The CaStim has remained vastly superior to abdominal US, CT, or MRI over time as a preoperative localizing tool for insulinomas. The utility of the CaStim for this purpose and in this setting is thus validated.

This case demonstrates the TH effect on BAT activity and volume in this patient and an association between BAT activity and glucose levels in this patient. Because the contribution of TH on skeletal muscle energy expenditure and fuel metabolism was not assessed, an association between BAT activity and glucose homeostasis can only be suggested.

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BACKGROUNDMalignant insulinoma occurs in a few patients with insulinoma. Due to the small sample of patients, there are little data regarding their clinical manifestation as well as the preferred treatment modalities. The aims of the current study were to summarize the National Institutes of Health experience during the last two decades and to conduct a critical review of the current literature.METHODSThe authors identified 10 patients with metastatic insulinoma.RESULTSThe patients presented with four patterns of clinical behavior. First, four patients presented with lymph node metastasis and, after surgical excision, maintained a prolonged tumor‐free survival. Second, four patients presented with metastatic disease to the liver, which appeared years after the initial diagnosis and presumed curative surgery. Third, one patient presented with a large α‐fetoprotein‐secreting liver mass. Finally, 9 of the 10 patients had a prolonged survival. Various treatment modalities were used to control hypoglycemia. Short‐term benefits were most often achieved with embolization and diazoxide. Less successful modalities included radiofrequency ablation, radical debulking surgery, verapamil therapy, octreotide therapy, and chemotherapy.CONCLUSIONSThe current study, as well as others, suggested that metastatic insulinoma may have a variable natural history. After the initial surgical resection, the biology of the tumor, rather than any treatment modality, was most likely the major determinant of long‐term survival. Cancer 2005. © Published 2005 American Cancer Society.

Context. The reliable localization of insulinoma is critical for the successful surgical treatment.Objective. This study compared the accuracy of 68 Gallium (Ga)-DOTATATE PET/CT to anatomic imaging modalities, selective arterial secretagogue injection (SASI), and intraoperative ultrasound (IOUS) and palpation for localizing insulinoma in patients who were biochemically cured. Design, Setting, and Patients. We conducted a retrospective analysis of 31 patients who had an insulinoma confirmed on histology and were biochemically cured. The results of CT, MRI, transabdominal US, IOUS, 68 Ga-DOTATATE PET/CT, SASI, and operative findings were analyzed. Intervention, Main Outcome Measures, Results: The insulinomas were correctly localized in 17 out of 31 (55%) of patients by CT, in 17 out of 28 (61%) by MRI, in 6 out of 28 (21%) by US, and in 9 out of 10 (90%) by 68 Ga-DOTATATE. IOUS was performed in 31 patients, and 29 of them had an insulinoma successfully localized (93.5%). Thirty patients underwent SASI, and the insulinoma was regionalized in 28 out of 30 patients (93%). In 19 out of 23 patients (83%), manual palpation identified insulinoma. In patients who had all four noninvasive imaging studies, CT was concordant with 68 Ga-DOTATATE in 6 out of 9 patients (67%); MRI in 8 out of 9 (78%); US in 0 out of 9; and in 1 out of 9 patients (11%) the lesion was only seen by 68 Ga-DOTATATE. Conclusions:68 Ga-DOTATATE PET/CT identifies most insulinomas and may be considered as an adjunct imaging study when all imaging studies are negative and when a minimally invasive surgical approach is planned.PRECIS: We studied 68Ga-DOTATATE PET/CT imaging in patients with insulinoma and found it identifies most tumors and should be considered as an adjunct imaging study.

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