Endoscopic ultrasonography and somatostatin receptor scintigraphy in the preoperative localisation of insulinomas and gastrinomas.

Zimmer, Thomas; Stölzel, Ulrich; Bäder, Michael; Koppenhagen, K; Hamm, Bernd; Buhr, H. J.; Riecken, Ernst–Otto; Wiedenmann, Bertram

doi:10.1136/gut.39.4.562

Cited by 197 publications

(116 citation statements)

References 29 publications

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“…In a study including 29 patients with suspected pancreatic NET, octreotide had a sensitivity of 54% and a specificity of 81% (16). In another study of 20 patients with the clinical suspicion of gastrinoma or insulinoma, octreotide was of high value in the detection of gastrinomas (sensitivity, 86%) but had a limited sensitivity (14%) in insulinomas (17). Furthermore, in a series of patients with ZollingerEllison syndrome, octreotide was more sensitive than conventional imaging methods but missed one third of all surgically confirmed gastrinomas (18).…”

Section: Discussionmentioning

confidence: 99%

The Role of ⁶⁸Ga-DOTATATE PET/CT in Suspected Neuroendocrine Tumors

Haug

Cindea-Drimus

Auernhammer³

et al. 2012

J Nucl Med

142

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In patients with suspected but yet not localized neuroendocrine tumors (NETs), early diagnosis or reliable exclusion is crucial for optimal individual prognosis and therapy. Despite recourse to several imaging modalities, the definite diagnosis of NET can be challenging. Therefore, we tested 68 Ga-DOTATATE PET/CT as a tool for improved diagnosis in a cohort of patients with suspected, nonlocalized NET. Methods: 68 Ga-DOTATATE PET/CT recordings were obtained in 104 consecutive patients meeting at least one of the following criteria: clinical suspicion of NET (n 5 70), elevated blood levels of tumor markers (n 5 49), and image-based suspicion of NET (n 5 53). The presence of NET was validated by histopathology (n 5 49) or clinical follow-up of 107 6 59 wk (n 5 55). Results: In 36 of 104 patients (35%), NET was histologically verified, most frequently located in the small bowel (10/36), pancreas (8/36), lung (5/36), and stomach (2/36). Twelve patients had tumors of nonneuroendocrine origin, and 7 patients had benign tumors. 68 Ga-DOTATATE PET/CT identified NET in 29 of the 36 cases and excluded the presence of a NET in 61 of the 68 non-NET patients, indicating a sensitivity of 81% and specificity of 90%. The PET/CT gave a false-positive result in 7 patients and a false-negative in another 7 patients, indicating positive and negative predictive values of 81% and 90%, respectively, and an accuracy of 87%. Chromogranin A levels were significantly higher in both PET-positive patients (1,841 vs. 342 ng/mL; P , 0.05) and patients with verified NET (2,214 vs. 524 ng/mL; P , 0.05). Conclusion: In patients with suspected NETs due to clinical symptoms, elevated levels of tumor markers, or indeterminate tumors suggestive of NET, 68 Ga-DOTATATE PET/CT is highly accurate, thus supporting its use in clinical routine diagnostics.

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Section: Discussionmentioning

confidence: 99%

The Role of ⁶⁸Ga-DOTATATE PET/CT in Suspected Neuroendocrine Tumors

Haug

Cindea-Drimus

Auernhammer³

et al. 2012

J Nucl Med

142

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“…A ultra-sonografia endoscópica tem-se mostrado o melhor método pré-operatório para a avaliação de insulinomas, evidenciando-os como nódulos hipoecóides bem definidos. A sensibilidade é de aproximadamente 93% (6) . O uso da ultra-sonografia intra-operatória para localização de insulinomas foi inicialmente descrito em 1982, por Lane e Coupland (7) .…”

Section: Discussionunclassified

Ultra-sonografia intra-operatória na localização de insulinoma: relato de dois casos

