Detection of Poorly Differentiated Gastric Adenocarcinoma Using Ga-68 FAPI-04 PET/CT

Background

Gastric cancer is a significant global health issue, often diagnosed at advanced stages due to nonspecific early symptoms. False-negative biopsy results can delay diagnosis, particularly in cases of poorly differentiated or signet-ring cell types.

Data Highlights

No numerical or trial data provided in the article.

Key Findings

• Repeated endoscopic biopsies showed chronic inflammation without malignancy in a patient with suspected gastric cancer.
• Ga-68 FAPI-04 PET/CT demonstrated intense uptake and clearer lesion delineation compared to F-18 FDG PET/CT.
• The patient underwent distal gastrectomy, which confirmed poorly differentiated gastric adenocarcinoma with partial signet-ring cell morphology.
• Postoperative treatment included XELOX chemotherapy, with the patient remaining clinically stable at 7 months follow-up.
• Ga-68 FAPI-04 PET/CT may serve as an adjunct diagnostic tool when standard biopsies are non-diagnostic but suspicion for cancer persists.

Clinical Implications

The case illustrates the potential of Ga-68 FAPI-04 PET/CT in enhancing the diagnostic process for gastric cancer when traditional methods fail. Clinicians should consider this imaging modality in cases with high clinical suspicion but negative biopsy results.

Conclusion

Ga-68 FAPI-04 PET/CT may improve the detection of poorly differentiated gastric adenocarcinoma, providing a valuable tool in the diagnostic pathway for challenging cases.

Related Resources & Content

1. European Radiology, 2022 -- Role of Dual-Tracer PET/CT with [68Ga]FAPI-04 and [18F]FDG in the Initial Assessment of Gastric Cancer
2. European Radiology, 2024 -- Assessing the Diagnostic Accuracy of [18F]ALF-NOTA-FAPI-04 PET/CT in Gastric Cancer Compared to [18F]FDG PET/CT: A Comparative Analysis
3. The ASCO Post, 2021 -- Molecular Imaging May Improve the Staging and Treatment of Pancreatic Ductal Adenocarcinoma
4. Japanese gastric cancer treatment guidelines 2025 (7th edition) | Gastric Cancer | Springer Nature Link
5. Head-to-head Comparison of [68Ga]Ga-FAPI-04 PET and [18F]FDG PET in the Evaluation of Primary Gastrointestinal Tumors and Metastases: A Systematic Review and Meta-analysis - PubMed
6. the asco post — Identification of FAP-Expressing Tumors With Radiotracer
7. Japanese gastric cancer treatment guidelines 2025 (7th edition) | Gastric Cancer | Springer Nature Link
8. Head-to-head Comparison of [68Ga]Ga-FAPI-04 PET and [18F]FDG PET in the Evaluation of Primary Gastrointestinal Tumors and Metastases: A Systematic Review and Meta-analysis - PubMed