, Volume 56, Issue 1, pp 158–163 | Cite as

Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) in insulinomas: Indications and clinical relevance in a single investigator cohort of 47 patients

  • Peter Herbert KannEmail author
  • Roland Moll
  • Detlef Bartsch
  • Andreas Pfützner
  • Thomas Forst
  • Gianluca Tamagno
  • Joachim N. Goebel
  • Verena Fourkiotis
  • Simona Raluca Bergmann
  • Maike Collienne
Original Article



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.


Endoscopic 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.

Ethical approval

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.

Informed consent

For this type of study (retrospective study) formal informed consent is not required.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Peter Herbert Kann
    • 1
    Email author
  • Roland Moll
    • 2
  • Detlef Bartsch
    • 3
  • Andreas Pfützner
    • 4
  • Thomas Forst
    • 5
  • Gianluca Tamagno
    • 1
    • 6
  • Joachim N. Goebel
    • 1
  • Verena Fourkiotis
    • 1
  • Simona Raluca Bergmann
    • 1
  • Maike Collienne
    • 1
  1. 1.Division of Endocrinology & DiabetologyPhilipp’s University and University HospitalMarburgGermany
  2. 2.Department of PathologyPhilipp’s University and University HospitalMarburgGermany
  3. 3.Department of SurgeryPhilipp’s University and University HospitalMarburgGermany
  4. 4.Pfützner Science & Health InstituteMainzGermany
  5. 5.Profil Mainz GmbHMainzGermany
  6. 6.Department of Endocrinology/DiabetesMater Misericordiae University Hospital—University CollegeDublinIreland

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