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Glucagon-like peptide-1 receptor imaging for the localisation of insulinomas: a prospective multicentre imaging study.

Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital of Berne, Inselspital, Berne, Switzerland. Department of Radiology, Division of Nuclear Medicine, University of Basel Hospital, Switzerland; Department of Nuclear Medicine, University Hospital Freiburg, Germany; Institute of Nuclear Medicine, University College Hospital, London, UK. Electronic address: damian.wild@usb.ch. Department of Radiology, Division of Nuclear Medicine, University of Basel Hospital, Switzerland. Department of Nuclear Medicine, University Hospital Freiburg, Germany; Center for Radiopharmaceutical Science ETH-PSI-USZ, Paul Scherrer Institute, Villingen, Switzerland. Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK. Division of Endocrinology, Diabetes and Osteology, Kantonsspital, St Gallen, Switzerland. Division of Visceral Surgery, Kantonsspital, St Gallen, Switzerland. Division of Endocrinology, Diabetes and Osteology, Kantonsspital Luzern, Switzerland. Institute of Nuclear Medicine, University College Hospital, London, UK. Division of Endocrinology and Diabetology, University Hospital Freiburg, Germany. Division of Visceral Surgery, University Hospital of Berne, Inselspital, Berne, Switzerland. Institute of Pathology, University of Berne, Berne, Switzerland.

The lancet. Diabetes & endocrinology. 2013;(2):115-22
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Abstract

BACKGROUND Small benign insulinomas are hard to localise, leading to difficulties in planning of surgical interventions. We aimed to prospectively assess the insulinoma detection rate of single-photon emission CT in combination with CT (SPECT/CT) with a glucagon-like peptide-1 receptor avid radiotracer, and compare detection rates with conventional CT/MRI techniques. METHODS In our prospective imaging study, we enrolled adults aged 25-81 years at centres in Germany, Switzerland, and the UK. Eligible patients had proven clinical and biochemical endogenous hyperinsulinaemic hypoglycaemia and no evidence for metastatic disease on conventional imaging. CT/MRI imaging was done at referring centres according to standard protocols. At three tertiary nuclear medicine centres, we used whole body planar images and SPECT/CT of the abdomen up to 168 h after injection of (111)In-[Lys40(Ahx-DTPA-(111)In)NH2]-exendin-4 ((111)In-DTPA-exendin-4) to identify insulinomas. Consenting patients underwent surgery and imaging findings were confirmed histologically. FINDINGS Between Oct 1, 2008, and Dec 31, 2011, we recruited 30 patients. All patients underwent (111)In-DTPA-exendin-4 imaging, 25 patients underwent surgery (with histological analysis), and 27 patients were assessed with CT/MRI. (111)In-DTPA-exendin-4 SPECT/CT correctly detected 19 insulinomas and four additional positive lesions (two islet-cell hyperplasia and two uncharacterised lesions) resulting in a positive predictive value of 83% (95% CI 62-94). One true negative (islet-cell hyperplasia) and one false negative (malignant insulinoma) result was identified in separate patients by (111)In-DTPA-exendin-4 SPECT/CT. Seven patients (23%) were referred to surgery on the basis of (111)In-DTPA-exendin-4 imaging alone. For 23 assessable patients, (111)In-DTPA-exendin-4 SPECT/CT had a higher sensitivity (95% [95% CI 74-100]) than did CT/MRI (47% [27-68]; p=0.011). INTERPRETATION (111)In-DTPA-exendin-4 SPECT/CT could provide a good second-line imaging strategy for patients with negative results on initial imaging with CT/MRI. FUNDING Oncosuisse, the Swiss National Science Foundation, and UK Department of Health.

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Publication Type : Clinical Trial ; Multicenter Study

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