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Milana P. Boukhman, BA; John M. Karam, MD; John Shaver, MD; Allan E. Siperstein, MD; Alfred A. DeLorimier, MD; Orlo H. Clark, MD

Arch Surg. 1999;134:818-823.

Hypothesis  Intraoperative ultrasonography is more sensitive than preoperative and other intraoperative techniques for localizing insulinoma.

Design  Retrospective review.

Setting  A tertiary referral center.

Patients  All patients with a biochemical diagnosis of organic hyperinsulinism who were referred to University of California, San Francisco, from 1975 to 1998.

Methods  Sensitivities of the localization techniques for insulinoma were evaluated.

Results  The sensitivities of tumor localization with arteriography, computed tomography, preoperative ultrasonography, magnetic resonance imaging, magnetic resonance imaging with gadolinium, transhepatic venous sampling, palpation, and intraoperative ultrasonography were 47%, 24%, 50%, 30%, 40%, 55%, 76%, and 91%, respectively. Nine of the 11 nonpalpable and nonvisible tumors at operation were localized by intraoperative ultrasonography.

Conclusion  The currently available preoperative localization tests are not reliable enough to be recommended when intraoperative ultrasonography is available.

From the Department of Surgery, University of California, San Francisco.

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