Selective Intra-Arterial Calcium Stimulation Venous Sampling Test for Preoperative Localization of Occult Neuroendocrine Tumors: Recall for an Old TechniqueFunding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Background Surgical resection is the curative treatment for neuroendocrine tumors (NETs). Noninvasive imaging is unreliable in localizing NETs measuring less than 2 cm. This study investigates the safety and efficacy of the selective intra-arterial calcium stimulation venous sampling test (SACST) for preoperative localization of functional NETs within the pancreas.
Methods This retrospective analysis of the patients referred for localization of radiologically occult functional NETs from 2004 to 2019 was performed at a single institution. The technical success, diagnostic accuracy, and complications of the test were evaluated.
Results Twenty-three patients underwent SACST. The SACST was technically successful in 100% of the patients. Lesions were successfully localized in 19 (83%) patients. Tumor blush was seen in one patient. The mean ± standard deviation of maximal dimension of the resected tumor was 2.0 ± 1.9 cm. Sensitivity, specificity, positive predictive value, and negative predictive value of the SACST for localization of all lesions were 1.0, 0.57, 0.84, and 1.0, as well as 1.0, 0.57, 0.80, and 1.0 for insulinomas, respectively.
Conclusion SACST is a feasible, safe, well-tolerated, and effective procedure to preoperatively localize radiologically occult NETs within the pancreas.
Received: 29 August 2020
Accepted: 06 January 2021
11 February 2021 (online)
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- 1 Dasari A, Shen C, Halperin D. et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol 2017; 3 (10) 1335-1342
- 2 Deguelte S, de Mestier L, Hentic O. et al. Preoperative imaging and pathologic classification for pancreatic neuroendocrine tumors. J Visc Surg 2018; 155 (02) 117-125
- 3 Phan GQ, Yeo CJ, Hruban RH, Littemoe KD, Pitt HA, Cameron JL. Surgical experience with pancreatic and peripancreatic neuroendocrine tumors: review of 125 patients. J Gastrointest Surg 1998; 2 (05) 473-482
- 4 Burghardt L, Meier JJ, Uhl W, Kahle-Stefan M, Schmidt WE, Nauck MA. Importance of localization of insulinomas: a systematic analysis. J Hepatobiliary Pancreat Sci 2019; 26 (09) 383-392
- 5 Hirshberg B, Libutti SK, Alexander HR. et al. Blind distal pancreatectomy for occult insulinoma, an inadvisable procedure. J Am Coll Surg 2002; 194 (06) 761-764
- 6 Zhu L, Xue H, Sun Z. et al. Prospective comparison of biphasic contrast-enhanced CT, volume perfusion CT, and 3 Tesla MRI with diffusion-weighted imaging for insulinoma detection. J Magn Reson Imaging 2017; 46 (06) 1648-1655
- 7 Kaczirek K, Ba-Ssalamah A, Schima W, Niederle B. The importance of preoperative localisation procedures in organic hyperinsulinism–experience in 67 patients. Wien Klin Wochenschr 2004; 116 (11–12): 373-378
- 8 Krenning EP, Kwekkeboom DJ, Bakker WH. et al. Somatostatin receptor scintigraphy with [111In-DTPA-D-Phe1]- and [123I-Tyr3]-octreotide: the Rotterdam experience with more than 1000 patients. Eur J Nucl Med 1993; 20 (08) 716-731
- 9 de Herder WW, Kwekkeboom DJ, Valkema R. et al. Neuroendocrine tumors and somatostatin: imaging techniques. J Endocrinol Invest 2005; 28 (11, Suppl International): 132-136
- 10 Deroose CM, Hindié E, Kebebew E. et al. Molecular imaging of gastroenteropancreatic neuroendocrine tumors: current status and future directions. J Nucl Med 2016; 57 (12) 1949-1956
- 11 Doppman JL, Miller DL, Chang R, Shawker TH, Gorden P, Norton JA. Insulinomas: localization with selective intraarterial injection of calcium. Radiology 1991; 178 (01) 237-241
- 12 Monroe EJ, Carney BW, Ingraham CR, Johnson GE, Valji K. An interventionist's guide to endocrine consultations. Radiographics 2017; 37 (04) 1246-1267
