Diagnostic performance of [68Ga]Ga-FAPI-04 PET vs. [18F]FDG PET in detecting lymph node metastasis in digestive system cancers: a head-to-head comparative meta-analysis

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Purpose This meta-analysis aimed to compare the diagnostic effectiveness of [68Ga]Ga-FAPI-04 PET and [18F]FDG PET for detecting lymph node metastasis in digestive system cancer patients. Methods A comprehensive search of PubMed, Web of Science, and Embase databases was conducted to identify relevant articles up to June 2024. Studies were included if they evaluated the diagnostic performance of [68Ga]Ga-FAPI-04 PET and [18F]FDG PET in detecting lymph node metastasis in digestive system cancer patients. Sensitivity and specificity were assessed using the DerSimonian and Laird method and were transformed using the Freeman-Tukey double arcsine transformation. Results Fifteen articles, encompassing a total of 617 patients, were included in this study. The overall sensitivity of [68Ga]Ga-FAPI-04 PET for diagnosing lymph node metastasis in digestive system cancers was 0.82 (95% CI: 0.67–0.93), and the specificity was 0.91 (95% CI: 0.84–0.97). In comparison, the sensitivity of [18F]FDG PET was 0.51 (95% CI: 0.38–0.63), with a specificity of 0.81 (95% CI: 0.64–0.94). These results suggest that [68Ga]Ga-FAPI-04 PET has a significantly higher sensitivity (P < 0.01) and similar specificity (P = 0.20) compared to [18F]FDG PET in detecting lymph node metastasis in digestive system cancers. Conclusion Our meta-analysis indicates that [68Ga]Ga-FAPI-04 PET has higher sensitivity and similar specificity compared to [18F]FDG PET in diagnosing lymph node metastasis in digestive system cancers. However, the high heterogeneity among the studies may impact the robustness of the current evidence. Therefore, future research should prioritize larger prospective studies with more diverse populations and specific cancer subtypes to draw more definitive conclusions. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024572412 , Unique Identifier: CRD42024572412.

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