SFEBES2007 Poster Presentations AMEND Young Investigator's Award (21 abstracts)
Optimal strategy for the localisation of biochemical proven insulinomas
Daniel Morganstein 1 , Danielle Lewis 1 , James Jackson 2 , William Fleming 3 , Alberta Isla 3 , John Lynn 3 , Senen Devendra 1 , Karim Meeran 1 & Jeannie Todd 1
1Department of Endocrinology, Imperial College Faculty of Medicine, Hammersmith Hospital, London, United Kingdom; 2Department of Imaging, Imperial College Faculty of Medicine, Hammersmith Hospital, London, United Kingdom; 3Department of Endocrine Surgery, Imperial College Faculty of Medicine, Hammersmith Hospital, London, United Kingdom.
Insulinomas, although rare, cause significant morbidity. They are frequently small at diagnosis. Whilst this means they are frequently curable by surgery, it makes localisation of the tumour difficult. However the importance of accurate pre-operative localisation is essential especially since laparoscopic surgery has been developed, which allows a minimally invasive approach to be used, but makes it vital that multiple tumours are identified pre-operatively.
Conventional cross sectional imaging techniques have poor sensitivity in localising insulinomas, with even MRI quoted as having a sensitivity of less than 60%. Selective arterial stimulation with calcium with simultaneous venous sampling (ASVS) has sensitivity and specificity in excess of 90%. As well as confirming the functionality of any lesion
The optimal combination of imaging modalities has not been determined. We have examined 28 patients with biochemical proven insulinomas, all who had undergone ASVS. ASVS identified the lesion in all cases. Two patients had previous unsuccessful surgery, one had previous unsuccessful localisation. Endoscopic ultrasound was performed in 70% of cases, and identified a lesion in 90%, which corresponded to the territory suggested by the ASVS in 88% of cases. In contrast CT identified a lesion in only 50%, and MRI in just over 60%, but only 75% of these lesions agreed with the ASVS. Octreotide scanning was only positive in 46%, but of these 83% agreed with the ASVS. Successful surgery was performed in all cases, including a laparascopic procedure in 19 cases.
We suggest that all patients with biochemical proven insulinomas undergo ASVS and endoscopic ultrasound to localise the tumour, confirm if it is solitary, functional and provide anatomical information. The use of additional cross sectional imaging modalities would then be left at the discretion of the surgeon. This approach is likely to result in significant cost savings over current approaches where multiple modalities are frequently used.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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