Superior Diagnostic Performance of the GLP-1 Receptor Agonist [Lys40(AhxHYNIC-[99mTc]/EDDA)NH2]-Exendin-4 over Conventional Imaging Modalities for Localization of Insulinoma

Senica, Katra; Tomažič, Aleš; Skvarča, Aleš; Peitl, Petra Kolenc; Mikołajczak, Renata; Hubalewska‐Dydejczyk, Alicja; Ležaič, Luka

doi:10.1007/s11307-019-01372-z

Cited by 10 publications

(12 citation statements)

References 28 publications

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“…We reviewed 179 cases from 16 publications on exendin‐4‐based imaging in insulinoma for IPD‐MA 12–14,16–28 . Among the included studies, seven were case reports, six were prospective studies and three were retrospective studies.…”

Section: Resultsmentioning

confidence: 99%

Exendin‐4‐based imaging in insulinoma localization: Systematic review and meta‐analysis

Shah

Garg

Majmundar

et al. 2021

Clinical Endocrinology

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Background and context: Glucagon-like peptide-1 receptor (GLP-1 R) based imaging has shown higher sensitivity for insulinoma localization as compared to other anatomic/functional imaging. Methodology:We reviewed the published English literature for GLP-1 R targeted imaging in insulinoma in PubMed until August 2020 in accordance with PRISMA guidelines using the MeSH terms "((Exendin-4 PET/CT) OR (Exendin-4 SPECT/CT) OR (GLP-1 R imaging)) AND (Insulinoma)". An individual patient data-metanalysis (IPD-MA) was performed, and performance parameters were calculated for the histopathological diagnosis of insulinoma.Main outcome measures: True-positive (TP), false-positive (FP), false-negative (FN), true-negative (TN), sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) for insulinoma localization.Results: A total of 179 cases (316 lesions) from 16 publications were included for IPD-MA. For insulinoma localization, exendin-4-PET/CT (Sn & PPV: 94%) performed better than exendin-4-SPECT/CT (Sn: 63%, PPV: 94%). The Sn was lower in malignant insulinoma cases whereas the Sp was higher in cases with MEN-1 syndrome. With exendin-4-based imaging, FP uptakes in Brunner's gland, normal pancreas, and other β-cell pathologies and FN results in pancreatic tail lesions and malignancy were seen in a few patients. TN results suggested the correct diagnosis of other endogenous hyperinsulinemic hypoglycaemia (EHH) subtypes. Conclusion:For insulinoma localization, exendin-4 PET/CT should be preferred over exendin-4 SPECT/CT because of higher sensitivity and specificity. FP uptakes in Brunner's gland, normal pancreas, and other β-cell pathologies and FN results in tail lesions, and malignant insulinomas are limitations. Higher specificity for insulinoma localization is particularly useful in patients with MEN-1 syndrome.

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Section: Resultsmentioning

confidence: 99%

Exendin‐4‐based imaging in insulinoma localization: Systematic review and meta‐analysis

Shah

Garg

Majmundar

et al. 2021

Clinical Endocrinology

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“…Case 8 proved the importance of Ga‐exendin‐4‐based PET/CT in the rare case of ectopic insulinoma. Usually, the mass remains difficult to localize with anatomic imaging to an unaware radiologist whereas high specificity of GLP1 R imaging obviates the need for biopsy and IHC 23,24 …”

Section: Discussionmentioning

confidence: 99%

Exendin‐4‐based imaging in endogenous hyperinsulinemic hypoglycaemia cohort: A tertiary Endocrine centre experience

