Endoscopic ultrasound in the localisation of pancreatic islet cell tumours

doi:10.1016/j.beem.2004.11.012

Best Practice & Research Clinical Endocrinology & Metabolism

Volume 19, Issue 2, June 2005, Pages 177-193

https://doi.org/10.1016/j.beem.2004.11.012 Get rights and content

The role of endoscopic ultrasound (EUS) in the evaluation of entero-pancreatic endocrine tumours has evolved in conjunction with advances in other imaging methods. The high spatial resolution of this technique allows the detection of very small lesions and their precise anatomical localisation. In patients with biochemically proven insulinoma, EUS can be effectively used as a first line investigation, with a sensitivity of 94%. Combined with thin section CT, the sensitivity rises to 100%. There is also high sensitivity in diagnosing intrapancreatic gastrinomas but lower for those arising in the duodenal wall which require detailed duodenal evaluation at surgery. EUS in conjunction with Somatostatin Receptor Scanning (SRS) has a combined sensitivity of 93% for gastrinomas. EUS is recommended for screening of asymptomatic patients with genetically proven MEN1. There is a limited role for EUS guided biopsy in pancreatic endocrine tumours.

Section snippets

Treatment options

The therapeutic approach to islet cell tumours has undergone significant change over the last decade with a move to less invasive therapy which has driven the requirement for accurate pre-operative localisation.

Standard surgical treatments for islet cell tumours include tumour enucleation for small tumours, distal pancreatectomy and pancreatico-duodenectomy-which represented, respectively, 17, 31 and 40% of surgical procedures in a series of 125 patients who underwent operation for pancreatic

Endoscopic ultrasound-technique

The examination requires the combined skills of endoscopy and ultrasound interpretation. Two types of echoendoscope are in common use, both using a specialized forward oblique viewing endoscope with an ultrasound transducer incorporated into the rigid tip of the instrument distal to the optics. Detection rates for tumours do not appear to significantly vary between scanners and relate to the experience of the operator.

Mechanically rotating radial scanners (for example, Olympus GF-UM 2000) (

Non-functioning tumours

Non-functioning tumours produce few systemic symptoms and, unless critically placed close to the bile duct, are therefore usually large at diagnosis. The majority (86%) present with the symptoms of a mass lesion with abdominal pain, jaundice and weight loss.⁴ In a retrospective review of 50 patients with non-functioning tumours, mean tumour diameter was 7.7 cm. The majority demonstrated a heterogeneous appearance on imaging, cystic degeneration was present in over half and 30% were calcified²⁷ (

EUS intervention

Linear endoscopes are necessary for guided biopsy as the orientation of the scanning head allows the needle path to be followed into the target lesion (Figure 12). Some scopes have an elevator mechanism to direct the needle. Needle diameters range from 22 to 19 gauge and there is potential for obtaining histological cores although this may be technically more difficult. At least 2–4 needle passes and frequently more are usually required in solid pancreatic masses to obtain adequate cytology

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1Endoscopic ultrasound in the localisation of pancreatic islet cell tumours

Section snippets

Treatment options

Endoscopic ultrasound-technique

Non-functioning tumours

EUS intervention

Surgery

Clin Rad

Am J Gastroenterol

Gastrointest Endosc

Surgery

Gastrointest Endosc

Surg Oncol

Gastroenterology

Am J Gastroenterol

Gastrointest Endoc

Clin Radiol

Gastrointest Endosc

Localisation of pancreatic endocrine tumours by endoscopic ultrasonography

N Engl J Med

CT, endoscopic sonography and a combined protocol for preoperative evaluation of pancreatic insulinomas

Am J Roentgenol

Islet cell tumour of the pancreas: biphasic CT vs MR imaging in tumour detection

Radiology

Surgical experience with pancreatic and peri-pancreatic neuroendocrine tumours: review of 125 patients

J Gastrointest Surg

Laparoscopic localization and resection of insulinoma

Arch Surg

1
Endoscopic ultrasound in the localisation of pancreatic islet cell tumours