Silveira¹,

Hauagii²,

Wiltgen³

et al. 2002

Radiol Bras

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307 INTRODUÇÃOO insulinoma é uma neoplasia rara, porém é o tumor endócrino pancreático mais freqüente. Sintomas causados por hipoglicemia associados a hiperinsulinemia orgânica fazem o diagnóstico. São tumores geralmente solitários e pequenos, medindo até 2 cm em 66% dos casos e menos de 1 cm em 24% dos casos.A ressecção cirúrgica é o tratamento de escolha. Para facilitar tal procedimento, estudos de imagem como ultra-sonografia abdominal e endoscópica, tomografia computadorizada, venografia portal com cateterização de veias pancreáticas, estudos com radionuclídeos e, mais recentemente, por ressonância magnética têm sido utilizados. Aproximadamente 20% a 60% dos insulinomas não podem ser localizados em estudos pré-operatórios de imagem(1) . Em 10% a 20% dos pacientes com insulinoma a exploração cirúrgica falha em localizar o tumor (2) . A ultra-sonografia intra-operatória tem mostrado resultados satisfatórios na localização de insulinomas pancreáticos, evitando ressecções complexas desnecessá-rias, com sensível redução no número de complicações cirúrgicas (3). Nos casos de tumores localizados no estudo pré-operatório, em especial nos insulinomas malignos (10% dos insulinomas), a ultra-sonografia intra-operatória deve ser usada para demonstrar as relações com estruturas vasculares, ducto pancreático e órgãos adjacentes, facilitando a ressecção do tumor (4) . Relatamos dois casos de insulinomas pancreáticos, sendo um deles maligno, em que se utilizou a ultra-sonografia intraoperatória como importante método auxiliar ao procedimento cirúrgico. RELATO DOS CASOS Caso 1Paciente do sexo masculino, 41 anos de idade, varredor de rua, brasileiro, natural Relato de Casose procedente de Guarulhos, SP, com história de episódios recorrentes de tontura há dois anos, associados a agitação psicomotora, confusão mental, tremores, perda de consciência ocasional, geralmente precedida por sudorese profusa que surgia após jejum prolongado e exercício físico. Devido ao caráter progressivo dos sintomas, procurou auxílio médico, com diagnósti-co prévio de epilepsia e medicado com fenobarbital e difenil-hidantoína.A dois meses da internação, os sintomas acentuaram-se. Referia ganho ponderal de 17 kg em seis meses. Após realização de exames laboratoriais, evidenciou-se aumento dos níveis séricos de insulina (88 µU/ml) e redução dos níveis de glicemia de forma persistente. O paciente foi submetido a ultra-sonografia abdominal e tomografia computadorizada, que não mostraram alterações, à exceção de um cisto renal. A arteriografia seletiva também foi normal. Realizou então exame de ultra-sonografia endoscópica, que evidenciou pequeno nódulo hipoecogênico, de aproximadamente 7 mm, na cabeça pancreática.O paciente foi submetido a laparotomia exploradora para ressecção do nódulo. Durante este procedimento, após a exposição do pâncreas, não foi possível identificar com certeza o nódulo apenas à palpação. Os autores descrevem dois casos em que se utilizou a ultra-sonografia intra-operatória como método auxiliar à ressecção cirúrgica de insulinoma...

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“…EUS enables a high-frequency ultrasound probe to be placed in close proximity to the pancreas. Compared with other imaging modalities, EUS was more accurate in detecting and localizing PNETs, especially those smaller than 2.5 cm, with an overall accuracy between 89% and 97% (21)(22)(23)(24). Varas Lorenzo et al (6) compared preoperative EUS with transabdominal ultrasound, CT, MRI, angiography and OctreoScan (Mid-South Imaging and Therapeutics, USA) in 37 patients suspected to have gastrointestinal neuroendocrine tumours.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Preoperative Endoscopic Ultrasound on the Surgical Management of Pancreatic Neuroendocrine Tumours

