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Beyond FDG: Serial 68Ga-FAPI PET/CT for Staging and Treatment Response Assessment in Metastatic Pleomorphic Lobular
Khulood Al Riyami1, Anjali Jain, Asiya Al Busaidi
1Department of Radiology and Nuclear Medicine, Sultan Qaboos comprehensive cancer care and research center (SQCCCRC), University Medical City, Muscat, Oman.
Clinical Nuclear Medicine
|May 18, 2026
Summary
Gallium-68 fibroblast activation protein inhibitor (68Ga-FAPI) PET/CT shows higher sensitivity than 18F-FDG PET/CT for breast cancer, especially lobular types. This case highlights FAPI PET/CT
Area of Science:
- Oncology
- Nuclear Medicine
- Radiomics
Background:
- 18F-FDG PET/CT is standard for breast cancer staging and response assessment.
- 68Ga-FAPI PET/CT shows promise for improved sensitivity in detecting breast cancer, particularly invasive lobular carcinoma (ILC).
- The utility of 68Ga-FAPI PET/CT in assessing treatment response, especially in ILC, requires further investigation.
Purpose of the Study:
- To report a case of recurrent metastatic pleomorphic lobular breast cancer.
- To evaluate the performance of baseline 68Ga-FAPI PET/CT compared to 18F-FDG PET/CT in disease detection.
- To assess the role of serial 68Ga-FAPI PET/CT in monitoring treatment response to olaparib.
Main Methods:
- A patient with recurrent metastatic pleomorphic lobular breast cancer underwent baseline 68Ga-FAPI PET/CT and 18F-FDG PET/CT.
- Serial 68Ga-FAPI PET/CT scans were performed after initiating olaparib treatment.
- Disease extent and treatment response were evaluated based on imaging findings.
Main Results:
- Baseline 68Ga-FAPI PET/CT revealed more extensive regional and distant disease compared to 18F-FDG PET/CT.
- Follow-up 68Ga-FAPI PET/CT demonstrated a marked treatment response with near complete resolution of metastatic disease after olaparib initiation.
- FAPI PET/CT provided a more comprehensive assessment of disease burden and response.
Conclusions:
- 68Ga-FAPI PET/CT may offer superior sensitivity for detecting metastatic lobular breast cancer compared to 18F-FDG PET/CT.
- Serial 68Ga-FAPI PET/CT can effectively monitor treatment response in lobular breast cancer.
- FAPI PET/CT shows potential as a valuable tool for response assessment in lobular breast cancer management.
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