Garg

Shah

Tiwari

et al. 2020

Clinical Endocrinology

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Context: Insulinoma needs accurate preoperative localization for minimally invasive surgery. Exendin-4-based imaging has shown promising results. Objective: To evaluate performance parameters of exendin-4-based imaging in insulinoma localization and compare with other imaging modalities. Design: Retrospective cross-sectional study. Patients: We report 14 patients with endogenous hyperinsulinemic hypoglycaemia (EHH) managed at our centre; in whom, the final diagnosis was insulinoma (n = 11), Munchausen syndrome (MS) (n = 2) and inconclusive (n = 1). Retrospective reporting of CECT, 68 Ga-DOTATATE PET/CT and 68 Ga-NODAGA-exendin-4-PET/CT was done. With per-lesion analysis, performance parameters were calculated for the histopathological diagnosis of insulinoma. Main Outcome Measures: True positive (TP), false positive (FP), false negative (FN), true negative (TN), sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) for insulinoma localization. Results: In our cohort, 12 histopathologically proven insulinoma lesions [(TP): 11 primary lesions, 1 metastasis] were detected in 11 patients, whereas two patients had MS (TN). Sn and PPV were 75% and 100%, 33.3% and 80% and 83.3% and 71.4% for CECT, 68 Ga-DOTATATE PET/CT and 68 Ga-NODAGA-exendin-4-PET/CT, respectively. With exendin-4-based imaging, FP uptake in normal pancreatic tissue and FN results in the pancreatic tail lesion was seen. In one patient, TN result suggested the correct diagnosis of MS. Conclusion: 68 Ga-NODAGA-exendin-4-PET/CT has higher sensitivity than 68 Ga-DOTATATE PET/CT and CECT for insulinoma localization. FP uptake in normal pancreas and FN result in tail lesions are limitations of currently utilized exendin-4-based imaging.

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“…In all patients, surgical pathology confirmed the insulinoma diagnosis. None of the patients had any further recurrence of their hypoglycemia during post-surgical follow-up (range 1-75 months, median 24.5 months) [15].…”

Section: Ct/mrimentioning

confidence: 93%

Changing Insulinoma Management Due to Incidentally Discovered Metastasis: A Case Report

2020

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Objective: Rare disease Background: Hypoglycemia is rare in individuals without drug-treated diabetes mellitus. In a seemingly well individual, the differential diagnosis of hypoglycemia narrows to 2 major categories: 1) accidental, surreptitious, or intentional hypoglycemia, or 2) endogenous hyperinsulinism (EHH). Insulinomas are the most common cause of EHH. Localization of insulinomas can be challenging, as most tumors are less than 2 cm in size and may be present in any part of the pancreas. In fact, almost 30% of neuroendocrine tumors (NET) cannot be located preoperatively by traditional imaging techniques such as computerized tomography (CT) or magnetic resonance imaging (MRI). Case Report: This report describes a case of metastatic insulinoma in a patient with a complex medical history. CT with contrast of the abdomen identified 1 lesion located in the pancreas body. Endoscopic ultrasound (EUS) identified an additional 3 to 4 hypoechoic lesions in the pancreatic neck and body. 68-Gallium Dotatate scanning identified 3 distinct lesions within the pancreas and a right posterior rib sclerotic lesion. Conclusions: Reliance upon traditional imaging techniques (CT/MRI) for tumor localization would not have identified the multifocal pancreatic lesions and the metastatic bone lesion. Accurate identification of multifocal, metastatic insulinomas requires multiple imaging modalities, including first-line non-invasive imaging (CT or MRI) followed by second-line imaging (EUS or nuclear imaging).

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Superior Diagnostic Performance of the GLP-1 Receptor Agonist [Lys40(AhxHYNIC-[99mTc]/EDDA)NH2]-Exendin-4 over Conventional Imaging Modalities for Localization of Insulinoma

Cited by 10 publications

References 28 publications

Exendin‐4‐based imaging in insulinoma localization: Systematic review and meta‐analysis

Exendin‐4‐based imaging in insulinoma localization: Systematic review and meta‐analysis

Exendin‐4‐based imaging in endogenous hyperinsulinemic hypoglycaemia cohort: A tertiary Endocrine centre experience

Changing Insulinoma Management Due to Incidentally Discovered Metastasis: A Case Report

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