Intraoperative ultrasound with palpation is still superior to intra-arterial calcium stimulation test in localising insulinoma

M. Wong, S. H Md Isa, Zahiah Mohamed, Nor Azmi Kamaruddin

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Abstract

Aim: This study assessed the sensitivities of preoperative localisation modalities such as computed tomography (CT), magnetic resonance imaging (MRI), arteriography and arterial stimulation venous sampling (ASVS) using serum insulin and C-peptide gradients to intraoperative techniques in localising insulin-secreting tumours in our institution. Methods: Fourteen patients with proven insulinoma, aged 20-66 years, who presented from 1997 to 2004, were studied retrospectively. All patients underwent ASVS where C-peptide and/or insulin gradients were calculated. The results were compared with the preoperative findings of CT, MRI, arteriography, as well as intraoperative ultrasound and palpation. Results: Intraoperative ultrasound with palpation correctly localised 10 of the 11 tumours with a sensitivity of 91%. Sensitivities of other localisation techniques were lower: 31% by CT, 50% by MRI, and 46% by arteriography. ASVS with insulin gradients alone allowed accurate localisation in 40% of patients while localisation using only C-peptide gradients of more than 2 was 43%. The insulinomas, measuring 10-30 mm, were successfully removed in 13 patients-6 from the body, 4 from the tail, 2 from the head and 1 from the junction of the body and tail. All except 1 were cured by selective surgery and remained free of hypoglycaemia over the next 2-60 months of follow-up. One patient had left lobectomy due to liver metastases from a malignant insulinoma and remained asymptomatic with medical therapy. Conclusions: Intraoperative ultrasound with palpation is a highly sensitive method for the localisation of insulinoma compared with other preoperative localisation techniques.

Original languageEnglish
Pages (from-to)586-592
Number of pages7
JournalWorld Journal of Surgery
Volume31
Issue number3
DOIs
Publication statusPublished - Mar 2007

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Insulinoma
Palpation
C-Peptide
Calcium
Insulin
Angiography
Tomography
Magnetic Resonance Imaging
Hypoglycemia
Neoplasms
Head
Neoplasm Metastasis
Liver
Serum

ASJC Scopus subject areas

  • Surgery

Cite this

Intraoperative ultrasound with palpation is still superior to intra-arterial calcium stimulation test in localising insulinoma. / Wong, M.; Isa, S. H Md; Mohamed, Zahiah; Kamaruddin, Nor Azmi.

In: World Journal of Surgery, Vol. 31, No. 3, 03.2007, p. 586-592.

Research output: Contribution to journalArticle

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