Abstract
Based on our patient material, preoperative localization of insulinoma was correct with sonography in 13 (61.9%) of 21 patients, with computed tomography in 3 (21.4%) of 14 patients, with computed tomography with bolus injection of contrast medium in 11 (73.3%) of 15 patients, with angiography in 20 (66.6%) of 30 patients, and with percutaneous transhepatic portal vein catheterization with selective measurement of insulin in 10 (76.9%) of 13 patients. Intraoperatively, 40 (95.2%) of 42 insulinomas were palpable and 12 of 16 insulinomas were identified during intraoperative sonography. Although 95.2% of the insulinomas can be palpated, we would support additional diagnostic localization since it may improve the reliability of palpation.
Résumé
Dans cette série de patients, la localisation préopératoire des insulinomes était précise chez 13 (61.9%) des 21 patients ayant eu une échographie, chez 3 (21.4%) des 14 patients après un examen tomodensitométrique sans préparation, chez 11 (73.3%) des 15 patients après un examen tomodensitométrique avec injection de produit de contraste, chez 20 (66.7%) des 30 patients qui avaient eu une angiographie, et chez 10 (76.9%) des 13 patients ayant eu une opacification de la veine porte par voie transhépatique percutanée avec dosage de l'insuline par cathéterisation. A l'intervention, 40 (95.2%) des 42 insulinomes étaient palpables et dans 12 des 16 cas d'échographie peropératoire, cet examen a localisé avec précision la tumeur. Bien que 95.2% des insulinomes étaient reconnus à la palpation, nous continuons de recommander des examens d'imagérie pour augmenter la fiabilité de la palpation.
Resumen
Estudiado nuestro material clínico, se encontró que la localización preoperatoria del insulinoma mediante sonografía résultó correcta en 13 (61.9%) de 21 pacientes; mediante tomografía computadorizada en 3 (21.4%) de 14 pacientes; mediante tomografía computadorizada con inyección en bolo de medio de contraste en 11 (73.8%) de 15 pacientes; mediante angiografía en 20 (66.6%) de 30 pacientes; y mediante cateterización percutánea de la vena porta y medición selectiva de la insulina en 10 (76.9%) de 13 pacientes. Intraoperatoriamente 40 (95.2%) de 42 insulinomas aparecieron palpables y 12 de 16 insulinomas fueron identificados mediante sonografía intraoperatoria. Aunque 95.2% de los insulinomas pueden ser palpados, nosotros recomendamos estudios de diagnóstico adicionales que pueden hacer mas confiable la palpacion intraoperatoria.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aeberhard, P., König, M.P.: Endokrine Pankreastumoren. Chirurg54:65, 1983
Rückert, K., Günther, R., Klotter, H.J., Kümmerle, F.: Intraoperative sonographische Lokalisation von Insulinomen. Chirurg54:589, 1983
Stark, D.D., Moss, A.A., Goldberg, H.J., Deveney, C.W., Way, L.: Computed tomography and nuclear magnetic resonance imaging of pancreatic islet cell tumors. Surgery94:1024, 1983
Broughan, T.A., Leslie, I.D., Soto, I.M., Hermann, R.E.: Pancreatic islet cell tumors. Surgery99:671, 1986
Charboneau, J.W., James, E.M., van Heerden, J.A.: Intraoperative real-time ultrasonographie localization of pancreatic insulinoma. J. Ultrasound Med.2:251, 1983
Daggett, P.R., Kurtz, A.B., Morris, D.V., Goodburn, E.A., Le Quesne, L.P., Nabarro, I.D.N., Raphael, M.J.: Is preoperative localisation of insulnomas necessary? LancetI:493, 1981
Goode, P.N., Farndon, J.R., Anderson, J., Johnston, I.D.A., Morte, J.A.: Diazoxide in the management of patients with insulinoma. World J. Surg.10:586, 1986
Gorman, B., Charboneau, J.W., James, E.M.: Benign pancreatic insulinoma: Preoperative and intraoperative sonographic localization. Ann. J. Radiol.147:929, 1986
Günther, R., Kümmerle, F., Beyer, J., Klose, K., Kuhn, E.P., Rückert, K., Cordes, U.: Lokalisationsdiagnostik von Inselzelltumoren durch Sonographie, Computertomographie, Arteriographie und selektive Hormonbestimmung. Fortschr. Röntgenstr.135:657, 1981
Heberer, G., Teichmann, R.K.: Endokrine Pankreastumoren. Münch. Med. Wochenschr.124:945, 1982
van Heerden, J.A., Edis, A.J., Service, I.F.: The surgical aspects of insulinoma. Ann. Surg.189:677, 1979
van Heerden, J.A.: Invited Commentary. World J. Surg.12:689, 1988
Ingemansson, S., Kühl, C., Larsson, L.J., Lunderquist, A., Nobin, A.: Islet cell hyperplasia localized by panceatic vein catheterization and insulin radioimmunoassay. Am. J. Surg.133:643, 1977
Ingemansson, S., Lunderquist, A., Lundquist, I., Rövdahl, R., Tibblin, S.: Portal and pancreatic vein catheterization with radioimmunologic determination of insulin. Surg. Gynecol. Obstet.141:705, 1975
Kallio, H., Suoranto, H.: Localisation of occult insulin secreting tumors of the pancreas. Ann. Surg.1:49, 1979
Lane, R.J., Coupland, G.A.E.: Operative ultrasonic features of insulinomas. Am. J. Surg.144:585, 1982
Norton, J.A., Sigel, B., Baker, A.R., Ehingheausen, S.E., Shawker, T.H., Krudy, A.G., Doppmann, I.L., Taylor, S.I., Gordon, P.: Localization of an occult insulinoma by intraoperative ultrasonography. Surgery97:381, 1985
Norton, J., Cromack, D.T., Shawker, T.H., Doppman, I.L., Comi, R., Gordon, P., Maton, P.N., Gardner, J.D., Jensen, R.T.: Intraoperative ultrasonographic localization of islet cell tumors. Ann. Surg.207:160, 1988
Roche, A., Raisonnier, A., Gillon-Savouret, M.C.: Pancreatic venous sampling and arteriography in localizing insulinomas and gastrinomas: Procedure and results in 55 cases. Radiology145:621, 1982
Rückert, K., Günter, R.: Ist die “blinde Pankreaslinksresektion” beim Insulinom noch indiziert? Chirurg53:98, 1982
Sigel, B., Duarte, B., Coelho, J.C.U., Nyhus, L.M., Baker, R.J., Machi, J.: Localization of insulinomas of the pancreas at operation by real-time ultrasound scanning. Surg. Gynecol. Obstet.156:145, 1983
Stefanini, P., Carboni, M., Patrassi, N., Basoli, A.: Beta-islet cell tumors of the pancreas: Results of a study on 1067 cases. Surgery75:597, 1974
Teichmann, R.K., Speisberg, F., Heberer, G.: Intraoperative biochemical localization of insulinomas by quick radioimmunoassay. Am. J. Surg.143:113, 1982
Quesne, L.P.L., Nabarro, J.D.N., Zweig, S.: The management of insulin tumors of the pancreas. Br. J. Surg.66:373, 1979
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Böttger, T.C., Weber, W., Beyer, J. et al. Value of tumor localization in patients with insulinoma. World J. Surg. 14, 107–112 (1990). https://doi.org/10.1007/BF01670557
Issue Date:
DOI: https://doi.org/10.1007/BF01670557