[68Ga]Ga-FAPI Surpasses [18F]FDG in Pancreatic Adenosquamous Carcinoma Restaging

Pancreatic adenosquamous carcinoma (PASC) represents a rare, aggressive exocrine neoplasm. We describe a 33-year-old woman with an aggressive disease trajectory and limited survival. Baseline [18F]FDG PET/CT enabled accurate staging and treatment planning of stage IV malignancy. Following FOLFIRINOX chemotherapy, complete metabolic resolution was achieved on follow-up [18F]FDG PET/CT. Nevertheless, disease relapse ensued within 5 months. During restaging, [18F]FDG PET/CT failed to reveal any hypermetabolic lesions, whereas [68Ga]Ga-FAPI PET/CT successfully identified both local and metastatic recurrences. Notably, this case highlights the superiority of [68Ga]Ga-FAPI PET/CT for detecting recurrent PASC compared with [18F]FDG PET/CT.