A new meta-analysis suggests that FAPI PET/CT provides enhanced detection of peritoneal metastases.
For the meta-analysis, recently published in the European Journal of Radiology, researchers reviewed positron emission tomography/computed tomography (PET/CT) data from 15 studies and a total of 837 patients with cancer.
For the 10 studies with patient-based analysis, the meta-analysis authors found that FAPI PET-CT had pooled sensitivity of 97 percent, specificity of 95 percent and a 99 percent AUC for detecting peritoneal metastases.
In the six studies that provided a lesion-based analysis, the researchers noted that FAPI PET/CT provided 92 percent pooled sensitivity, 90 percent specificity and a 96 percent AUC.
“ … This updated meta-analysis demonstrated that FAPI PET/CT shows promising and clinically relevant diagnostic performance for detecting (peritoneal metastases) in both patient-based and lesion-based analyses, supporting its value as an imaging modality for assessing peritoneal involvement and tumor burden,” noted lead study author Wan Qi-Chang, MD, who is affiliated with the Department of Nuclear Medicine at the China-Japan Union Hospital of Jilin University in Changchun, China, and colleagues.
Three Key Takeaways
• High diagnostic accuracy for peritoneal metastases detection. FAPI PET/CT demonstrated strong performance in patient-based analysis (97 percent sensitivity, 95 percent specificity, 99 percent AUC) and somewhat more modest but still robust results in lesion-based analysis (92 percent sensitivity, 90 percent specificity, 96 percent AUC), supporting its use as a reliable imaging modality for identifying peritoneal involvement.
• Particular value in ovarian cancer staging. In ovarian cancer patients specifically, FAPI PET/CT showed 92 percent sensitivity and 96 percent specificity for detecting peritoneal metastases, suggesting it could meaningfully inform surgical and treatment planning by helping clinicians accurately gauge the extent of peritoneal disease.
• Findings should be interpreted with caution given study limitations. All included studies were single-center and conducted exclusively in China with heterogeneous reference standards used across studies — factors that may limit generalizability. The meta-analysis authors emphasized the need for multicenter trial validation of these findings before broader clinical adoption.
Additionally, the meta-analysis authors emphasized the utility of FAPI PET/CT in women with ovarian cancer. Based on four studies with lesion-based data, the researchers found that FAPI PET/CT offered pooled sensitivity and specificity of 92 percent and 96 percent, respectively for detection of peritoneal metastases.
“ … (These findings indicated) that FAPI PET is highly accurate in assessing the exact number and extent of PM. Hence, high clinical impact of FAPI PET toward better treatment strategies in advanced ovarian cancer patients can be expected,” added Qi-Chang and colleagues.
(Editor’s note: For related content, see “Can FAPI PET Enhance Pre-Op Evaluation of Peritoneal Carcinomatosis?,” “New Meta-Analysis Assesses Impact of 68Ga-FAPI PET CT/MRI for Ovarian Cancer” and “Should FAPI PET/CT be the New Standard of Care for Detecting Lymph Node Metastases in Patients with Lung Cancer?”)
In regard to study limitations, the authors acknowledged that all reviewed studies were single-center studies conducted in China, and heterogeneous reference standards.
