Localization of pancreatic insulinoma: comparison of pre- and intraoperative US with CT and angiography.

Galiber, A K; Reading, Carl C.; Charboneau, J. William; Sheedy, Patrick F.; James, E M; Gorman, Brian P.; Grant, Clive S.; Heerden, J A van; Telander, R L

doi:10.1148/radiology.166.2.2827232

Cited by 191 publications

(98 citation statements)

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“…Doherty et al (27) have identified 64% of insulinomas by means of palpation. Machado et al (16) have reported the detection of 98.2% of cases by means of inspection/palpation, a result similar to those of other authors (35)(36)(37) . The literature review demonstrates that smaller the lesions to be evaluated, the greater will be the limitations of preoperative examinations.…”

Section: Introductionsupporting

confidence: 81%

Avaliação dos insulinomas pela ultra-sonografia intra-operatória: estado atual do tema

et al. 2006

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The authors review the literature about intraoperative ultrasonography for evaluation of pancreatic insulinomas. Results of intraoperative ultrasound, preoperative ultrasound and computed tomography are discussed, as well as results of inspection and palpation of the pancreas during surgery, reported in the literature. Keywords: Insulinoma; Ultrasonography; Intraoperative ultrasonography.Avaliação dos insulinomas pela ultra-sonografia intra-operatória: estado atual do tema. Os autores fazem uma revisão da literatura sobre a utilização da ultra-sonografia intra-operatória para a avaliação dos insulinomas pancreáticos. São referidos os resultados da ultra-sonografia intra-operatória, ultra-sonografia e tomografia computadorizada realizadas no pré-operatório, e os resultados da inspeção e palpação do pâncreas realizadas durante procedimentos cirúrgicos referidos na literatura. Unitermos: Insulinoma; Ultra-sonografia; Ultra-sonografia intra-operatória. AbstractResumo

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Section: Introductionsupporting

confidence: 81%

Avaliação dos insulinomas pela ultra-sonografia intra-operatória: estado atual do tema

et al. 2006

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“…Preoperative localization studies using extracorporeal ultrasound, CT, and angiography fail to localize the primary tumor in 40 -60% of patient, and frequently miss small tumors (Ͻ2 cm) (5,6). Recently, arterial stimulation of the tumor with the appropriate secretagogue followed by selective portal venous sampling, has improved localization sen-sitivity and specificity.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas

Anderson¹,

Carpenter²,

Thompson³

et al. 2000

Am J Gastroenterology

349

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OBJECTIVE:Preoperative localization of pancreatic neuroendocrine tumors with traditional imaging fails in 40 -60% of patients. Endoscopic ultrasound (EUS) is highly sensitive in the detection of these tumors. Previous reports included relatively few patients or required the collaboration of multiple centers. We report the results of EUS evaluation of 82 patients with pancreatic neuroendocrine tumors. METHODS:We prospectively used EUS early in the diagnostic evaluation of patients with biochemical or clinical evidence of neuroendocrine tumors. Patients had surgical confirmation of tumor localization or clinical follow-up of Ͼ1 yr. RESULTS:Eighty-two patients underwent 91 examinations (cases). Thirty patients had multiple endocrine neoplasia syndrome type I. One hundred pancreatic tumors were visualized by EUS in 54 different patients. The remaining 28 patients had no pancreatic tumor or an extrapancreatic tumor. Surgical/pathological confirmation was obtained in 75 patients. The mean tumor diameter was 1.51 cm and 71% of the tumors were Յ2.0 cm in diameter. Of the 54 explorations with surgical confirmation of a pancreatic tumor, EUS correctly localized the tumor in 50 patients (93%). Twentynine insulinomas, 18 gastrinomas, as well as one glucagonoma, one carcinoid tumor, and one somatostatinoma were localized. The most common site for tumor localization was the pancreatic head (46 patients). Most tumors were hypoechoic, homogenous, and had distinct margins. EUS of the pancreas was correctly negative in 20 of 21 patients (specificity, 95%). EUS was more accurate than angiography with or without stimulation testing (secretin for gastrinoma, calcium for insulinoma), transcutaneous ultrasound, and CT in those patients undergoing further imaging procedures. EUS was not reliable in localizing extrapancreatic tumors. CONCLUSIONS:In this series, the largest single center experience reported to date, EUS had an overall sensitivity and accuracy of 93% for pancreatic neuroendocrine tumors. Our results support the use of EUS as a primary diagnostic modality in the evaluation and management of patients with neuroendocrine tumors of the pancreas. (Am J Gastroenterol 2000;95:2271-2277.

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“…48 In several series its sensitivity in localizing insulinoma is higher than 90% and considered superior to preoperative imaging studies, it being able to detect lesions as small as 2-3mm. 15,[49][50][51] It is hence is easy to understand that in laparoscopic surgery where there is typically a loss of tactile sensation, IOUS gains even greater importance with results being comparable to IOUS in open surgery. [52][53][54] A lack of laparoscopic IOUS, despite positive preoperative identification, has been cited as an important factor in the failure to intraoperatively identify lesions leading to increased incidences of conversion to open procedure.…”

Section: Localization Of the Tumormentioning

confidence: 99%

Laparoscopic surgery for pancreatic insulinomas: an update

Aggeli¹,

Nixon²,

Karoumpalis³

et al. 2016

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Insulinomas are the most common functioning neuroendocrine tumors of the pancreas, occurring in almost 1-4 per 1 million persons each year. In contrast to other pancreatic neuroendocrine tumors, they are usually benign and solitary at the time of diagnosis. Due to their benign nature, surgical excision is the treatment of choice, with excellent long-term results. The introduction of minimally invasive techniques in the surgical treatment of insulinoma has been gaining popularity due to shorter length of hospital stay and better cosmetic results, with serious complications being comparable to those of open surgery. Preoperative localization is of paramount importance in the determination of the appropriate surgical approach. Many invasive and non-invasive methods exist for localization of an insulinoma. A combination of these modalities is usually adequate to preoperatively localize the vast majority of tumors. Laparoscopic ultrasound is mandatory to localize these tumors intraoperatively. Despite extensive experience in highly specialized centers producing encouraging results, no randomized trials have been realized to conclusively validate these case series, this partly due to the rarity of insulinoma in the population. In this article we present the current state of laparoscopic management of insulinoma delineating still unanswered issues and we underscore some of the technical details of the most common laparoscopic procedures employed.

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Localization of pancreatic insulinoma: comparison of pre- and intraoperative US with CT and angiography.

Cited by 191 publications

References 0 publications

Avaliação dos insulinomas pela ultra-sonografia intra-operatória: estado atual do tema

Avaliação dos insulinomas pela ultra-sonografia intra-operatória: estado atual do tema

Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas

Laparoscopic surgery for pancreatic insulinomas: an update

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