Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) in insulinomas: Indications and clinical relevance in a single investigator cohort of 47 patients
- 296 Downloads
This study was aimed to investigate the role and relevance of endoscopic ultrasound-guided fine-needle aspiration biopsy in the diagnostic work-up of insulinomas.
We have analysed the frequency, clinical indications, success rate (obtaining diagnostic tissue), diagnostic accuracy (in comparison to the pathological diagnosis after surgery), complications, and tolerability of endoscopic ultrasound-guided fine-needle aspiration biopsy and the localization and size of the lesions in 47 consecutive patients (29 females, 18 males; 46 ± 15 years) who had surgery for insulinoma following fasting test and were explored by single investigator EUS 1994–2015.
Endoscopic ultrasound-guided fine-needle aspiration biopsy was performed in 21 % (10/47) of the patients. The clinical indications for endoscopic ultrasound-guided fine-needle aspiration biopsy were non-conclusive result of fasting test (n = 7), missing toxicology (n = 2), suspected malignancy at EUS (n = 1), suspicious extra-pancreatic localization of the lesion (n = 1). The diagnostic success rate of the procedure was 80 % (8/10 cases), the diagnostic accuracy of the fine-needle aspiration biopsy 70 % (7/10 cases). The lesions undergoing endoscopic ultrasound-guided fine-needle aspiration biopsy were localized in the cauda (n = 5), corpus (n = 2), caput/processus uncinatus (n = 3), the diameter of the tumors was 21 ± 18 (10–70) mm. Only one accidental vascular puncture without any clinical complication occurred and all patients tolerated the procedure well.
In the majority of cases, positive fasting test, negative toxicology, and detection of a typical pancreatic lesion at endoscopic ultrasound is sufficient for the diagnosis of insulinoma and the definition of the appropriate surgical strategy. Based on our data, we suggest including endoscopic ultrasound-guided fine-needle aspiration biopsy in the diagnostic work-up of organic hyperinsulinism in selected patients with inconclusive or uncertain diagnosis before surgery.
KeywordsEndoscopic ultrasound (EUS) Fine-needle aspiration biopsy (FNA) Insulinoma Pancreas Neuroendocrine tumor (NET)
This paper is dedicated to our (Peter Herbert Kann, Andreas Pfützner, Thomas Forst) academic and clinical teacher Professor Dr. med. Jürgen Beyer, who aroused our scientific interest in insulinoma research, to his 80th birthday.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study (retrospective study) formal informed consent is not required.
- 1.P.H. Kann, S. Schaefer, Neuroendokrine Tumoren des Pankreas: Insulinome—Klinische Symptomatik und Diagnostik. ed. by J.R. Siewert, M. Rothmund, V. Schumpelick Praxis der Viszeralchirurgie—Endokrine Chirurgie. (Springer Medizin Verlag, Heidelberg, 2007), pp. 403–407Google Scholar
- 10.G.N. Zografos, A. Stathopoulou, G. Mitropapas, J. Karoubalis, G. Kontogeorgos, G. Kaltsas, G. Piaditis, G.I. Papastratis, Preoperative imaging and localization of small sized insulinoma with EUS-guided fine needle tattoing: a case report. Hormones (Athens) 4, 111–116 (2005)Google Scholar
- 13.A. Popescu, A.M. Ciocalteu, D.I. Gheonea, S. Iordache, C.F. Popescu, A. Saftoiu, T. Ciurea, Utility of endoscopic ultrasound multimodal examination with fine needle aspiration for the diagnosis of pancreatic insulinoma—a case report. Curr. Health. Sci. J. 38, 36–40 (2012)PubMedPubMedCentralGoogle Scholar
- 19.A. Fritscher-Ravens, J.R. Izbicki, P.V. Sriram, C. Krause, W.T. Knoefel, T. Topalidis, S. Jaeckle, F. Thonke, N. Soehendra, Endosonography-guided, fine-needle aspiration cytology extending the indication for organ-preserving pancreatic surgery. Am. J. Gastroenterol. 95, 2255–2260 (2000)CrossRefPubMedGoogle Scholar
- 23.M. Falconi, B. Eriksson, G. Kaltsas, D.K. Bartsch, J. Capdevila, M. Caplin, B. Kos-Kudla, D. Kwekkeboom, G. Rindi, G. Klöppel, N. Reed, R. Kianmanesh, R.T. Jensen, ENETS Consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 103, 153–171 (2016)CrossRefPubMedPubMedCentralGoogle Scholar
- 26.J. Unno, A. Kanno, A. Masamune, A. Kasajima, F. Fujishima, K. Ishida, S. Hamada, K. Kume, K. Kikuta, M. Hirota, F. Motoi, M. Unno, T. Shimosegawa, The usefulness of endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of pancreatic neuroendocrine tumors based on the world health organization classification. Scand. J. Gastroenterol. 49, 1367–1374 (2014)CrossRefPubMedGoogle Scholar