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Surgical Management, Preoperative Tumor Localization, and Histopathology of 80 Patients Operated on for Insulinoma

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@article{055b0327d62f4285a1d5c0fe18933f75,
title = "Surgical Management, Preoperative Tumor Localization, and Histopathology of 80 Patients Operated on for Insulinoma",
abstract = "INTRODUCTION: Diagnosis and pathological classification of insulinomas are challenging.AIM: To characterize localization of tumors, surgery outcomes, and histopathology in patients with insulinoma.METHODS: Patients with surgically resected sporadic insulinoma were included.RESULTS: Eighty patients were included. Seven had a malignant tumor. A total of 312 diagnostic examinations were performed: endoscopic ultrasonography (EUS; n = 59; sensitivity, 70{\%}), MRI (n = 33; sensitivity, 58{\%}), CT (n = 55; sensitivity, 47{\%}), transabdominal ultrasonography (US; n = 45; sensitivity, 40{\%}), somatostatin receptor imaging (n = 17; sensitivity, 29{\%}), 18F-fluorodeoxyglucose positron emission tomography/CT (n = 1; negative), percutaneous transhepatic venous sampling (n = 10; sensitivity, 90{\%}), arterial stimulation venous sampling (n = 20; sensitivity, 65{\%}), and intraoperative US (n = 72; sensitivity, 89{\%}). Fourteen tumors could not be visualized. Invasive methods were used in 7 of these 14 patients and localized the tumor in all cases. Median tumor size was 15 mm (range, 7 to 80 mm). Tumors with malignant vs benign behavior showed less staining for insulin (3 of 7 vs 66 of 73; P = 0.015) and for proinsulin (3 of 6 vs 58 of 59; P < 0.001). Staining for glucagon was seen in 2 of 6 malignant tumors and in no benign tumors (P < 0.001). Forty-three insulinomas stained negative for somatostatin receptor subtype 2a.CONCLUSION: Localization of insulinomas requires many different diagnostic procedures. Most tumors can be localized by conventional imaging, including EUS. For nonvisible tumors, invasive methods may be a useful diagnostic tool. Malignant tumors showed reduced staining for insulin and proinsulin and increased staining for glucagon.",
author = "Mikkel Andreassen and Emma Ilett and Dominik Wiese and Slater, {Emily P} and Marianne Klose and Hansen, {Carsten Paln{\ae}s} and Norman Gercke and Langer, {Seppo W} and Andreas Kjaer and Elisabeth Maurer and Birgitte Federspiel and Kann, {Peter H} and Bartsch, {Detlef K} and Ulrich Knigge",
note = "Copyright {\circledC} 2019 Endocrine Society.",
year = "2019",
month = "12",
day = "1",
doi = "10.1210/jc.2019-01204",
language = "English",
volume = "104",
pages = "6129--6138",
journal = "Journal of Clinical Endocrinology and Metabolism",
issn = "0021-972X",
publisher = "The/Endocrine Society",
number = "12",

}

RIS

TY - JOUR

T1 - Surgical Management, Preoperative Tumor Localization, and Histopathology of 80 Patients Operated on for Insulinoma

AU - Andreassen, Mikkel

AU - Ilett, Emma

AU - Wiese, Dominik

AU - Slater, Emily P

AU - Klose, Marianne

AU - Hansen, Carsten Palnæs

AU - Gercke, Norman

AU - Langer, Seppo W

AU - Kjaer, Andreas

AU - Maurer, Elisabeth

AU - Federspiel, Birgitte

AU - Kann, Peter H

AU - Bartsch, Detlef K

AU - Knigge, Ulrich

N1 - Copyright © 2019 Endocrine Society.

PY - 2019/12/1

Y1 - 2019/12/1

N2 - INTRODUCTION: Diagnosis and pathological classification of insulinomas are challenging.AIM: To characterize localization of tumors, surgery outcomes, and histopathology in patients with insulinoma.METHODS: Patients with surgically resected sporadic insulinoma were included.RESULTS: Eighty patients were included. Seven had a malignant tumor. A total of 312 diagnostic examinations were performed: endoscopic ultrasonography (EUS; n = 59; sensitivity, 70%), MRI (n = 33; sensitivity, 58%), CT (n = 55; sensitivity, 47%), transabdominal ultrasonography (US; n = 45; sensitivity, 40%), somatostatin receptor imaging (n = 17; sensitivity, 29%), 18F-fluorodeoxyglucose positron emission tomography/CT (n = 1; negative), percutaneous transhepatic venous sampling (n = 10; sensitivity, 90%), arterial stimulation venous sampling (n = 20; sensitivity, 65%), and intraoperative US (n = 72; sensitivity, 89%). Fourteen tumors could not be visualized. Invasive methods were used in 7 of these 14 patients and localized the tumor in all cases. Median tumor size was 15 mm (range, 7 to 80 mm). Tumors with malignant vs benign behavior showed less staining for insulin (3 of 7 vs 66 of 73; P = 0.015) and for proinsulin (3 of 6 vs 58 of 59; P < 0.001). Staining for glucagon was seen in 2 of 6 malignant tumors and in no benign tumors (P < 0.001). Forty-three insulinomas stained negative for somatostatin receptor subtype 2a.CONCLUSION: Localization of insulinomas requires many different diagnostic procedures. Most tumors can be localized by conventional imaging, including EUS. For nonvisible tumors, invasive methods may be a useful diagnostic tool. Malignant tumors showed reduced staining for insulin and proinsulin and increased staining for glucagon.

AB - INTRODUCTION: Diagnosis and pathological classification of insulinomas are challenging.AIM: To characterize localization of tumors, surgery outcomes, and histopathology in patients with insulinoma.METHODS: Patients with surgically resected sporadic insulinoma were included.RESULTS: Eighty patients were included. Seven had a malignant tumor. A total of 312 diagnostic examinations were performed: endoscopic ultrasonography (EUS; n = 59; sensitivity, 70%), MRI (n = 33; sensitivity, 58%), CT (n = 55; sensitivity, 47%), transabdominal ultrasonography (US; n = 45; sensitivity, 40%), somatostatin receptor imaging (n = 17; sensitivity, 29%), 18F-fluorodeoxyglucose positron emission tomography/CT (n = 1; negative), percutaneous transhepatic venous sampling (n = 10; sensitivity, 90%), arterial stimulation venous sampling (n = 20; sensitivity, 65%), and intraoperative US (n = 72; sensitivity, 89%). Fourteen tumors could not be visualized. Invasive methods were used in 7 of these 14 patients and localized the tumor in all cases. Median tumor size was 15 mm (range, 7 to 80 mm). Tumors with malignant vs benign behavior showed less staining for insulin (3 of 7 vs 66 of 73; P = 0.015) and for proinsulin (3 of 6 vs 58 of 59; P < 0.001). Staining for glucagon was seen in 2 of 6 malignant tumors and in no benign tumors (P < 0.001). Forty-three insulinomas stained negative for somatostatin receptor subtype 2a.CONCLUSION: Localization of insulinomas requires many different diagnostic procedures. Most tumors can be localized by conventional imaging, including EUS. For nonvisible tumors, invasive methods may be a useful diagnostic tool. Malignant tumors showed reduced staining for insulin and proinsulin and increased staining for glucagon.

U2 - 10.1210/jc.2019-01204

DO - 10.1210/jc.2019-01204

M3 - Journal article

VL - 104

SP - 6129

EP - 6138

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 12

ER -

ID: 58981560