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Transhepatic portal vein catheterization for localization of sporadic and MEN gastrinomas: a ten-year experience.
Surgery. 1990 Mar; 107(3):246-55.S

Abstract

We review here the 10-year experience at the University of Michigan with 35 patients with gastrin hypersecretion who underwent transhepatic venous sampling (THVS) for tumor localization. Since 1978 THVS has been done routinely in all patients with gastrinoma syndrome considered for operation. Thirty-one patients had proved gastrinomas--21 benign sporadic tumors and 10 tumors associated with multiple endocrine neoplasia type-I (MEN I) syndrome. The correlation between the site of the maximal gradient and location of a sporadic tumor was poor. Overall sensitivity was only 35%, specificity 89%, and negative predictive value 89%. If gradients were regionalized to three areas--body and tail, gastrinoma triangle, and hepatic lobes--then sensitivity was 94%, positive predictive value 94%, and specificity 97%, with a negative predictive value of 97%. The maximal gastrin gradient above the mean for other values gave the greatest sensitivity and specificity. In MEN I syndrome, only four of eight patients with macroadenomas had their tumors correctly localized, a sensitivity of 50% and specificity and negative predictive value of 75%. In 19 patients who had operative localization of sporadic gastrinoma, computed tomography had a sensitivity of 31%, specificity of 66%, positive predictive value of 83%, and negative predictive value of 15%. Selective angiography was better, with a sensitivity of 29%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 100%. Regionalization to the triangle proved valuable for detection of microgastrinomas, as was measurement of hepatic vein gastrins for identification of intrahepatic tumors. In MEN I syndrome, if regionalization was achieved (50%), tumor resection appeared to offer hope of "cure." We conclude that THVS is the best tool for tumor regionalization to the pancreatic tail and body, gastrinoma triangle, and hepatic lobes. It has allowed us to achieve surgical cure in 19 of 21 patients with sporadic gastrinomas and improvement in four of eight patients with MEN I syndrome.

Authors+Show Affiliations

Department of Surgery, University of Michigan Medical Center, Ann Arbor 48109-0331.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

1968682

Citation

Vinik, A I., et al. "Transhepatic Portal Vein Catheterization for Localization of Sporadic and MEN Gastrinomas: a Ten-year Experience." Surgery, vol. 107, no. 3, 1990, pp. 246-55.
Vinik AI, Moattari AR, Cho K, et al. Transhepatic portal vein catheterization for localization of sporadic and MEN gastrinomas: a ten-year experience. Surgery. 1990;107(3):246-55.
Vinik, A. I., Moattari, A. R., Cho, K., & Thompson, N. (1990). Transhepatic portal vein catheterization for localization of sporadic and MEN gastrinomas: a ten-year experience. Surgery, 107(3), 246-55.
Vinik AI, et al. Transhepatic Portal Vein Catheterization for Localization of Sporadic and MEN Gastrinomas: a Ten-year Experience. Surgery. 1990;107(3):246-55. PubMed PMID: 1968682.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transhepatic portal vein catheterization for localization of sporadic and MEN gastrinomas: a ten-year experience. AU - Vinik,A I, AU - Moattari,A R, AU - Cho,K, AU - Thompson,N, PY - 1990/3/1/pubmed PY - 1990/3/1/medline PY - 1990/3/1/entrez SP - 246 EP - 55 JF - Surgery JO - Surgery VL - 107 IS - 3 N2 - We review here the 10-year experience at the University of Michigan with 35 patients with gastrin hypersecretion who underwent transhepatic venous sampling (THVS) for tumor localization. Since 1978 THVS has been done routinely in all patients with gastrinoma syndrome considered for operation. Thirty-one patients had proved gastrinomas--21 benign sporadic tumors and 10 tumors associated with multiple endocrine neoplasia type-I (MEN I) syndrome. The correlation between the site of the maximal gradient and location of a sporadic tumor was poor. Overall sensitivity was only 35%, specificity 89%, and negative predictive value 89%. If gradients were regionalized to three areas--body and tail, gastrinoma triangle, and hepatic lobes--then sensitivity was 94%, positive predictive value 94%, and specificity 97%, with a negative predictive value of 97%. The maximal gastrin gradient above the mean for other values gave the greatest sensitivity and specificity. In MEN I syndrome, only four of eight patients with macroadenomas had their tumors correctly localized, a sensitivity of 50% and specificity and negative predictive value of 75%. In 19 patients who had operative localization of sporadic gastrinoma, computed tomography had a sensitivity of 31%, specificity of 66%, positive predictive value of 83%, and negative predictive value of 15%. Selective angiography was better, with a sensitivity of 29%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 100%. Regionalization to the triangle proved valuable for detection of microgastrinomas, as was measurement of hepatic vein gastrins for identification of intrahepatic tumors. In MEN I syndrome, if regionalization was achieved (50%), tumor resection appeared to offer hope of "cure." We conclude that THVS is the best tool for tumor regionalization to the pancreatic tail and body, gastrinoma triangle, and hepatic lobes. It has allowed us to achieve surgical cure in 19 of 21 patients with sporadic gastrinomas and improvement in four of eight patients with MEN I syndrome. SN - 0039-6060 UR - https://www.unboundmedicine.com/medline/citation/1968682/Transhepatic_portal_vein_catheterization_for_localization_of_sporadic_and_MEN_gastrinomas:_a_ten_year_experience_ L2 - http://www.diseaseinfosearch.org/result/7025 DB - PRIME DP - Unbound Medicine ER -