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Endoscopic Ultrasonography for the Preoperative Localization of Insulinomas
Pancreas, 1996
Objective: To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in preoperative staging of esophageal carcinoma (EC). Material and methods: A total of 86 surgical patients with EC who were confirmed by endoscopy and biopsy underwent preoperative TN staging with EUS examination. The EUS findings were compared with surgical pathologic results. Results: The accuracy of EUS in T and N staging of EC was 82.6% and 84.9%, respectively. While determining whether EC invades the muscularis propria or outer membrane, EUS had the favorable sensitivity, specificity, positive predictive value and negative predictive value. The short-axis diameter of lymph nodes of 5mm had high sensitivity and negative predictive value to determine malignance with low specificity and positive predictive value. The short-axis diameter of 10mm presented the satisfactory sensitivity, specificity, positive predictive value and negative predictive value. Conclusion: EUS can accurately determine the TN staging of EC and provide a reliable basis for the treatment of EC.
Role of EUS in the preoperative localization of insulinomas compared with spiral CT
Gastrointestinal Endoscopy, 2000
Background: Preoperative radiologic localization of insulinomas often fails because of the small size of these tumors. Endoscopic ultrasound (EUS) can localize insulinomas in up to 80% of the cases.The aim of this study was to compare EUS and computed tomography (CT) diagnostic accuracy for insulinomas. Methods: We reviewed medical records from 12 patients (10 women) with a biochemical diagnosis of hypoglycemia and hyperinsulinism from 1 university hospital and 1 community hospital. A diagnosis of insulinoma was ultimately made in all cases and before surgery the patients underwent abdominal US, spiral CT and EUS in an attempt to precisely localize the tumor. Surgery was considered the standard for tumor localization. Results: Ten tumors were benign (83.3%) and 2 were malignant (16.7%). The overall sensitivity of EUS in identifying insulinomas was 83.3% compared with 16.7% for CT. Tumors not detected by EUS had a mean size of 0.75 cm. EUS-guided fine-needle aspiration was possible in only 3 patients, with a positive cytologic diagnosis in 2 (66.6%). Tumors located in the head and body of the pancreas were identified by EUS in all patients, but those located in the tail were diagnosed in only 50% of the cases.
Journal of Gastrointestinal Surgery, 2009
Introduction Presently, the need for and choice of preoperative localization tests for insulinomas remain controversial. We report the results from a single institution experience whereby the management policy adopted was that of accurate preoperative localization before surgical exploration. Materials and Methods From 1990 to 2008, 17 patients with a clinical and biochemical diagnosis of an insulinoma who underwent surgery were retrospectively reviewed. The diagnosis of all insulinomas were confirmed pathologically. Results All tumors were localized preoperatively and an average of 2.2 preoperative localization studies including 1.4 noninvasive studies and 0.8 invasive studies were utilized per patient. Invasive localization modalities were more sensitive (92%) than noninvasive modalities in localizing insulinomas (71%). Intra-arterial calcium stimulation with hepatic venous sampling was the most sensitive invasive modality (100%), whereas magnetic resonance imaging was the most sensitive noninvasive modality (63%). Fifteen of 17 tumors (88%) were localized intraoperatively via inspection/palpation and/or intraoperative ultrasonography. Both insulinomas which were not localized intraoperatively were localized correctly to the distal pancreas via preoperative transhepatic portal venous sampling. None of the patients required a blind resection or surgical reexploration for failed localization. All 17 patients underwent complete surgical resection which included eight enucleations and nine distal pancreatectomies with a cure rate of 94% (16/17) at a median follow-up of 35 (range, 1-217) months. The postoperative morbidity and long-term outcome of enucleation was similar to distal pancreatectomy despite a higher rate of microscopic margin involvement. Conclusion Accurate preoperative localization of insulinomas is useful as it eliminates the need for blind distal pancreatectomy and avoids reoperation. Complete surgical resection is the treatment of choice, and whenever possible, a pancreas-sparing approach such as enucleation should be adopted.
