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Is preoperative radiographic localization of islet cell tumors in patients with insulinoma necessary?

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Abstract

Preoperative localization tests [sonography, computed tomography, angiography, percutaneous transhepatic portal venous sampling for insulin radioimmunoassay (PTP)] have a sensitivity of 60% to 90% in cases of organic hyperinsulinism. In all publications, however, the sensitivity of intraoperative localization, 75% to 100%, is distinctly higher. With the exception of PTP, all tumors that can be identified by preoperative localization can also be detected using palpation or intraoperative sonography. Preoperative localization diagnosis is therefore not absolutely necessary prior to primary operation in the case of organic hyperinsulinism. It is requested by many surgeons because: (1) only a few clinics have extensive experience with patients with an organic hyperinsulinism; (2) only a few clinics have extensive experience with intraoperative sonography; (3) the accuracy of palpation is improved following appropriate preoperative localization; and (4) in rare cases, the results of a PTP influence the operative procedure.

Résumé

Pour localiser les insulinomes en période préopératoire, la sensibilité de l'échographie, de la tomodensitométrie, de l'angiographie et des dosages hormonaux du sang porte (DHSP) varie entre 60 et 90%. Dans la littérature, cependant, on trouve des chiffres allant de 75 à 100%. A l'exception des tumeurs localisées par les DHSP, la plupart de ces tumeurs peuvent être retrouvées par la palplation et l'échographie peropératoires. La localisation préopératoire n'est pas donc absolument nécessaire en cas d'insulinome hypersécrétant, mais la plupart des chirurgiens essaient de le faire quand même en raison de leur faible expérience de telles tumeurs à l'aide de la localisation échographique peropératoire, l'amélioration des résultats de la palpation peropératoire lorsque l'exploration préopératoire est positive et pour réduire l'influence des résultats des DHSP.

Resumen

La localizatión preoperatoria por imágenes diagnósticas (sonografía, tomografía computadorizada, angiografía y muestreo venoso portal percutáneo para radioinmunoanálisis de insulina) tiene una sensibilidad de 60–90% en el caso de Hiperinsulinismus orgánico. Sin embargo, en todas las pubicaciones la sensilibilidad de la localización intraoperatoria es del orden de 75–100%, significativamente más alta. Con la excepción del muestreo portai percutáneo, la totalidad de los tumores que pueden ser identificados mediante estudios diagnósticos de localización preoperatoria también pueden ser detectados por palpación o por sonografía intraoperatoria. Por lo tanto, aparece innecesaria la localización diagnóstica preoperatoria en el caso de Hiperinsulinismus orgánico.

Sin embargo, es solicitada por muchos ciruganos porque:

  1. 1.

    Sólo unos pocos centros poseen vasta experiencia con pacientes con hiperinsulinismo orgánico.

  2. 2.

    Sólo unos pocos centros poseen vasta experiencia con sonografía intraoperatoria.

  3. 3.

    La certeza de la palpación resulta incrementada después de un procedimiento de localización preoperatoria adecuado.

  4. 4.

    En algunos casos los resultados de la punción venosa percutánea influyen sobre el procedimiento operatorio.

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Authors and Affiliations

  1. Department of Abdominal and General Surgery, Johannes Gutenberg-University of Mainz, Mainz, Germany

    Thomas C. Böttger M.D. & Theo Junginger M.D.

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  1. Thomas C. Böttger M.D.
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  2. Theo Junginger M.D.
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Böttger, T.C., Junginger, T. Is preoperative radiographic localization of islet cell tumors in patients with insulinoma necessary?. World J. Surg. 17, 427–432 (1993). https://doi.org/10.1007/BF01655099

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