{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:08:12Z","timestamp":1788959292549,"version":"build-2803163510"},"reference-count":47,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Dutch Cancer Society -Koningin Wilhelmina Fonds","award":["14610"],"award-info":[{"award-number":["14610"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,13]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Colorectal cancer patients with peritoneal metastases have a very poor prognosis. A minority of these patients is eligible for curative cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The peritoneal cancer index (PCI) is an important criterion to select patients for CRS-HIPEC. Due to challenges in peritoneal metastasis detection by imaging, the PCI is currently routinely assessed by invasive diagnostic laparoscopy in addition to CT and\/or MRI. Yet, open-close procedures and early disease recurrence following CRS-HIPEC are common, indicating the need for better patient selection tools. Fibroblast activation protein (FAP)-targeted imaging has recently emerged as a promising strategy for visualising peritoneal disease. The aim of this study is to assess the potential value of FAP inhibitor positron emission tomography\/CT (FAPI-PET\/CT) as an alternative non-invasive tool for quantitative PCI assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      <jats:italic>TROMPET<\/jats:italic>\n                      is a prospective observational proof-of-concept study. A total of 25 colorectal cancer patients with suspected or verified peritoneal metastases who are eligible for CRS-HIPEC based on MRI will be included in this study. Patients younger than 18, pregnant and\/or breastfeeding, with any contraindication(s) for MRI, PET, CT and\/or CRS-HIPEC, and\/or with a known additional malignancy within the past five years are excluded. Participants will receive [\n                      <jats:sup>18<\/jats:sup>\n                      F]AlF-FAPI-74 PET\/CT prior to surgery. The primary objective is to determine the correlation between PCI scores determined by FAPI-PET\/CT and \u2018true\u2019 PCI scores determined by histopathological analysis of all resected lesions. The secondary objectives include the correlations between PCI scores determined by FAPI-PET\/CT, by MRI and during surgery, the potential of FAPI-PET\/CT to detect extraperitoneal metastases, and molecular and immunohistochemical analysis of resected tissue to provide insight into the nature of FAPI-PET-positive lesions. The primary endpoint is all PCI scores determined by FAPI-PET and histopathology and their correlation on patient level. If this study shows that the PCI score can be accurately determined preoperatively by FAPI-PET\/CT, it will form the basis for further developing FAPI-PET\/CT as a quantitative, standardised, non-invasive diagnostic tool for selecting patients for CRS-HIPEC. Moreover, the \u2018radiology-pathology\u2019 setup of the study will allow us to characterise FAPI-PET-positive and PET-negative lesions in detail, providing further insight into the strengths and potential pitfalls of FAPI-PET\/CT in the detection of peritoneal metastases from colorectal cancer.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study is approved by the assigned Medical-Research-Ethics-Committee (METC NedMec) on 19-08-2024. All participants will provide written informed consent. Study results will be disseminated through (inter)national meetings and peer-reviewed publications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>2024-512301-16-01<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-125722","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T12:40:47Z","timestamp":1788957647000},"page":"e125722","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["[\n                    <sup>18<\/sup>\n                    F]AlF-FAPI-74 PET\/CT for preoperative assessment of the peritoneal cancer index and comparison with MRI-based, surgical and pathological assessment in colorectal cancer patients eligible for CRS-HIPEC: study protocol for a prospective observational proof-of-concept study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9249-8461","authenticated-orcid":false,"given":"Myrna","family":"van den Bos","sequence":"first","affiliation":[{"name":"Department of Imaging and Oncology, Laboratory Translational Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands"},{"name":"Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wouter V","family":"Vogel","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, Netherlands"},{"name":"Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurice","family":"van Duijvenvoorde","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Economic Evaluation, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels F M","family":"Kok","sequence":"additional","affiliation":[{"name":"Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arend G J","family":"Aalbers","sequence":"additional","affiliation":[{"name":"Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petur","family":"Snaebjornsson","sequence":"additional","affiliation":[{"name":"Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands"},{"name":"Faculty of Medicine, University of Iceland, Reykjav\u00edk, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miangela M","family":"Lacle","sequence":"additional","affiliation":[{"name":"Department 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