Efficacy of laparoscopic ultrasonography in laparoscopic resection of insulinoma

Wu, Mei; Wang, Huaitao; Zhang, Xiaobo; Gao, Feng; Liu, Peng; Yu, Boqiang; Qiu, Huanbing; Huang, Guan‐Long; Tan, Xiaodong

doi:10.4103/2303-9027.194703

Cited by 14 publications

(7 citation statements)

References 52 publications

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“…However, An et al. 2 , 5 , 11 reported a high sensitivity of 86.5% for CEUS in patients with insulinomas. According to Chinese standards, four patients (33.3%) in the present study were overweight (body mass index (BMI) ≥24.0 and <28.0 kg/m 2 ) and seven patients (58.3%) were obese (BMI ≥28.0 kg/m 2 ).…”

Section: Discussionmentioning

confidence: 98%

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Value of multi-detector computed tomography during intra-arterial infusion of contrast medium for locating insulinomas

et al. 2020

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This study aimed to evaluate the accuracy of multi-detector computed tomography (CT) during intra-arterial infusion of contrast medium (MDCT-IA) for locating insulinomas. Methods: This retrospective study included patients with insulinomas who underwent surgery at the Chinese PLA General Hospital in 2013 to 2014. The patients' case notes and investigation results were reviewed. Preoperative tumor localization was carried out by MDCT-IA and noninvasive methods including MDCT, magnetic resonance imaging (MRI), and contrast-enhanced ultrasound (CEUS). Insulinoma localization using these methods was compared with the histologically confirmed location following surgical excision. Results: Twelve insulinomas were identified in 12 patients, all of which were treated surgically. All patients received MDCT-IA (100%), 11 patients also underwent MRI (91.7%), seven underwent CT (58.3%), and all 12 underwent CEUS (100%). Tumor localization was determined successfully in 12/12 patients by MDCT-IA (100%), in 9/11 by MRI (81.8%), 4/7 by CT (57.1%), and 7/12 by CEUS (58.3%). Overall, MDCT-IA correctly localized 100% of the lesions. Conclusions: MDCT-IA can be used to determine the preoperative localization of insulinomas.

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Section: Discussionmentioning

confidence: 98%

“…The sensitivity of ultrasonography is affected by various factors, such as the physician's expertise, patient's body weight, tumor size, and tumor location, leading to reported sensitivities of 0% to 86.5%. However, An et al 2,5,11 reported MDCT-IA, multi-detector CT during intra-arterial infusion of contrast medium.…”

Section: Discussionmentioning

confidence: 99%

Value of multi-detector computed tomography during intra-arterial infusion of contrast medium for locating insulinomas

et al. 2020

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“…Unfortunately, the diagnosis of insulinoma is often delayed due to varied clinical presentations, low-specificity clinical diagnostic models, and the costly equipment of SPECT ( Dauben et al, 2019 ; Giannis et al, 2020 ). Hence, early and accurate diagnosis and treatment are crucial for a better prognosis ( Wu et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Identifying target ion channel-related genes to construct a diagnosis model for insulinoma

Mo,

Wang,

et al. 2023

Front. Genet.

