Localization of Insulinomas

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Abstract
A VARIETY of procedures have been advocated for detecting insulin-secreting tumors, but there is little consensus about the best method or combination of methods. After the diagnosis of insulinoma is established, most endocrinologists, surgeons, and patients would prefer preoperative localization if a reliable and cost-effective test were available. Selective arteriography was formerly used for preoperative localization of insulinoma but is usually no longer recommended because it only, at best, identifies about 60% of the tumors, and these are the larger tumors that the surgeon can usually easily identify. Arteriography is also invasive and expensive.1 Other localization studies have been used, including preoperative ultrasonography, transgastric endoscopy, computed tomography (CT), magnetic resonance (MR) imaging, radionuclide scanning, transhepatic venous catheterization, and calcium-stimulated angiography with catheterization of hepatic veins.2-5 Despite the many attempts aimed at localizing insulinomas, the tumors remain undetected in about 40% of patients.6 The purpose of this study was to review the results of the localization techniques in 66 consecutive patients who were surgically treated for insulinomas at University of California, San Francisco, from 1975 to 1998. This period was chosen for patient review because new noninvasive localization techniques became available beginning in 1975.