Localization of insulinomas to regions of the pancreas by intraarterial calcium stimulation: the NIH experience.
BACKGROUND
Selective intraarterial calcium injection of the major pancreatic arteries with hepatic venous sampling [calcium arterial stimulation (CaStim)] has been used as a localizing tool for insulinomas at the National Institutes of Health (NIH) since 1989. The accuracy of this technique for localizing insulinomas was reported for all cases until 1996.


OBJECTIVE
The aim of the study was to assess the accuracy and track record of the CaStim over time and in the context of evolving technology and to review issues related to result interpretation and procedure complications. CaStim was the only invasive preoperative localization modality used at our center. Endoscopic ultrasound (US) was not studied.


METHODS
We conducted a retrospective case review at a referral center.


METHODS
Twenty-nine women and 16 men (mean age, 47 yr; range, 13-78) were diagnosed with an insulinoma from 1996-2008.


METHODS
A supervised fast was conducted to confirm the diagnosis of insulinoma. US, computed tomography (CT), magnetic resonance imaging (MRI), and CaStim were used as preoperative localization studies. Localization predicted by each preoperative test was compared to surgical localization for accuracy.


RESULTS
We measured the accuracy of US, CT, MRI, and CaStim for localization of insulinomas preoperatively.


RESULTS
All 45 patients had surgically proven insulinomas. Thirty-eight of 45 (84%) localized to the correct anatomical region by CaStim. In five of 45 (11%) patients, the CaStim was falsely negative. Two of 45 (4%) had false-positive localizations.


CONCLUSIONS
The CaStim has remained vastly superior to abdominal US, CT, or MRI over time as a preoperative localizing tool for insulinomas. The utility of the CaStim for this purpose and in this setting is thus validated.
Guettier
Jean-Marc
JM
National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland 20892, USA. guettierj@mail.nih.gov
Kam
Anthony
A
Chang
Richard
R
Skarulis
Monica C
MC
Cochran
Craig
C
Alexander
H Richard
HR
Libutti
Steven K
SK
Pingpank
James F
JF
Gorden
Phillip
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D002118:Calcium / Q000008:administration & dosage / Q000494:pharmacology*; D005215:Fasting; D005260:Female; D006503:Hepatic Veins; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007269:Injections, Intra-Arterial; D007328:Insulin / Q000097:blood; D007340:Insulinoma / Q000473:pathology* / Q000601:surgery; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
D007328:Insulin; D002118:Calcium