Diagnostic value of ASVS for insulinoma localization: A systematic review and meta-analysis

Abstract

BackgroundPrevious studies on the diagnostic value of arterial calcium stimulation with hepatic venous sampling (ASVS) for the localization of insulinoma have reported inconsistent results. Here, we performed a meta-analysis of the relevant published studies.MethodsPubMed, Embase, Web of Science, the Cochrane Library, and Wanfang Data were searched for studies on the diagnostic value of ASVS in insulinoma localization published up to May 2019. We calculated the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and receiver operating characteristic (ROC) curve of ASVS in the localization of insulinoma.ResultsWe included ten studies involving 337 patients in the study. The pooled sensitivity, specificity, PLR, and NLR were 0.93 (95% confidence interval [CI]: 0.83–0.97), 0.86 (95%CI: 0.75–0.93), 6.8(95%CI: 3.7–12.7), and 0.08 (95%CI: 0.03–0.19), respectively. The DOR was 84 (95%CI: 30–233), and the area under the ROC curve was 0.96 (95%CI: 0.94–0.97).The results of the heterogeneity of the studies (P = 0.00, I2 = 80.17) were calculated using forest plots of the DOR.ConclusionASVS is of significant value in localization of insulinoma. If a qualitative diagnosis of insulinoma is definite and the imaging examination results are negative, ASVS should be performed to confirm the localization of insulinoma.

A case report of insulinoma presenting with seizures and localized on endoscopic ultrasound

“…EUS and ASVS are invasive techniques to localize insulinoma when the non-invasive techniques fail, and the suspicion remains high. EUS has a sensitivity of up to 89%, whereas the sensitivity of ASVS has been reported to be up to 93% (5,6). Patel et al reported 2 cases of insulinomas with negative imaging (including negative octreotide scan in one case).…”

“…Several non-invasive techniques are used to localize the lesion and include an ultrasound (US) abdomen, CT scan, MRI, and molecular imaging techniques like NM 18F-DOPA whole-body PET CT and Ga-68 DOTATATE scan (2)(3)(4). Due to the low sensitivity of the non-invasive methods, the localization of the tumor presents a diagnostic challenge, and invasive techniques like endoscopic ultrasound (EUS) and angiography and arterial stimulation venous sampling (ASVS) should be used if the suspicion is high (5,6). We present a case of insulinoma presenting with seizure episodes.…”

The insulinoma as a diagnostically and therapeutically challenging neoplasm

“…After biochemical confirmation of insulinoma, medical imaging is recommended. An intraoperative ultrasound has a very high positive detection rate, however revealing the insulinoma before a surgery treatment makes surgery easier [3,7]. The small size of insulinomas challenges the detectability by conventional imaging techniques like contrastenhanced CT and contrast enhanced MRI beacause of motion artifacts.…”

“…On the other hand, an endoscopic ultrasound is invasive technique and the visualisation of pancreas is not always possible. It has a positive rate of 80-89%, depending on the operator's technique and experience [7]. The selective arterial calcium stimulation test with hepatic venous sampling (SACST) is used when the preoperative localization of insulinomas by previous techniques is not possible.…”

“…Thanks to this, surgeon can limit the intraoperative search of the insulinoma to the corresponding arterial territory. Based on the systematic review and metaanalysis it has a significant importance in localization of insulinoma [7]. However, SACST determines only the arterial territory and not the tumor itself and is invasive procedure [8].…”