Intraoperative gamma probe detection of lymph node recurrence of insulinoma

Abstract

Insulinomas are rare endocrine tumors that are mostly sporadic, benign, and small. Preoperative radiography diagnosis may be difficult. Intraoperative palpation and ultrasound remain the gold standard for detection and planned resection. Recent studies find intraoperative gamma-probe localization as a good technique for identifying primary neuroendocrine tumors. We report a case of a 75-year-old woman with functioning lymph node recurrence of a malignant insulinoma. Spleno-pancreatectomy was performed in order to treat the malignant insulinoma. Clinical, biochemical, and radiological examination confirmed the total excision of the primary lesion. However, clinical symptoms appeared 9 months later. Octreo-scan, abdominal CT, and biochemical study showed lymph node recurrence and four hepatic metastases. Surgery was performed after two [111In-DTPA] octreotide scans. Intraoperative gamma probe detection was planned in order to localize a small latero-aortic lymph node recurrence. Intraoperative count rates were high in para-aortic tissue. Para-aortic lymphadenectomy and metastasectomy were carried out. Ex-situ count rates and histological examination confirmed the recurrence. Six months later clinical and biochemical studies and scans remain negative for recurrence. Intraoperative [111In-DTPA] octreotide gamma probe examination may be a useful tool in the surgical approach to insulinoma recurrence.

Intraoperative identification of a neuro endocrine tumour diagnosed by 68Ga-DOTATOC PET but undetectable by surgical palpation or conventional imaging

“…Intraoperative detection of 111 In-octreotide positive lesions by conventional gamma probes has been used with success (1,3,6,12). However, surgery guided by gamma probes and PET radiotracers has been limited by the requirement for large and heavy tungsten collimators (1,6,7,11,12). The recent development of a high energy gamma probe with electronic collimation has resulted in a compact and easy to handle design.…”

Radioguided Surgery for Gastroenteropancreatic Neuroendocrine Tumours: a Systematic Literature Review

“…The majority of published studies using OCT described a 24-72-h interval between administration and surgery. Even though this is a much shorter period than suggested as optimal by Wang, 10 of the 11 authors described how RGS benefitted the surgeon by identifying additional foci over other techniques [10][11][12]15,16,18,19 ; minimising the extent or duration of surgery [12][13][14]16 ; assisting with differentiation between normal tissue and tumour 12,13,15 ; and /or aiding the surgeon in localising the tumour 12,[15][16][17] .…”

Radioguided Surgery for Gastroenteropancreatic Neuroendocrine Tumours; a Systematic Literature Review

“…The majority of published studies using OCT described a 24-72 hour interval between administration and surgery. Even though this is a much shorter period than suggested as optimal by Wang, 10 of the 11 authors described how RGS bene tted the surgeon by: identifying additional foci over other techniques [11][12][13][14][15][16][17]; minimising the extent or duration of surgery [12,16,18,19]; assisting with differentiation between normal tissue and tumour [12,15,18]; and /or aiding the surgeon in localising the tumour [12,15,16,20].…”