Preoperative Localization Of Insulinoma In Nineveh

Abstract

Background:

Localization of insulinoma, a very rare tumor, is mandatory for surgical removal of the tumor.  

Objective: This study aims to investigate pre-operative imaging techniques for insulinoma localization in Nineveh.

Materials and Methods:

This is a retrospective study that revised seventeen years' reports of eighteen cases of insulinoma. After clinical and biochemical diagnosis of hyperinsulinemia, all of the patients subjected to ultrasonography of the abdomen, computerized tomography and magnetic resonance imaging and. Later on, surgical exploration and intraoperative ultrasonography of the pancreas were done. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of magnetic resonance imaging, computed tomography of the pancreas and abdominal ultrasonography, were statistically analyzed, considering the intraoperative ultrasonography as the gold standard.

Results:

The average age was 35.6 years old. The ratio for men/women was 1:5. On surgical exploration using intraoperative ultrasonography, all of the patients proved to have pancreatic insulinoma. Magnetic resonance imaging localized only four out of the eighteen cases of insulinoma. It had a high positive predictor value and a low negative predictor value, low sensitivity, low specificity, low positive, but high negative likelihood ratios, all indicating a low validity. The ultrasonography of the abdomen and computerized tomography of the pancreas completely failed to achieve any localization in any patient.

Conclusion:

In Nineveh, preoperative localization of insulinoma is of low validity. Intraoperative ultrasonography should be the mainstay after confirming the diagnosis hyperinsulinemia.