Alsohaibani¹,

Bigam²,

Kneteman³

et al. 2008

Canadian Journal of Gastroenterology

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GS Sandha. The impact of preoperative endoscopic ultrasound on the surgical management of pancreatic neuroendocrine tumours. Can J Gastroenterol 2008;22(10):817-820.BACKGROUND: Endoscopic ultrasound (EUS) is accurate in diagnosing pancreatic neuroendocrine tumours (PNETs), but its impact on surgical management is unclear. OBJECTIVE: To determine whether preoperative EUS findings altered the decision for, and extent of, surgery in patients with PNETs. METHODS: A retrospective review of patients referred for EUS because of suspected PNETs was conducted. The diagnosis of PNETs was confirmed by EUS-guided fine needle aspiration cytology, where indicated, or by surgical histology. EUS findings were compared with computed tomography (CT) findings to determine whether there was an impact on the decision for surgical management. RESULTS: Fourteen patients (10 women), with a mean age of 44 years, underwent EUS for suspected PNETs. PNETs were seen with CT in 10 of 13 patients (77%) and with EUS in 14 of 14 patients (100%). One obese patient could not fit into the CT scanner. This patient had five PNETs on EUS. Three patients with a normal CT scan were determined to have one or two PNETs on EUS. Three patients with one or two PNETs on CT were found to have five to eight PNETs on EUS. EUS altered the decision for possible surgical management in five of 14 patients (36%), either by identifying a PNET or by finding multiple and multifocal PNETs that were not visualized on CT scans. CONCLUSION: EUS is useful in the preoperative assessment of PNETs by providing information that significantly influences the decision for surgical intervention or changes the extent of the planned surgery.Key Words: Biopsy; Endosonography; Neuroendocrine tumour; Outcome; Pancreas Les répercussions de l'endoscopie préopértoire sur la prise en charge chirurgicale des tumeurs neuroendocriniennes du pancréas HISTORIQUE : L'endoscopie est une méthode précise pour diagnostiquer les tumeurs neuroendocriniennes du pancréas (TNEP), mais on n'en connaît pas exactement les répercussions sur la prise en charge chirurgicale. OBJECTIF : Déterminer si les résultats des endoscopies préopératoires modifient la décision d'opérer les patients atteints de TNEP et l'importance de la chirurgie. MÉTHODOLOGIE : Les auteurs ont procédé à une analyse rétrospective des patients aiguillés en vue de subir une endoscopie à cause de TNEP pré-sumées. Le diagnostic de TNEP était confirmé au moyen d'une cytologie par aspiration à l'aiguille guidée par endoscopie, au besoin, ou d'une histologie chirurgicale. Les auteurs ont comparé les résultats de l'endoscopie à ceux de la tomodensitométrie pour déterminer si la première avait des répercussions sur la décision de prise en charge chirurgicale. RÉSULTATS : Quatorze patients (dix femmes) d'un âge moyen de 44 ans ont subi une endoscopie à cause de TNEP présumées. La tomodensitométrie a révélé des TNEP chez dix des 13 patients (77 %) et l'endoscopie, chez 14 des 14 patients (100 %). Un patient obèse ne pouvait pénétrer dans le tomodensi...

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Endoscopic ultrasonography and somatostatin receptor scintigraphy in the preoperative localisation of insulinomas and gastrinomas.

Cited by 197 publications

References 29 publications

The Role of ⁶⁸Ga-DOTATATE PET/CT in Suspected Neuroendocrine Tumors

The Role of ⁶⁸Ga-DOTATATE PET/CT in Suspected Neuroendocrine Tumors

Ultra-sonografia intra-operatória na localização de insulinoma: relato de dois casos

The Impact of Preoperative Endoscopic Ultrasound on the Surgical Management of Pancreatic Neuroendocrine Tumours

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Endoscopic ultrasonography and somatostatin receptor scintigraphy in the preoperative localisation of insulinomas and gastrinomas.

Cited by 197 publications

References 29 publications

The Role of 68Ga-DOTATATE PET/CT in Suspected Neuroendocrine Tumors

The Role of 68Ga-DOTATATE PET/CT in Suspected Neuroendocrine Tumors

Ultra-sonografia intra-operatória na localização de insulinoma: relato de dois casos

The Impact of Preoperative Endoscopic Ultrasound on the Surgical Management of Pancreatic Neuroendocrine Tumours

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The Role of ⁶⁸Ga-DOTATATE PET/CT in Suspected Neuroendocrine Tumors

The Role of ⁶⁸Ga-DOTATATE PET/CT in Suspected Neuroendocrine Tumors