- 13 Khalilzadeh O, Baerlocher MO, Shyn PB. et al. Proposal of a new adverse event classification by the Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol 2017; 28 (10) 1432.e3-1437.e3
- 14 Kajiwara K, Yamagami T, Toyota N. et al. New diagnostic criteria for the localization of insulinomas with the selective arterial calcium injection test: decision tree analysis. J Vasc Interv Radiol 2018; 29 (12) 1749-1753
- 15 Doppman JL, Chang R, Fraker DL. et al. Localization of insulinomas to regions of the pancreas by intra-arterial stimulation with calcium. Ann Intern Med 1995; 123 (04) 269-273
- 16 Pereira PL, Roche AJ, Maier GW. et al. Insulinoma and islet cell hyperplasia: value of the calcium intraarterial stimulation test when findings of other preoperative studies are negative. Radiology 1998; 206 (03) 703-709
- 17 Chavan A, Kirchhoff TD, Brabant G, Scheumann GF, Wagner S, Galanski M. Role of the intra-arterial calcium stimulation test in the preoperative localization of insulinomas. Eur Radiol 2000; 10 (10) 1582-1586
- 18 Lo CY, Chan FL, Tam SC, Cheng PW, Fan ST, Lam KS. Value of intra-arterial calcium stimulated venous sampling for regionalization of pancreatic insulinomas. Surgery 2000; 128 (06) 903-909
- 19 Brändle M, Pfammatter T, Spinas GA, Lehmann R, Schmid C. Assessment of selective arterial calcium stimulation and hepatic venous sampling to localize insulin-secreting tumours. Clin Endocrinol (Oxf) 2001; 55 (03) 357-362
- 20 Tseng LM, Chen JY, Won JG. et al. The role of intra-arterial calcium stimulation test with hepatic venous sampling (IACS) in the management of occult insulinomas. Ann Surg Oncol 2007; 14 (07) 2121-2127
- 21 Wong M, Isa SH, Zahiah M, Azmi KN. Intraoperative ultrasound with palpation is still superior to intra-arterial calcium stimulation test in localising insulinoma. World J Surg 2007; 31 (03) 586-592
- 22 Morera J, Guillaume A, Courtheoux P. et al. Preoperative localization of an insulinoma: selective arterial calcium stimulation test performance. J Endocrinol Invest 2016; 39 (04) 455-463
- 23 Defreyne L, König K, Lerch MM. et al. Modified intra-arterial calcium stimulation with venous sampling test for preoperative localization of insulinomas. Abdom Imaging 1998; 23 (03) 322-331
- 24 Guettier JM, Kam A, Chang R. et al. Localization of insulinomas to regions of the pancreas by intraarterial calcium stimulation: the NIH experience. J Clin Endocrinol Metab 2009; 94 (04) 1074-1080
- 25 Ueda K, Ito T, Kawabe K. et al. Should the selective arterial secretagogue injection test for insulinoma localization be evaluated at 60 or 120 seconds?. Intern Med 2017; 56 (22) 2985-2991
- 26 Thompson SM, Vella A, Service FJ, Andrews JC. Selective arterial calcium stimulation with hepatic venous sampling in immune-mediated hypoglycemia. J Endocr Soc 2017; 1 (06) 671-675
- 27 Moreno-Moreno P, Alhambra-Expósito MR, Herrera-Martínez AD. et al. Arterial calcium stimulation with hepatic venous sampling in the localization diagnosis of endogenous hyperinsulinism. Int J Endocrinol 2016; 2016: 4581094
- 28 Sundin A, Arnold R, Baudin E. et al; Antibes Consensus Conference participants. ENETS consensus guidelines for the standards of care in neuroendocrine tumors: radiological, nuclear medicine & hybrid imaging. Neuroendocrinology 2017; 105 (03) 212-244
- 29 Deveney CW, Deveney KS, Jaffe BM, Jones RS, Way LW. Use of calcium and secretin in the diagnosis of gastrinoma (Zollinger-Ellison syndrome). Ann Intern Med 1977; 87 (06) 680-686
- 30 Doppman JL, Miller DL, Chang R. et al. Gastrinomas: localization by means of selective intraarterial injection of secretin. Radiology 1990; 174 (01) 25-29
- 31 Turner JJ, Wren AM, Jackson JE, Thakker RV, Meeran K. Localization of gastrinomas by selective intra-arterial calcium injection. Clin Endocrinol (Oxf) 2002; 57 (06) 821-825