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Exendin‐4‐based imaging in endogenous hyperinsulinemic hypoglycaemia cohort: A tertiary Endocrine centre experience
Author(s) -
Garg Robin,
Shah Ravikumar,
Tiwari Ankita,
Purandare Nilendu,
Lele Vikram R.,
Malhotra Gaurav,
Verma Priyanka,
Gosavi Vikrant,
Dalvi Abhay,
Kumar Jaiswal Sanjeet,
Patil Virendra,
RamtekeJadhav Swati,
Lila Anurag,
Shah Nalini,
Bandgar Tushar
Publication year - 2020
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.14299
Subject(s) - insulinoma , medicine , hyperinsulinemic hypoglycemia , retrospective cohort study , neuroendocrine tumors , context (archaeology) , pancreas , cohort , hypoglycemia , lesion , multiple endocrine neoplasia , nuclear medicine , radiology , gastroenterology , endocrinology , pathology , insulin , chemistry , biology , paleontology , biochemistry , gene
Context Insulinoma needs accurate preoperative localization for minimally invasive surgery. Exendin‐4‐based imaging has shown promising results. Objective To evaluate performance parameters of exendin‐4‐based imaging in insulinoma localization and compare with other imaging modalities. Design Retrospective cross‐sectional study. Patients We report 14 patients with endogenous hyperinsulinemic hypoglycaemia (EHH) managed at our centre; in whom, the final diagnosis was insulinoma (n = 11), Munchausen syndrome (MS) (n = 2) and inconclusive (n = 1). Retrospective reporting of CECT, 68 Ga‐DOTATATE PET/CT and 68 Ga‐NODAGA‐exendin‐4‐PET/CT was done. With per‐lesion analysis, performance parameters were calculated for the histopathological diagnosis of insulinoma. Main Outcome Measures True positive (TP), false positive (FP), false negative (FN), true negative (TN), sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) for insulinoma localization. Results In our cohort, 12 histopathologically proven insulinoma lesions [(TP): 11 primary lesions, 1 metastasis] were detected in 11 patients, whereas two patients had MS (TN). Sn and PPV were 75% and 100%, 33.3% and 80% and 83.3% and 71.4% for CECT, 68 Ga‐DOTATATE PET/CT and 68 Ga‑NODAGA‑exendin‑4‐PET/CT, respectively. With exendin‐4‐based imaging, FP uptake in normal pancreatic tissue and FN results in the pancreatic tail lesion was seen. In one patient, TN result suggested the correct diagnosis of MS. Conclusion 68 Ga‑NODAGA‑exendin‑4‐PET/CT has higher sensitivity than 68 Ga‐DOTATATE PET/CT and CECT for insulinoma localization. FP uptake in normal pancreas and FN result in tail lesions are limitations of currently utilized exendin‐4‐based imaging.