Avoiding Pitfalls in Insulinomas by Preoperative Localization with a Dual Imaging Approach

Area of Science:

• Endocrinology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Insulinomas are rare pancreatic neuroendocrine tumors.
• Accurate preoperative localization is crucial for successful surgical resection.
• Existing localization methods have variable accuracy.

Purpose of the Study:

• To review and enhance preoperative localization techniques for insulinomas.
• To evaluate the diagnostic accuracy of various imaging modalities.
• To identify an optimal strategy for insulinoma localization.

Main Methods:

• Retrospective review of 38 patients with surgically resected insulinomas (1998-2016).
• Analysis of localization accuracy for selective arterial calcium stimulation (CaStim), CT, MRI, angiography, and somatostatin receptor scintigraphy.
• Comparison of individual modalities versus combined approaches.

Main Results:

• CaStim demonstrated 89% accuracy, CT 67%, and MRI 46%.
• A combination of CaStim and CT achieved 100% preoperative localization.
• CaStim was the sole positive modality in cases with negative CT and MRI.

Conclusions:

• Selective arterial calcium stimulation (CaStim) is a highly accurate method for insulinoma localization.
• Combining CaStim with CT imaging significantly improves preoperative localization accuracy to 100%.
• A dual imaging approach using CaStim and CT is proposed as a superior strategy for insulinoma localization.