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Preoperative [18F]FAPI-42 PET/CT is associated with tumor budding in colorectal cancer: a dual-center retrospective
Xingyu Mu1, Ge He2, Xiaoqi Huang3
1Department of Nuclear Medicine, The First Affiliated Hospital of Guilin Medical University, Guilin, China.
Objectives:
To determine whether preoperative [18F]FAPI-42 PET/CT is associated with postoperative pathological phenotypes and tumor budding grade in colorectal cancer.
Materials And Methods:
This retrospective dual-center study included consecutive adults who underwent [18F]FAPI-42 PET/CT before surgery between January 2022 and January 2026. The index test was quantitative primary-tumor PET uptake; the reference standard was surgical pathology including tumor budding grade. PET parameters were compared across postoperative phenotypes and binary budding groups. Logistic regression, receiver operating characteristic analysis, calibration, bootstrap validation, and decision-curve analysis were performed.
Results:
Sixty-four patients (mean age, 63.8 years ± 9.4; 40 men) with 65 primary lesions were analyzed. Maximum standardized uptake value (SUVmax) differed significantly by tumor budding grade among seven phenotypes (p = 0.012). Intermediate/high-grade budding lesions had higher SUVmax than low-grade lesions (12.66 ± 3.36 versus 10.16 ± 3.86; p = 0.012). A model combining body mass index and SUVmax achieved an area under the curve of 0.841 (95% confidence interval: 0.731, 0.934), with an optimism-corrected area under the curve of 0.830.
Conclusion:
Preoperative [18F]FAPI-42 PET/CT uptake was associated with colorectal cancer tumor budding. A simple body mass index-SUVmax model provides internally validated, interpretable preoperative information on tumor budding grade; however, independent multicenter external validation is required before clinical application.
Key Points:
Question Can preoperative fibroblast activation protein inhibitor PET/CT identify colorectal cancer tumor budding, a clinically relevant marker of aggressive invasive-front biology? Findings Higher [18F]FAPI-42 uptake was associated with intermediate/high-grade tumor budding; combining body mass index and maximum standardized uptake value improved discrimination. Clinical relevance Fibroblast activation protein inhibitor PET/CT may support noninvasive preoperative risk stratification of colorectal cancer by identifying tumor budding-related aggressive biology without additional procedures.
