Department of Endocrinology, Barts and the London Medical School, St Bartholomew's Hospital, London, UK.
Eur J Endocrinol. 2010 May;162(5):971-8. doi: 10.1530/EJE-10-0056. Epub 2010 Mar 5.
Preoperative localisation of insulinoma improves cure rate and reduces complications, but may be challenging.
To review diagnostic features and localisation accuracy for insulinomas.
Cross-sectional, retrospective analysis.
A single tertiary referral centre.
Patients with insulinoma in the years 1990-2009, including sporadic tumours and those in patients with multiple endocrine neoplasia syndromes.
Patients were identified from a database, and case notes and investigation results were reviewed. Tumour localisation by computed tomography (CT), magnetic resonance imaging (MRI), octreotide scanning, endoscopic ultrasound (EUS) and calcium stimulation was evaluated.
MAIN OUTCOME MEASURE(S): Insulinoma localisation was compared to histologically confirmed location following surgical excision.
Thirty-seven instances of biochemically and/or histologically proven insulinoma were identified in 36 patients, of which seven were managed medically. Of the 30 treated surgically, 25 had CT (83.3%) and 28 had MRI (90.3%), with successful localisation in 16 (64%) by CT and 21 (75%) by MRI respectively. Considered together, such imaging correctly localised 80% of lesions. Radiolabelled octreotide scanning was positive in 10 out of 20 cases (50%); EUS correctly identified 17 lesions in 26 patients (65.4%). Twenty-seven patients had calcium stimulation testing, of which 6 (22%) did not localise, 17 (63%) were correctly localised, and 4 (15%) gave discordant or confusing results.
Preoperative localisation of insulinomas remains challenging. A pragmatic combination of CT and especially MRI predicts tumour localisation with high accuracy. Radionuclide imaging and EUS were less helpful but may be valuable in selected cases. Calcium stimulation currently remains useful in providing an additional functional perspective.
胰岛素瘤的术前定位可提高治愈率并减少并发症，但可能具有挑战性。
回顾胰岛素瘤的诊断特征和定位准确性。
横断面、回顾性分析。
一家单中心三级转诊中心。
1990 年至 2009 年间患有胰岛素瘤的患者，包括散发性肿瘤和多发性内分泌肿瘤综合征患者。
从数据库中确定患者，并回顾病历和检查结果。评估计算机断层扫描（CT）、磁共振成像（MRI）、奥曲肽扫描、内镜超声（EUS）和钙刺激对肿瘤定位的作用。
将胰岛素瘤的定位与手术切除后的组织学证实位置进行比较。
在 36 名患者中发现了 37 例生化和/或组织学证实的胰岛素瘤，其中 7 例接受了药物治疗。30 例接受手术治疗的患者中，25 例行 CT（83.3%），28 例行 MRI（90.3%），CT 成功定位 16 例（64%），MRI 成功定位 21 例（75%）。综合考虑，这些影像学检查正确定位了 80%的病变。20 例放射性标记奥曲肽扫描中有 10 例（50%）呈阳性；EUS 在 26 例患者中正确识别了 17 个病变（65.4%）。27 例患者进行了钙刺激试验，其中 6 例（22%）未定位，17 例（63%）定位正确，4 例（15%）结果不一致或混淆。
胰岛素瘤的术前定位仍然具有挑战性。实用的 CT 与特别是 MRI 的组合可以准确预测肿瘤定位。放射性核素成像和 EUS 帮助较小，但在某些情况下可能具有价值。钙刺激目前仍然有助于提供额外的功能视角。
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