1 (HEP) | No lymphonodal metastases | Down | — |
| 21 | P-NET G3 | FDG PET: T2 N0 M1 (HEP) | T2 N0 M1 (HEP) | — | — | — |
| 22 | P-NEC | FDG PET: Tx N0 M1 (HEP, OSS) | Tx N0 M1 (HEP, OSS) | — | — | — |
| 23 | P-NEC | FDG PET: Tx N0 M1 (LYM) | T2 N0 M1 (LYM) | Visible pancreatic primary | Up | — |
| 24 | GIT-NEC | FDG PET: T0 N1 M1 (PER, PUL, LYM) | T0 N1 M1 (PER, LYM) | No pulmonary lesion | Down | — |
| 25 | GIT-NEC | FDG PET: T4, N1, M1 (HEP, PUL, OSS) | T4 N1 M1 (HEP, PUL) | No osseous lesion | Down | Minor |
| 26 | GIT-NEC | FDG PET: T0 N1 M1 (HEP, PUL) | T0 N1 M1 (HEP, PUL) | — | — | — |
| 27 | GIT-NEC | FDG PET: Tx N0 M0 | Tx N0 M0 | — | — | — |
| 28 | GIT-NEC | FDG PET: Tx N1 M1 (OSS, LYM) | Tx N1 M1 (OSS, LYM) | — | — | — |
| 29 | GIT-MiNEN | FDG PET: T0 N0 M1 (HEP, OSS) | T0 N0 M1 (HEP, OSS) | — | — | — |
| 30 | GIT-MiNEN | FDG PET: Tx N2 M1 (HEP, PUL) | Tx N2 M1 (HEP, PUL) | — | — | — |
| 31 | GIT-MiNEN | FDG PET: T0 N0 M0 | T0 N0 M0 | — | — | — |
| 32 | GIT-MiNEN | FDG PET: Tx N1 M1 (HEP, PER, LYM) | Tx N1 M1 (HEP, PER, LYM) | — | — | — |
Upstaging and major changes are marked in bold, downstaging and minor changes in italic.
*Staging and management according to the BCLC strategy.
GIT-NET, gastrointestinal tract neuroendocrine tumor; P-NET, pancreatic neuroendocrine tumor; P-NEC, pancreatic neuroendocrine carcinoma; GIT-NEC, gastrointestinal tract neuroendocrine carcinoma; SSTR-PET, somatostatin receptor positron emission tomography; HEP, hepatic; OSS, osseous; PER, peritoneal; TISS, soft tissue; LYM, lymphatic; SPLE, splenic.