One patient in this group had an imaging study that was positive for a pancreatic lesion. Controversy exists concerning the use of preoperative imaging studies in patients with islet cell tumors. Of the eight patients with ZES, four were known to have multiple endocrine neoplasia type 1. All patients underwent conventional imaging studies followed by provocative angiography. Angiograms were graded based on the ability to detect tumor and regionalize it within the pancreas.
Provocative angiography is the localization study of choice for both gastrinoma and insulinoma.
Preoperative imaging studies were obtained. Fourteen were evaluated by a surgeon blinded to preoperative imaging results. IOUS can then be used to guide safe enucleation. Insulinoma tissues were surgically obtained for primary culture. PCR products were subcloned and sequenced.