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Localization of insulinomas.

M P Boukhman1, J M Karam, J Shaver

  • 1Department of Surgery, University of California, San Francisco 94115, USA.

Archives of Surgery (Chicago, Ill. : 1960)
|August 12, 1999
PubMed
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Intraoperative ultrasonography is the most sensitive method for locating insulinomas, significantly outperforming other preoperative and intraoperative techniques. This advanced imaging approach improves tumor localization for better surgical outcomes.

Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Diagnostic Imaging

Background:

  • Insulinoma, a rare pancreatic tumor, presents diagnostic challenges in precise localization.
  • Accurate preoperative and intraoperative localization is crucial for successful surgical resection and management of organic hyperinsulinism.

Purpose of the Study:

  • To evaluate and compare the sensitivities of various imaging modalities for insulinoma localization.
  • To determine the most effective technique for identifying insulinoma during surgery.

Main Methods:

  • Retrospective review of patients with biochemically diagnosed organic hyperinsulinism.
  • Analysis of the diagnostic accuracy of arteriography, computed tomography, preoperative ultrasonography, magnetic resonance imaging, transhepatic venous sampling, palpation, and intraoperative ultrasonography.

Related Experiment Videos

  • Comparison of localization sensitivities for each technique.

    • Main Results:

    • Intraoperative ultrasonography demonstrated the highest sensitivity (91%) for insulinoma localization.
    • Preoperative ultrasonography (50%) and transhepatic venous sampling (55%) showed moderate sensitivity.
    • Computed tomography (24%) and magnetic resonance imaging (30-40%) had lower sensitivities.
    • Intraoperative ultrasonography successfully localized 9 out of 11 tumors that were nonpalpable and not visible during surgery.

    Conclusions:

    • Intraoperative ultrasonography is superior to all other evaluated preoperative and intraoperative localization techniques for insulinoma.
    • Current preoperative localization tests are insufficient and not recommended when intraoperative ultrasonography is available.
    • The high sensitivity of intraoperative ultrasonography enhances surgical planning and improves the chances of complete tumor resection.