Comparative 18F-FDG and [68Ga]Ga-DOTA-FAPI-04 PET/CT Imaging in Vulvar Cancer Recurrence

A 35-year-old female with recurrent vulvar squamous cell carcinoma underwent dual-tracer PET/CT imaging with 18 F-FDG and [ 68 Ga]Ga-DOTA-FAPI-04. Both scans showed concordant involvement of infradiaphragmatic lymph nodes, iliac nodal conglomerates, and focal uptake in the left iliac muscle. Notably, [ 68 Ga]Ga-DOTA-FAPI-04 imaging provided superior lesion contrast, especially in regions with high physiological 18 F-FDG uptake. The high tumor-to-background ratio, even in challenging sites like the peritoneum and pelvis, enhances its value for image-guided interventions. These findings highlight the potential of [ 68 Ga]Ga-DOTA-FAPI-04 PET/CT as both a diagnostic and theranostic tool, particularly for 177 Lu-labeled targeted radiotherapy in gynecologic malignancies.