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Background: Insulinoma is the most common functional pancreatic neuroendocrine tumor (PNET) with abnormal insulin hypersecretion. The etiopathogenesis of insulinoma remains indefinable. Based on multiple bioinformatics methods and machine learning algorithms, this study proposed exploring the molecular mechanism from ion channel-related genes to establish a genetic diagnosis model for insulinoma.Methods: The mRNA expression profile dataset of GSE73338 was applied to the analysis, which contains 17 insulinoma samples, 63 nonfunctional PNET (NFPNET) samples, and four normal islet samples. Differently expressed ion channel-related genes (DEICRGs) enrichment analyses were performed. We utilized the protein–protein interaction (PPI) analysis and machine learning of LASSO and support vector machine-recursive feature elimination (SVM-RFE) to identify the target genes. Based on these target genes, a nomogram diagnostic model was constructed and verified by a receiver operating characteristic (ROC) curve. Moreover, immune infiltration analysis, single-gene gene set enrichment analysis (GSEA), and gene set variation analysis (GSVA) were executed. Finally, a drug–gene interaction network was constructed.Results: We identified 29 DEICRGs, and enrichment analyses indicated they were primarily enriched in ion transport, cellular ion homeostasis, pancreatic secretion, and lysosome. Moreover, the PPI network and machine learning recognized three target genes (MCOLN1, ATP6V0E1, and ATP4A). Based on these target genes, we constructed an efficiently predictable diagnosis model for identifying insulinomas with a nomogram and validated it with the ROC curve (AUC = 0.801, 95% CI 0.674–0.898). Then, single-gene GSEA analysis revealed that these target genes had a significantly positive correlation with insulin secretion and lysosome. In contrast, the TGF-beta signaling pathway was negatively associated with them. Furthermore, statistically significant discrepancies in immune infiltration were revealed.Conclusion: We identified three ion channel-related genes and constructed an efficiently predictable diagnosis model to offer a novel approach for diagnosing insulinoma.

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“…Laparoscopic surgical resection is associated with shorter hospitalisation compared to traditional open surgical approaches; however, a disadvantage is the inability to perform manual palpation for intraoperative localisation. Laparoscopic ultrasonography can be useful and has been shown to have a sensitivity of around 90% ( 15 ). As this case demonstrates, however, the resection of small insulinomas can be challenging despite the use of pre-operative and intraoperative localisation techniques.…”

Section: Discussionmentioning

confidence: 99%

Insulinoma presenting with post-prandial hypoglycaemia following fundoplication

Qian

Hare

Pham

et al. 2018

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryInsulinomas are rare neuroendocrine tumours that classically present with fasting hypoglycaemia. This case report discusses an uncommon and challenging case of insulinoma soon after upper gastrointestinal surgery. A 63-year-old man presented with 6 months of post-prandial hypoglycaemia beginning after a laparoscopic revision of Toupet fundoplication. Hyperinsulinaemic hypoglycaemia was confirmed during a spontaneous episode and in a mixed-meal test. Localisation studies including magnetic resonance imaging (MRI), endoscopic ultrasound (EUS) and gallium dotatate positron emission tomography (68Ga Dotatate PET) were consistent with a small insulinoma in the mid-body of the pancreas. The lesion was excised and histopathology was confirmed a localised well-differentiated neuroendocrine pancreatic neoplasm. There have been no significant episodes of hypoglycaemia since. This case highlights several key points. Insulinoma should be sought in proven post-prandial hyperinsulinaemic hypoglycaemia – even in the absence of fasting hypoglycaemia. The use of nuclear imaging targeting somatostatin and GLP1 receptors has improved accuracy of localisation. Despite these advances, accurate surgical resection can remain challenging.Learning points:Hypoglycaemia is defined by Whipple’s triad and can be provoked by fasting or mixed-meal tests.Although uncommon, insulinomas can present with post-prandial hypoglycaemia.In hypoglycaemia following gastrointestinal surgery (i.e. bariatric surgery or less commonly Nissen fundoplication) dumping syndrome or non-insulinoma pancreatogenous hypoglycaemia syndrome (NIPHS) should be considered.Improved imaging techniques including MRI, endoscopic ultrasound and functional nuclear medicine scans aid localisation of insulinomas.Despite advances in imaging and surgical techniques, accurate resection of insulinomas remains challenging.

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Efficacy of laparoscopic ultrasonography in laparoscopic resection of insulinoma

Cited by 14 publications

References 52 publications

Value of multi-detector computed tomography during intra-arterial infusion of contrast medium for locating insulinomas

Value of multi-detector computed tomography during intra-arterial infusion of contrast medium for locating insulinomas

Identifying target ion channel-related genes to construct a diagnosis model for insulinoma

Insulinoma presenting with post-prandial hypoglycaemia following fundoplication

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