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The ultrasonic detection of insulinomas during surgical exploration of the pancreas

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Abstract

The sensitivity of preoperative imaging was evaluated for the localization of insulinomas in 2 series of 54 and 17 patients, respectively. In the first series, diagnosis was obtained with ultrasonography (US) in 14.8%, with computed tomographic (CT) scan in 60%, and with arteriography and/or angio CT scan in 75% of patients. In the second series, US, CT scan, and arteriography were performed preoperatively showing a sensitivity of 53% of one or more of the imaging techniques. The last 17 patients all underwent intraoperative pancreatosonography, and the insulinoma was localized in each.

Considering the high reliability of intraoperative ultrasonography, and the high costs and low benefits of other current diagnostic techniques, a new management plan is suggested for patients with a definite laboratory diagnosis of insulinoma.

Résumé

La sensibilité de l'imagerie pré-opératoire permettant la localisation des insulinomes a été étudiée dans 2 séries de 54 et 17 sujects. Dans la première série le diagnostic fut posé par l'échographie dans 14.8% des cas, par la tomodensitométrie dans 60% des cas, par l'artériographie et/ou l'angiotomodensitométrie dans 75% des cas. Dans la seconde série, l'échographie, la tomodensitométrie et l'artériographie furent pratiquées avant l'intervention avec une sensibilité de 53% pour l'une ou pour plusieurs techniques. Chez les 17 derniers malades l'échographie opératoire fut systématiquement pratiquée et permit la localisation de la tumeur dans 100% des cas.

Considérant la haute fiabilité de l'échographie opératoire, le coût élevé et les faibles résultats des autres techniques de diagnostic, un nouveau plan d'investigation est proposé pour explorer les malades qui présentèrent certains signes biologiques d'insulinome. Il repose sur la localisation per-opératoire de la tumeur par l'échographie, méthode qui peut être pratiquée dans des centres spécialisés.

Resumen

La sensibilidad de la imagenología preoperatoria para la localización de insulinomas fue evaluada en 2 series de 54 y 17 pacientes respectivamente. En la primera serie, el diagnóstico fue logrado con ultrasonografía en 14.8%, con escanografía computadorizada en 60%, y con arteriografía y/o angiografía con escanografía computadorizada en 75% de los casos. En la segunda serie, la ultrasonografía, la escanografía computadorizada, y la arteriografía fueron realizadas preoperatoriamente demostrando una sensibilidad de 53% en una o más de las técnicas de imagenología. En los últimos 17 pacientes se realizó pancreatosonografía, la cual permitió la localización del tumor en 100% de los casos.

En consideración a la elevada confiabilidad de la ultrasonografía intraoperatoria, y los altos costos y bajo rendimiento de las técnicas corrientes de diagnóstico, se sugiere un nuevo plan de manejo para pacientes con un diagnóstico de laboratorio certero de insulinoma. Se fundamenta en la localización ultrasonográfica intraoperatoria del tumor, la cual puede ser aplicada en los más comprensivos centras médicos.

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Authors and Affiliations

  1. Departments of Surgery, Endocrinology, and Chair of Technology Applications in Surgery, University “La Sapienza”, Rome

    Licinio Angelini M.D., F.A.C.S., Mario Bezzi M.D., Gianfranco Tucci M.D., Marco M. Lirici M.D., Francesco Candiani M.D., Leopoldo Rubaltelli M.D., Carlo Tremolada M.D., Guido Tamburrano M.D. & Gianfranco Fegiz M.D., F.A.C.S.

  2. Departments of Radiology and Surgery, University of Padua, Italy

    Licinio Angelini M.D., F.A.C.S., Mario Bezzi M.D., Gianfranco Tucci M.D., Marco M. Lirici M.D., Francesco Candiani M.D., Leopoldo Rubaltelli M.D., Carlo Tremolada M.D., Guido Tamburrano M.D. & Gianfranco Fegiz M.D., F.A.C.S.

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  1. Licinio Angelini M.D., F.A.C.S.
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  2. Mario Bezzi M.D.
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  3. Gianfranco Tucci M.D.
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  4. Marco M. Lirici M.D.
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  5. Francesco Candiani M.D.
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  6. Leopoldo Rubaltelli M.D.
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  7. Carlo Tremolada M.D.
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  8. Guido Tamburrano M.D.
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  9. Gianfranco Fegiz M.D., F.A.C.S.
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Angelini, L., Bezzi, M., Tucci, G. et al. The ultrasonic detection of insulinomas during surgical exploration of the pancreas. World J. Surg. 11, 642–647 (1987). https://doi.org/10.1007/BF01655841

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