title: Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) in insulinomas: Indications and clinical relevance in a single investigator cohort of 47 patients.
abstract: OBJECTIVE
  This study was aimed to investigate the role and relevance of endoscopic ultrasound-guided fine-needle aspiration biopsy in the diagnostic work-up of insulinomas.
  
  
  METHODS
  We have analysed the frequency, clinical indications, success rate (obtaining diagnostic tissue), diagnostic accuracy (in comparison to the pathological diagnosis after surgery), complications, and tolerability of endoscopic ultrasound-guided fine-needle aspiration biopsy and the localization and size of the lesions in 47 consecutive patients (29 females, 18 males; 46 ± 15 years) who had surgery for insulinoma following fasting test and were explored by single investigator EUS 1994-2015.
  
  
  RESULTS
  Endoscopic ultrasound-guided fine-needle aspiration biopsy was performed in 21 % (10/47) of the patients. The clinical indications for endoscopic ultrasound-guided fine-needle aspiration biopsy were non-conclusive result of fasting test (n = 7), missing toxicology (n = 2), suspected malignancy at EUS (n = 1), suspicious extra-pancreatic localization of the lesion (n = 1). The diagnostic success rate of the procedure was 80 % (8/10 cases), the diagnostic accuracy of the fine-needle aspiration biopsy 70 % (7/10 cases). The lesions undergoing endoscopic ultrasound-guided fine-needle aspiration biopsy were localized in the cauda (n = 5), corpus (n = 2), caput/processus uncinatus (n = 3), the diameter of the tumors was 21 ± 18 (10-70) mm. Only one accidental vascular puncture without any clinical complication occurred and all patients tolerated the procedure well.
  
  
  CONCLUSIONS
  In the majority of cases, positive fasting test, negative toxicology, and detection of a typical pancreatic lesion at endoscopic ultrasound is sufficient for the diagnosis of insulinoma and the definition of the appropriate surgical strategy. Based on our data, we suggest including endoscopic ultrasound-guided fine-needle aspiration biopsy in the diagnostic work-up of organic hyperinsulinism in selected patients with inconclusive or uncertain diagnosis before surgery.
authors.affiliation: Division of Endocrinology & Diabetology, Philipp's University and University Hospital, Marburg, Hessia, Germany. kannp@med.uni-marburg.de.
authors.forename: Peter Herbert
authors.initials: PH
authors.lastname: Kann
authors.affiliation: Department of Pathology, Philipp's University and University Hospital, Marburg, Hessia, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Moll
authors.affiliation: Department of Surgery, Philipp's University and University Hospital, Marburg, Hessia, Germany.
authors.forename: Detlef
authors.initials: D
authors.lastname: Bartsch
authors.affiliation: Pfützner Science & Health Institute, Mainz, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Pfützner
authors.affiliation: Profil Mainz GmbH, Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Forst
authors.affiliation: Division of Endocrinology & Diabetology, Philipp's University and University Hospital, Marburg, Hessia, Germany.|Department of Endocrinology/Diabetes, Mater Misericordiae University Hospital-University College, Dublin, Ireland.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Tamagno
authors.affiliation: Division of Endocrinology & Diabetology, Philipp's University and University Hospital, Marburg, Hessia, Germany.
authors.forename: Joachim N
authors.initials: JN
authors.lastname: Goebel
authors.affiliation: Division of Endocrinology & Diabetology, Philipp's University and University Hospital, Marburg, Hessia, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Fourkiotis
authors.affiliation: Division of Endocrinology & Diabetology, Philipp's University and University Hospital, Marburg, Hessia, Germany.
authors.forename: Simona Raluca
authors.initials: SR
authors.lastname: Bergmann
authors.affiliation: Division of Endocrinology & Diabetology, Philipp's University and University Hospital, Marburg, Hessia, Germany.
authors.forename: Maike
authors.initials: M
authors.lastname: Collienne
mesh_terms: D000328:Adult; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D007340:Insulinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies
keywords: Endoscopic ultrasound (EUS); Fine-needle aspiration biopsy (FNA); Insulinoma; Neuroendocrine tumor (NET); Pancreas