Diagnostic performance of FAPI PET/CT for the detection of peritoneal metastases: an updated systematic review and bivariate meta-analysis.

Abstract

PurposeTo perform an updated systematic review and meta-analysis on the diagnostic accuracy of FAPI PET/CT in detecting peritoneal metastases (PM) in various cancer patients.MethodsThe PubMed and Embase databases were searched through January 2026 to identify relevant articles. We included studies reporting the diagnostic accuracy of FAPI PET/CT in detecting PM in cancer patients, using histopathology and/or a multidisciplinary approach as the reference standard. The pooled sensitivity, specificity, and area under the summary receiver-operating characteristics curve (AUC) were determined by using a bivariate random-effects model.ResultsFifteen studies with 837 patients were eligible, of which nine provided patient-level data, five provided lesion-level data, and one provided both types of data. On patient-based analysis, the pooled sensitivity, specificity, and AUC value for FAPI PET/CT in detecting PM were 97 % (95 % CI, 91-99 %), 95 % (95 % CI, 80-99 %), and 0.99 (95 % CI, 0.98-1.00), respectively. On lesion-based analysis, the pooled sensitivity, specificity, and AUC value for FAPI PET/CT in detecting PM were 92 % (95 % CI, 83-96 %), 90 % (95 % CI, 70-97 %), and 0.96 (95 % CI, 0.94-0.97), respectively. Of note, lesion-based data from four ovarian cancer studies showed a pooled sensitivity of 92 % (95 % CI, 79-97 %) and a pooled specificity of 96 % (95 % CI, 85-99 %).ConclusionThis updated meta-analysis showed that FAPI PET/CT has promising and clinically relevant diagnostic performance for the detection of PM in both patient-based and lesion-based analyses. These findings support its value for evaluating the presence and extent of peritoneal involvement, particularly in PM-prone cancers such as ovarian cancer, while further prospective validation is still warranted.