[18F]FB(ePEG12)12-exendin-4 noninvasive imaging of insulinoma negative for insulin immunostaining on specimen from endoscopic ultrasonography-guided fine needle aspiration: a case report with review of literature.

IF 1.3 4区 医学 Q4 ENDOCRINOLOGY & METABOLISM Endocrine journal Pub Date : 2024-09-02 Epub Date: 2024-06-05 DOI:10.1507/endocrj.EJ24-0187
Daisuke Otani, Takaaki Murakami, Saeko Murakami, Ikuko Hanaoka, Hiroyuki Fujimoto, Yoichi Shimizu, Kanae Kawai Miyake, Kentaro Sakaki, Yohei Ueda, Daisuke Tanaka, Tsuyoshi Ohno, Hironori Shimizu, Naoki Uyama, Norishige Iizuka, Daisuke Yabe, Yuji Nakamoto, Nobuya Inagaki
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Abstract

Insulinomas are the most common functional pancreatic neuroendocrine neoplasm; when treatment is delayed, they induce hyperinsulinemic hypoglycemia, which is life-threatening. As surgical resection is the only curative treatment for insulinoma, preoperative localization is crucial; however, localization based on conventional imaging modalities such as computed tomography (CT) and magnetic resonance imaging is often inconclusive. Somatostatin receptor-targeted imaging is another option for detecting pancreatic neuroendocrine neoplasms but has low sensitivity and is not specific for insulinoma. The clinical application of other localizing approaches such as selective arterial calcium stimulation and endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is limited by their being invasive and/or technically complex. Moreover, an EUS-FNA specimen of an insulinoma may be negative on insulin immunostaining. Thus, a noninvasive and clinically practical insulinoma-specific diagnostic tool to discriminate insulinomas with high accuracy is anticipated. Glucagon-like peptide-1 receptor (GLP-1R)-targeted imaging has emerged in the effort to fulfill this need. We recently developed the novel fluorine-18-labeled exendin-4-based probe conjugated with polyethylene glycol, [18F]FB(ePEG12)12-exendin-4 (18F-exendin-4) for positron emission tomography (PET) imaging and reported its clinical benefit in a case of insulinoma in the pancreatic tail. We report here a case of insulinoma in the pancreatic head in which an EUS-FNA specimen was negative on insulin immunostaining while precise preoperative localization and conclusive evidence for curative enucleation was provided by 18F-exendin-4 PET/CT (Japan Registry of Clinical Trials; jRCTs051200156).

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内镜超声引导下细针穿刺标本上胰岛素免疫染色阴性的胰岛素瘤的[18F]FB(ePEG12)12-exendin-4无创成像:病例报告与文献综述。
胰岛素瘤是最常见的功能性胰腺神经内分泌肿瘤;一旦延误治疗,就会诱发高胰岛素血症性低血糖,危及生命。由于手术切除是治疗胰岛素瘤的唯一方法,因此术前定位至关重要;然而,根据计算机断层扫描(CT)和磁共振成像等传统成像模式进行定位往往无法得出结论。体生长抑素受体靶向成像是检测胰腺神经内分泌肿瘤的另一种方法,但敏感性较低,对胰岛素瘤的特异性不强。其他定位方法,如选择性动脉钙刺激法和内镜超声引导下细针穿刺术(EUS-FNA),由于具有创伤性和/或技术复杂性,其临床应用受到限制。此外,胰岛素瘤的 EUS-FNA 标本可能在胰岛素免疫染色上呈阴性。因此,人们期待一种无创、临床实用的胰岛素瘤特异性诊断工具,以高精度鉴别胰岛素瘤。为满足这一需求,胰高血糖素样肽-1 受体(GLP-1R)靶向成像技术应运而生。我们最近开发了基于氟-18标记的外显素-4探针,与聚乙二醇共轭,[18F]FB(ePEG12)12-外显素-4(18F-exendin-4),用于正电子发射断层扫描(PET)成像,并报告了其在一例胰腺尾部胰岛素瘤中的临床获益。我们在此报告了一例胰头胰岛素瘤患者,其 EUS-FNA 标本的胰岛素免疫染色呈阴性,而 18F-exendin-4 PET/CT 则提供了精确的术前定位和根治性去核的确凿证据(日本临床试验登记;jRCTs051200156)。
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来源期刊
Endocrine journal
Endocrine journal 医学-内分泌学与代谢
CiteScore
4.30
自引率
5.00%
发文量
224
审稿时长
1.5 months
期刊介绍: Endocrine Journal is an open access, peer-reviewed online journal with a long history. This journal publishes peer-reviewed research articles in multifaceted fields of basic, translational and clinical endocrinology. Endocrine Journal provides a chance to exchange your ideas, concepts and scientific observations in any area of recent endocrinology. Manuscripts may be submitted as Original Articles, Notes, Rapid Communications or Review Articles. We have a rapid reviewing and editorial decision system and pay a special attention to our quick, truly scientific and frequently-citable publication. Please go through the link for author guideline.
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