Advertisement

Endocrine

, 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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Endoscopic ultrasound (EUS) Fine-needle aspiration biopsy (FNA) Insulinoma Pancreas Neuroendocrine tumor (NET) 

Notes

Acknowledgments

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.

References

  1. 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
  2. 2.
    P.E. Cryer, L. Axelrod, A.B. Grossman, S.R. Heller, V.M. Montori, E.R. Seaquist, F.J. Service, Endocrine society: evaluation and management of adult hypoglycemic disorders: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 94, 709–728 (2009)CrossRefPubMedGoogle Scholar
  3. 3.
    J.M. Guettier, A. Lungu, A. Goodling, C. Cochran, P. Gorden, The role of proinsulin and insulin in the diagnosis of insulinoma: a critical evaluation of the Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 98, 4752–4758 (2013)CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    P.H. Kann, M. Rothmund, A. Zielke, Endoscopic ultrasound imaging of insulinomas: limitations and clinical relevance. Exp. Clin. Endocrinol. Diabetes 113, 471–474 (2005)CrossRefPubMedGoogle Scholar
  5. 5.
    P.H. Kann, D. Ivan, A. Pfützner, T. Forst, P. Langer, S. Schaefer, Preoperative diagnosis of insulinoma: low body mass index, young age, and female gender are associated with negative imaging by endoscopic ultrasound. Eur. J. Endocrinol. 157, 209–213 (2007)CrossRefPubMedGoogle Scholar
  6. 6.
    P.H. Kann, Endoscopic ultrasound in endocrinology: imaging of the adrenals and the endocrine pancreas. Front. Horm. Res. 45, 46–54 (2016)CrossRefPubMedGoogle Scholar
  7. 7.
    H. Kirkeby, P. Vilmann, F. Burcharth, Insulinoma diagnosed by endoscopic ultrasonography-guided biopsy. J. Laparoendosc. Adv. Surg. Tech. A. 9, 295–298 (1999)CrossRefPubMedGoogle Scholar
  8. 8.
    J.C. Ardengh, P. Rosenbaum, A.J. Ganc, A. Goldenberg, E.J. Lobo, C.A. Malheiros, F. Rahal, A.P. Ferrari, Role of EUS in the preoperative localization of insulinomas compared with spiral CT. Gastrointest. Endosc. 51, 552–555 (2000)CrossRefPubMedGoogle Scholar
  9. 9.
    F.G. Gress, M. Barawi, D. Kim, J.H. Grendell, Preoperative localization of a neuroendocrine tumor of the pancreas with EUS-guided fine needle tattooing. Gastrointest. Endosc. 55, 594–597 (2002)CrossRefPubMedGoogle Scholar
  10. 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
  11. 11.
    F.J. Service, Recurrent hyperinsulinemic hypoglycemia caused by an insulin-secreting insulinoma. Nat. Clin. Pract. Endocrinol. Metab. 2, 467–470 (2006)CrossRefPubMedGoogle Scholar
  12. 12.
    W. Hunger-Dathe, M. Hocke, A. Sämann, U.A. Müller, G. Wolf, M. Gajda, A 64-year-old female patient with recurring hypoglycaemia. Difficult aspects of diagnosis. Internist (Berl) 48, 1020–1028 (2007)CrossRefGoogle Scholar
  13. 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
  14. 14.
    E. Caglar, H. Senturk, D. Atasoy, G. Şişman, B.I. Canbakan, M. Tuncer, The role of EUS and EUS-FNA in the management of pancreatic masses: five-year experience. Hepatogastroenterology 60, 896–899 (2013)PubMedGoogle Scholar
  15. 15.
    P. Leelasinjaroen, W. Manatsathit, R. Berri, M. Barawi, F.G. Gress, Role of preoperative endoscopic ultrasound-guided fine-needle tattooing of a pancreatic head insulinoma. World J. Gastrointest. Endosc. 6, 506–509 (2014)CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    L. Kandaswamy, R. Raghavan, J.M. Pappachan, Spontaneous hypoglycaemia: diagnostic evaluation and management. Endocrine 53, 47–57 (2016)CrossRefPubMedGoogle Scholar
  17. 17.
    J.A. Madura, O.W. Cummings, E.A. Wiebke, T.A. Broadie, R.L. Goulet Jr, T.J. Howard, Nonfunctioning islet cell tumors of the pancreas: a difficult diagnosis but one worth the effort. Am. Surg. 63, 573–577 (1997)PubMedGoogle Scholar
  18. 18.
    M. Voss, P. Hammel, G. Molas, L. Palazzo, A. Dancour, D. O’Toole, B. Terris, C. Degott, P. Bernades, P. Ruszniewski, Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses. Gut. 46, 244–249 (2000)CrossRefPubMedPubMedCentralGoogle Scholar
  19. 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
  20. 20.
    A. McLean, Endoscopic ultrasound in the detection of pancreatic islet cell tumours. Cancer Imaging 4, 84–91 (2004)CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    J.C. Ardengh, G.A. de Paulo, A.P. Ferrari, F.N.A. EUS-guided, in the diagnosis of pancreatic neuroendocrine tumors before surgery. Gastrointest. Endosc. 60, 378–384 (2004)CrossRefPubMedGoogle Scholar
  22. 22.
    M. Atiq, M.S. Bhutani, M. Bektas, J.E. Lee, Y. Gong, E.P. Tamm, C.P. Shah, W.A. Ross, J. Yao, G.S. Raju, X. Wang, J.H. Lee, EUS-FNA for pancreatic neuroendocrine tumors: a tertiary cancer center experience. Dig. Dis. Sci. 57, 791–800 (2012)CrossRefPubMedGoogle Scholar
  23. 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
  24. 24.
    F.J. Service, Diagnostic approach to adults with hypoglycemic disorders. Endocrinol. Metab. Clin. North Am. 28, 519–532 (1999)CrossRefPubMedGoogle Scholar
  25. 25.
    F.J. Service, N. Natt, The prolonged fast. J. Clin. Endocrinol. Metab. 85, 3973–3974 (2000)CrossRefPubMedGoogle Scholar
  26. 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

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

Personalised recommendations