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Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head
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Diagnostic Performance of Exendin-4 PET/CT in Localizing Insulinomas: A Systematic Review and Meta-analysis
Wan Qi-Chang1, Wei Lan2, Ji Bin2
1Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun 130033, China (W.Q.C., W.L., J.B.); Department of Nuclear Medicine, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan 511500, China (W.Q.C.).
Purpose:
To systematically evaluate the performance of Exendin-4 PET/CT in localizing insulinomas in patients with endogenous hyperinsulinemic hypoglycemia (EHH).
Methods:
The PubMed and Embase databases were searched through May 2025 to identify relevant articles. The sensitivity and specificity were pooled by using the bivariate random-effects model. The detection rate (DR) and positive predictive value (PPV) were pooled by using the DerSimonian-Laird model. A combination of histopathology, follow-up information, and clinical diagnosis served as the reference standard.
Results:
Ten studies were included in the systematic review, of which seven studies were eligible for meta-analysis. On patient-based analysis, six studies involving 518 patients provided data for pooling sensitivity and specificity. The pooled sensitivity and specificity were 94% (95% CI, 91-97%) and 99% (95% CI, 75-100%), respectively. On lesion-based analysis, four studies with 573 lesions provided data for pooling DR and PPV, and the pooled value was 85% (95% CI, 80-89%) and 98% (95% CI, 88-100%), respectively. In 34 (8.1%) of 422 patients from eight studies, among all localization methods, Exendin-4 PET/CT was the sole method that had successfully localized insulinoma lesions. Three studies described DR on specific insulinoma subtypes, with each reporting data for two kinds of subtypes. Exendin-4 PET/CT had a lower DR in malignant [66.4% (93/140) and 50.0% (1/2)] and inherited syndrome-associated (ISA) insulinoma [68.0% (66/97) and 84.6% (11/13)] than in benign insulinoma [95.5% (253/265) and 90.9% (10/11)].
Conclusion:
Exendin-4 PET/CT showed a high sensitivity and specificity on patient-based analysis and moderately high DR and high PPV on lesion-based analysis in detecting insulinoma in EHH patients. However, careful correlation with conventional imaging modalities is still needed as initial studies showed that Exendin-4 PET/CT had a low DR in the malignant and ISA insulinomas.
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