PREOPERATIVE ANGIOGRAPHIC LOCALIZATION OF INSULIN-PRODUCING TUMORS OF THE PANCREAS

The significant morbidity and mortality associated with pancreatic surgery for isletcell tumors indicate the need for accurate, reliable identification and preoperative localization of insulin-producing islet-cell tumors. The results of this study indicate that angiographic examination of the pancreas can detect such tumors with a degree of accuracy greater than 90 per cent, if attention is paid to the technical quality of the examination. This attention is as important for the accurate diagnosis as are the size, location, and vascularity of the tumor. Vascularity of the tumor as assessed histologically may not have as important a role in the diagnosis as previously suggested.

Supplementary techniques such as stereoscopy, subtraction, magnification, and selective injections are also important. We were able to demonstrate 6 of 12 occult insulin-producing islet-cell tumors within the pancreas preoperatively by means of such techniques, which otherwise might have resulted in a partial pancreatectomy without identification of the tumor by the surgeon. The small tumor, less than 5 mm. in diameter, will remain extremely difficult to localize, but attention to technique and utilization of the suggested roentgenologic methods will help in localization.

In all cases of clinically proved insulin-producing islet-cell tumors of the pancreas, an attempt should be made to localize the lesion preoperatively by angiography. Successful localization provides confirmation to the internist and enhances the surgeon’s chances for deciding upon the most appropriate surgical procedure, thereby reducing the risk to the patient of subsequent morbidity.

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