Diagnostic Difficulties in Insulinomas. The Importance of Endoscopic Ultrasonography
Acta Endocrinologica (Bucharest), 2006
Insulinoma is the most common endocrine tumor of the pancreas. The diagnosis suspicion is usually based on clinical symptoms and is confirmed by biochemical tests. Because the majority of insulinomas have a small size, the real problem is the localization of these tumors before surgery. We present the diagnostic and therapy difficulties, the value of available imaging techniques as well as our experience in five consecutive insulinoma patients from our clinic.
The Journal of Clinical Endocrinology & Metabolism, 2019
Introduction Diagnosis and pathological classifications is challenging in insulinomas Aim To characterize insulinoma patients with regard to localization of tumors, surgery outcomes and histopathology. Methods All patients with surgical resected sporadic insulinoma were included Results Eighty patients were included. Seven had a malignant tumor. 312 diagnostic examinations were performed: Endoscopic ultrasonography (EUS, n=59, sensitivity 70%), magnetic resonance imaging (n=33, sensitivity 58%), computed tomography (CT, n=55, sensitivity 47%), transabdominal US (n=45, sensitivity 40%), somatostatin receptor imaging (n=17, sensitivity 29%), 18F-FDG positron emission tomography/CT (n=1, negative), percutaneous transhepatic venous sampling (n=10, sensitivity 90%), arterial stimulation venous sampling (n=20, sensitivity 65%) and intra-operative US (n=72, sensitivity 89%). Fourteen tumors could not be visualized despite the use of numerous different imaging modalities. Invasive methods w...
Pre- and intraoperative localization of insulinomas: Report of 22 observations
World Journal of Surgery, 1988
From a retrospective analysis of 22 cases of pancreatic insulinoma operated in our center, we have determined the predictive value of various pre-and intraoperative localization procedures. In 18 patients, solitary insulinomas were localized by selective arteriography (SA) in 55.5% of cases, by transhepatic catheterization with pancreatic venous sampling (THVS) in 64% of cases, but by ultrasonography (US) and computed tomography (CT) in only 11% of cases. The combination of SA and THVS allowed the preoperative localization of the tumor in 83% of cases. Intraoperative palpation, ultrasonography, and blood glucose monitoring localized a single tumor in all cases. When the insulinomas were multiple, the various preoperative investigations were not reliable. In the 4 cases of multiple insulin0ma, various investigations (SA, US, CT, THVS) localized only 8 (28%) tumors of 28. Intraoperative palpation was also unreliable. Only intraoperative ultrasonography and continuous blood glucose monitoring localize all multiple tumors (the diameter of the smallest tumor was 4 ram). These 2 intraoperative investigations are now the procedures of choice for the detection of small pancreatic insulinomas.
Imaging and localization of pancreatic insulinomas
Clinical Imaging, 2001
For pancreatic insulinomas, the treatment of choice is surgical excision, which when successful is curative. Intraoperative palpation combined with ultrasonography theoretically depict almost all tumors, however the accuracy of palpation is improved by preoperative localization. All recent advances in imaging have improved the likely hood for curative surgical resection. Our purpose is to demonstrate the characteristics of all modalities, which may be used in the preoperative localization algorithm. D
The ultrasonic detection of insulinomas during surgical exploration of the pancreas
World journal of …, 1987
The sensitivity of preoperative imaging was evaluated for the localization of insulinomas in 2 series of 54 and 17 patients, respectively. In the first series, diagnosis was obtained with ultrasonography (US) in 14.8%, with computed tomographic (CT) scan in 60%, and with arteriography and/or angio CT scan in 75% of patients. In the second series, US, CT scan, and arteriography were performed preoperatively showing a sensitivity of 53% of one or more of the imaging techniques. The last 17 patients all underwent intraoperative pancreatosonography, and the insulinoma was localized in each. Considering the high reliability of intraoperative ultrasonography, and the high costs and low benefits of other current diagnostic techniques, a new management plan is suggested for patients with a definite laboratory diagnosis of insulinoma.