Head-to-head Comparison of Fibroblast Activation Protein Inhibitors and 18F-fluorodeoxyglucose in Cervical Cancer: A Systematic Review and Meta-analysis.

UNLABELLED: RATIONALE AND

OBJECTIVES

This study aims to compare the diagnostic performance of fibroblast activation protein inhibitor (FAPI) and 18F-fluorodeoxyglucose (18F-FDG) in patients with cervical cancer.

METHODS

In this review, we performed a systematic search of studies published in PubMed, Web of Science, and Embase databases up to October 30, 2025. All included studies used radionuclide labeled FAPI and 18F-FDG to evaluate their performance in patients with cervical cancer.

RESULTS

In patient-based analysis (n=109), FAPI showed higher sensitivity than 18F-FDG (0.96 vs 0.77) and greater specificity (0.98 vs 0.86). Lesion-based analysis (n=203 lymph nodes) yielded similar sensitivity patterns (0.99 vs 0.72) but may inflate precision due to within-patient clustering. Semi-quantitative parameters (SUVmax) showed variable patterns across studies (FAPI SUVmax range: 15.1-18.3 for primary lesions; FDG SUVmax range: 13.96-17.1). Descriptive comparison suggests FAPI SUVmax was generally comparable to or higher than FDG values, though formal pooled statistical comparison was not performed due to substantial heterogeneity in PET platforms, tracer variants, and acquisition protocols.

CONCLUSION

Compared with 18F-FDG, FAPI PET/CT and PET/MR are suggested to be promising imaging modalities with favorable sensitivity for cervical cancer. However, these results should be interpreted cautiously due to heterogeneity among studies and potential verification bias. Larger prospective studies are needed to confirm it in the future.