Detection of Poorly Differentiated Gastric Adenocarcinoma Using Ga-68 FAPI-04 PET/CT in a Case with Repeatedly Negative Biopsies
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By
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Zhipeng Cheng
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Xiuxiu Chang
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Yuying Lei
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Na Liu
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Jing Wu
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Lifei Zhang
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Aixia Sui
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July 17, 2026
Clinical Scorecard: Detection of Poorly Differentiated Gastric Adenocarcinoma Using Ga-68 FAPI-04 PET/CT in a Case with Repeatedly Negative Biopsies
At a Glance
| Category | Detail |
|---|
| Condition | Poorly Differentiated Gastric Adenocarcinoma |
| Key Mechanisms | Ga-68 FAPI PET/CT targets fibroblast activation protein expressed by cancer-associated fibroblasts, enhancing tumor-to-background contrast. |
| Target Population | Patients with suspected infiltrative gastric cancer and negative biopsy results. |
| Care Setting | Multidisciplinary diagnostic-therapeutic planning in a hospital setting. |
Key Highlights
- False-negative endoscopic biopsies can delay diagnosis of infiltrative gastric cancer.
- Ga-68 FAPI-04 PET/CT showed clearer lesion delineation compared to F-18 FDG PET/CT.
- Distal gastrectomy was performed for symptom relief and definitive diagnosis.
- Final histopathology confirmed poorly differentiated gastric adenocarcinoma with partial signet-ring cell morphology.
- Postoperative treatment included XELOX chemotherapy.
Guideline-Based Recommendations
Diagnosis
- Consider Ga-68 FAPI-04 PET/CT when repeated endoscopic biopsies are non-diagnostic but suspicion for malignancy persists.
Management
- Distal gastrectomy may be indicated for symptom relief and definitive diagnosis in cases of suspected gastric cancer.
Monitoring & Follow-up
- Follow-up for clinical stability and response to postoperative chemotherapy.
Risks
- Potential for delayed diagnosis due to false-negative biopsy results.
Patient & Prescribing Data
Adult patients with suspected gastric cancer and negative biopsy results.
Postoperative XELOX chemotherapy is a treatment option following diagnosis.
Clinical Best Practices
- Utilize multidisciplinary consultations in complex diagnostic cases.
- Consider advanced imaging techniques like Ga-68 FAPI-04 PET/CT for improved diagnostic accuracy.
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