The use of intraoperative sonography in endocrine tumors of the pancreas

Abstract

Intraoperative ultrasound (IOUS) was performed in 21 patients with 22 endocrine tumors of the pancreas. Seventeen patients suffered from an organic hyperinsulinism, 4 had Zollinger‐EUison syndrome. One patient with an insulinoma had a pancreatic‐polypeptide‐producing adenoma (PPoma) as a second tumor. Fifteen of the insulinomas investigated by IOUS were visible and palpable. In 2 patients no tumor was found during initial operation. At reoperation 1 tumor was detected by IOUS only, the reoperation in the other patient is planned. The PPoma was an incidental finding during IOUS. In 4 patients with Zollinger‐Ellison Syndrome, 1 gastrinoma was localized in the pancreas and 2 in the duodenal wall by palpation. In 1 patient we found no gastrinoma by either surgical exploration or by IOUS. In 1 of the positive cases the tumor was demonstrable by IOUS. In the other patient it was too small for imaging. Two of these patients had liver metastases, which could be demonstrated by IOUS only. We conclude that IOUS should be performed routinely in operations for pancreatic APUDomas.

Intraoperative ultrasonography

“…Localization rates of 85-95% are usually reported with this sensitive method [33][34][35][36]. In addition, the combination of intraoperative sonography and careful surgical inspection and palpation are very complementary, and virtually 100% of solitary insulinomas will be detected through the combination of these methods.…”

“…In pancreatic inflammatory disease, sonography can be used to demonstrate the size and appearance of the pancreatic duct, localize intra-and peripancreatic fluic collections, and guide needle aspiration of fluid collections. Although intraoperative sonography has been shown to be moderately useful in the evaluation of these relatively common disease processes of the pan- creas, it has proved to be both invaluable and indispensable in the localization of an uncommon pancreatic disease entity, the functioning islet-cell adenoma [32][33][34][35][36].…”

Spezielle diagnostische und therapeutische Aspekte beim Insulinom

“…Die Erfahrungen aus der Literatur und auch die eigenen konnten zeigen, daß eine Verbesserung der Ergebnisse insbesondere im Auffinden sehr kleiner, wenige Millimeter großen Tumoren gelingt [4,8,10,17]. Im eigenen Patientengut war bei 4 von 40 Patienten mit solitä rem Befund der Tumor nur mit Hilfe des IOUS auffindbar.…”

Avaliação do uso do ultra-som intra-operatório na cirurgia hepatobiliar e pancreática

“…A partir desse trabalho, começou-se a discutir a importância do UIO na identificação e localização dos tumores neuroendócrinos primários do pâncreas (Lane;Coupland, 1982). Diversos autores relatam a alta sensibilidade e especificidade do método na detecção dessas lesões, quando comparado com o USG convencional, com a TC, com a arteriografia e a RM (Sigel et al, 1983;Gunther et al, 1985;Klotter et al, 1987;Norton et al, 1990;Doherty et al, 1991). Alguns autores chegam a afirmar que, considerando-se a superioridade do UIO na localização precisa e na definição das relações anatômicas com o ducto pancreático principal, a mesma poderia substituir a extensa, e por vezes onerosa, investigação por imagem pré-operatória, nos casos com alta suspeita clínica e laboratorial (Grant et al, 1988;van Heerden et al, 1992;Bottger;Junginger, 1993;Owens et al 1995;Mabrut et al 2001).…”

“…No presente estudo, a RM identificou 92,9% dos pacientes com tumores, com apenas um resultado falso negativo. (Klotter et al, 1987;Grant et al, 1988;Norton et al, 1990;van Heerden et al, 1992;Owens et al, 1995). No presente estudo, o UIO identificou corretamente todos os pacientes e todos os tumores encontrados.…”