Surgical Management, Preoperative Tumor Localization, and Histopathology of 80 Patients Operated on for Insulinoma
Surgical Management, Preoperative Tumor Localization, and Histopathology of 80 Patients Operated on for Insulinoma
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DOI：
10.1210/jc.2019-01204
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发表时间：
2019-12-01
影响因子：
5.8
通讯作者：
Knigge, Ulrich
中科院分区：
文献类型：
--
作者：
Andreassen, Mikkel;Ilett, Emma;Knigge, Ulrich
简介：胰岛素瘤的诊断和病理分类具有挑战性。目的：描述胰岛素瘤患者的肿瘤定位、手术结局和组织病理学特征。方法：手术切除的散发性胰岛素瘤患者纳入研究。结果：80例患者纳入研究。7人患有恶性肿瘤。共进行了312项诊断性检查：（EUS; n = 59;灵敏度，70%），MRI（n=33;灵敏度，58%），CT（n=55;灵敏度，47%），经腹超声检查（US; n=45;灵敏度，40%），生长抑素受体成像（n = 17;灵敏度，29%），F-18-氟脱氧葡萄糖正电子发射断层扫描/CT（n = 1;阴性），经皮经鞘静脉采样（n = 10;灵敏度，90%）、动脉刺激静脉采样（n = 20;灵敏度，65%）和术中US（n = 72;灵敏度，89%）。14个肿瘤无法可视化。在这14例患者中，有7例使用了侵入性方法，所有病例均定位了肿瘤。中位肿瘤大小为15 mm（范围7 - 80 mm）。恶性肿瘤与良性肿瘤相比，胰岛素（7例中的3例对73例中的66例; P = 0.015）和胰岛素原（6例中的3例对59例中的58例; P < 0.001）染色较少。6例恶性肿瘤中2例胰高血糖素染色阳性，良性肿瘤中未见胰高血糖素染色（P < 0.001）。43例胰岛素瘤生长抑素受体2a亚型阴性。结论：胰岛素瘤的定位诊断需要多种方法。大多数肿瘤可以通过常规成像（包括EUS）进行定位。对于不可见的肿瘤，侵入性方法可能是一个有用的诊断工具。恶性肿瘤显示胰岛素和胰岛素原染色减少，胰高血糖素染色增加。
Introduction: Diagnosis and pathological classification of insulinomas are challenging.Aim: To characterize localization of tumors, surgery outcomes, and histopathology in patients with insulinoma.Methods: Patients with surgically resected sporadic insulinoma were included.Results: Eighty patients were included. Seven had a malignant tumor. A total of 312 diagnostic examinations were performed: endoscopic ultrasonography (EUS; n = 59; sensitivity, 70%), MRI (n=33; sensitivity, 58%), CT (n=55; sensitivity, 47%), transabdominal ultrasonography (US; n=45; sensitivity, 40%), somatostatin receptor imaging (n = 17; sensitivity, 29%), F-18-fluorodeoxyglucose positron emission tomography/CT (n = 1; negative), percutaneous transhepatic venous sampling (n = 10; sensitivity, 90%), arterial stimulation venous sampling (n = 20; sensitivity, 65%), and intraoperative US (n = 72; sensitivity, 89%). Fourteen tumors could not be visualized. Invasive methods were used in 7 of these 14 patients and localized the tumor in all cases. Median tumor size was 15 mm(range, 7 to 80 mm). Tumors with malignant vs benign behavior showed less staining for insulin (3 of 7 vs 66 of 73; P = 0.015) and for proinsulin (3 of 6 vs 58 of 59; P < 0.001). Staining for glucagon was seen in 2 of 6 malignant tumors and in no benign tumors (P < 0.001). Forty-three insulinomas stained negative for somatostatin receptor subtype 2a.Conclusion: Localization of insulinomas requires many different diagnostic procedures. Most tumors can be localized by conventional imaging, including EUS. For nonvisible tumors, invasive methods may be a useful diagnostic tool. Malignant tumors showed reduced staining for insulin and proinsulin and increased staining for glucagon.