FAPI PET shows higher sensitivity and specificity than FDG for cervical cancer diagnosis

UNLABELLED: RATIONALE AND OBJECTIVES: This study aims to compare the diagnostic performance of fibroblast activation protein inhibitor (FAPI) and F-fluorodeoxyglucose (F-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 F-FDG to evaluate their performance in patients with cervical cancer. RESULTS: In patient-based analysis (n=109), FAPI showed higher sensitivity than F-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 F-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.