Shetty Anirudh J, Das Liza, Jayant Satyam S, Bhadada Sanjay K, Kumar Rajender, Gulati Ajay, Rana Surinder S, Singh Harmandeep, Saikia Uma N, Behera Arunanshu, Mittal Bhagwant R, Walia Rama, Dutta Pinaki
Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Indian J Endocrinol Metab. 2024 May-Jun;28(3):279-288. doi: 10.4103/ijem.ijem_359_23. Epub 2024 Jun 26.
Insulinomas are rare, usually sporadic, and typically benign pancreatic neuroendocrine tumours. Pre-operative localization is challenging and evidence on comparative analysis of anatomic and scintigraphic modalities for pre-operative tumour localization is limited, even in contemporary series.
The current study was designed to study the clinical features and management challenges of insulinomas managed at a tertiary care centre. Clinical features, diagnosis, imaging techniques, surgical procedures, and outcomes details were collated. Pre-operative imaging techniques (CT/MRI, nuclear scintigraphy) were compared with intraoperative and histopathological findings to assess their accuracy of localization.
Thirty-seven patients (15 females [42%]; median age 36 years [IQR 28-49]) were included in the study. In four patients (10.8%), the tumour occurred in the setting of multiple endocrine neoplasia type 1 (MEN 1) while the remaining were sporadic. The sensitivity of pre-operative localization was 61.5% (multiphasic CT), 66.6% (multiphasic MRI), 100% (68Ga Exendin-4 PET-CT), and 91.6% (EUS). Three patients with normal multiphasic CT had localization on 68Ga Exendin-4 PET-CT. The positive predictive value (PPV) of both Exendin-PET-CT and EUS was similar at 91.6% and 91.6%, respectively. All patients (except one with nesidioblastosis), who underwent enucleation or partial pancreatic resection, were cured.
68Ga Exendin-4 PET-CT based is a non-invasive imaging modality that has high sensitivity and PPV and can be used as a first-line imaging modality. The overall prognosis of these tumours is good with high cure rates attained following surgical resection.
胰岛素瘤是一种罕见的、通常为散发性的、典型的良性胰腺神经内分泌肿瘤。术前定位具有挑战性，即使在当代系列研究中，关于术前肿瘤定位的解剖学和闪烁显像方式比较分析的证据也很有限。
本研究旨在探讨在三级医疗中心治疗的胰岛素瘤的临床特征和管理挑战。整理了临床特征、诊断、成像技术、手术程序和结果细节。将术前成像技术（CT/MRI、核闪烁显像）与术中及组织病理学结果进行比较，以评估其定位准确性。
本研究纳入了37例患者（15例女性[42%]；中位年龄36岁[四分位间距28 - 49岁]）。4例患者（10.8%）的肿瘤发生在多发性内分泌腺瘤1型（MEN 1）背景下，其余为散发性。术前定位的敏感性分别为：多期CT为61.5%，多期MRI为66.6%，68Ga艾塞那肽-4 PET-CT为100%，超声内镜（EUS）为91.6%。3例多期CT结果正常的患者在68Ga艾塞那肽-4 PET-CT上有定位。艾塞那肽-PET-CT和EUS的阳性预测值（PPV）相似，分别为91.6%和91.6%。所有接受摘除术或部分胰腺切除术的患者（除1例患有胰岛细胞增殖症）均治愈。
基于68Ga艾塞那肽-4的PET-CT是一种非侵入性成像方式，具有高敏感性和PPV，可作为一线成像方式。这些肿瘤的总体预后良好，手术切除后治愈率高。
