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SIR 2025

Gastrointestinal Interventions

Traditional Poster

Session: Traditional Poster Presentations

18 - Comparative Accuracy of Gallium-68 Fibroblast Activation Protein Inhibitor and 18 Fluorodeoxyglucose PET/CT in Detecting Biliary Tract Cancer: A Systematic Review and Meta-Analysis

Monday, March 31, 2025
12:10 PM – 1:10 PM CT
Location: Music City Center, Expo Poster Area
Purpose: Liver biopsy, while useful for diagnosing liver conditions, is invasive and carries risks such as bleeding and infection. Moreover, it may not accurately reflect the entire tumor due to sampling errors. These limitations underscore the need for less invasive diagnostic methods for biliary tract cancers (BTCs). This study aims to compare the diagnostic accuracy of Gallium-68 Fibroblast Activation Protein Inhibitor Positron Emission Tomography with Computed Tomography (68Ga-FAPI PET/CT) and Fluorodeoxyglucose Positron Emission Tomography with Computed Tomography (18F-FDG PET/CT) in detecting BTCs, advocating for a shift toward safer imaging techniques.

Materials and Methods: A thorough search was conducted across PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library from their inception to August 2024, focusing on the effectiveness of 68Ga-FAPI compared to 18F-FDG PET/CT scans in detecting biliary tract cancer. We assessed the quality of eligible studies using the Quality Assessment of Diagnostic Accuracy Studies for Comparing Index Tests (QUADAS-C) tool. Publication bias was examined for systematic variations among the studies included in the analysis through a funnel plot, which indicated visible symmetry. Statistical analyses were performed using R software (version 4.0.3) with the mada package. This study is registered in PROSPERO under registration number CRD42024525219.

 


Results: We screened 8,863 studies, identifying three studies included in the analysis. A total of 70 participants were enrolled, of whom 57 were confirmed to have BTC. All participants underwent both 18F-FDG PET/CT and 68Ga-FAPI PET/CT within one week. The sensitivity and specificity for 18F-FDG PET/CT were 70% (95% CI: 40-89%, I² = 77.9%) and 71% (95% CI: 27-96%, I² = 0%), respectively. In contrast, 68Ga-FAPI PET/CT exhibited a sensitivity of 95% (95% CI: 85-98%, I² = 0%) and specificity of 100% (95% CI: 0-100%, I² = 0%). Additionally, the mean maximum standardized uptake value (SUVmax) for 18F-FDG PET/CT was 8.01 (95% CI: 7.4-10.2, I² = 21%), which is lower than the mean SUVmax for 68Ga-FAPI PET/CT, which was 11 (95% CI: 8.9-14.8, I² = 87%). This indicates higher uptake in the tumors for the latter.

Conclusion: Despite the comparable performance of both PET/CT scans, 68Ga-FAPI demonstrates superior efficacy over 18F-FDG in diagnosing BTC and significantly higher SUVmax. However, due to some observed variations in sensitivity and tumor uptake, more high-quality clinical trials are needed to establish standard guidelines for relying on these imaging techniques.