Head-to-Head Comparison of ¹⁸F-FDG and ⁶⁸Ga-FAPI-04 PET/CT for Radiological Evaluation of Cervical Cancer

Purpose : We aimed to compare the potential value of Ga-68-FAPI-04 and F-18-FDG PET/CT in primary cervical cancer and lymph node metastases.Methods : Patients with cervical cancer underwent both Ga-68-FAPI-04 and F-18-FDG PET/CT. Histopathology and follow-up CT or MRI results (at least 3 months of follow-up) were used as reference criteria. Paired-sample t test was used to compare the SUVmax of F-18-FDG and Ga-68-FAPI-04 PET/CT for cervical cancer primary lesions and metastatic lymph nodes.Results : A total of 35 patients with a mean age of 53 +/- 11 years (range, 30-76 years) were included. The detection rate of both tracers for primary tumors was 100%. There was no significant correlation between F-18-FDG and Ga-68-FAPI-04 for SUVmax (14.5 +/- 5.7 vs 15.1 +/- 6.2; P = 0.645). In addition, the detection rates of Ga-68-FAPI-04 and F-18-FDG for lymph node metastasis were 100% and 98%, respectively. No significant difference was found in SUVmax between F-18-FDG and Ga-68-FAPI-04 groups (7.6 +/- 4.0 vs 7.0 +/- 3.5; P = 0.572). Twelve false-positive lymph nodes were detected in 8 patients with F-18-FDG PET/CT, none of which were developed on Ga-68-FAPI-04 PET/CT.Conclusion : Ga-68-FAPI-04 PET/CT has a high tracer rate for the diagnosis of primary cervical cancer and lymph node metastases. Moreover, Ga-68-FAPI-04 PET/CT also showed good results in distinguishing metastatic lymph nodes from reactive lymph nodes of cervical cancer.