LETTER
Somatostatin Receptor Scintigraphy in the Zollinger-Ellison Syndrome
Donato Ciaccia, MD, and
Frank G. Gress, MD
1 May 1997 | Volume 126 Issue 9 | Page 741
TO THE EDITOR:
We read with great interest the article by Gibril and coworkers [1] on the use of somatostatin receptor scintigraphy (SRS) for the detection of primary and metastatic gastrinomas in patients with the Zollinger-Ellison syndrome. The authors report a 58% sensitivity for diagnosing primary gastrinomas; this sensitivity was much higher than those of other methods-computed tomography, magnetic resonance imaging, angiography, and transabdominal ultrasonography.
However, we were surprised by the authors' failure to mention endoscopic ultrasonography (EUS) as the foremost diagnostic method for the localization of functioning islet cell tumors. The sensitivity of EUS for localization of hormonally active islet cell tumors has ranged from 57% to 100%, with a cumulative sensitivity of approximately 80% [2, 3]. In the diagnosis of primary gastrinomas, EUS has a reported sensitivity of 86% [4]. It can also detect local regional adenopathy. The downside is that EUS cannot adequately visualize the right lobe of the liver, and it is not useful for the detection of distant metastases other than those to the liver.
In addition, the advent of EUS-guided fine-needle aspiration biopsy [5] now allows localization, staging, and direct cytologic confirmation of suspected neuroendocrine tumors (Ciaccia D, Gress FG. Unpublished data). In academic health centers, where patients suspected of having active neuroendocrine tumors might be referred, EUS is becoming more widely available. Both the accuracy and availability of EUS should prompt physicians to consider it as the first diagnostic study in patients suspected of having a hormonally active islet cell tumor that is not metastatic. A study comparing SRS and EUS as diagnostic methods for the localization of islet cell tumors is needed. The omission of this information seriously detracts from what is otherwise an important paper in the management of gastrinomas and other islet cell tumors.
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Author and Article Information
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Indiana University Medical Center, Indianapolis, IN 46202
1. Gibril F, Reynolds JC, Doppman JL, Chen CC, Venzon DJ, Termanini B, et al. Somatostatin receptor scintigraphy: its sensitivity compared with that of other imaging methods in detecting primary and metastatic gastrinomas. Ann Intern Med. 1996; 125:26-34.
2. Rosch T, Lightdale C, Botet J, Boyce G, Sivak M, Yasuda K, et al. Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med. 1992; 326:1721-6.
3. Rosch T, Classen M. Pancreatic endocrine tumors. In: Gastroenterologic Endosonography: Textbook and Atlas. New York: Thieme Medical Publishers; 1992:134-9.
4. Ruszniewski P, Amouyal P, Amouyal G, Grange JD, Mignon M, Bouche O, et al. Localization of gastrinomas by endoscopic ultrasonography in patients with Zollinger-Ellison syndrome. Surgery. 1995; 117:629-35.
5. Chang KJ, Katz KD, Durbin TE, Erickson RA, Butler JA, Lin F, et al. Endoscopic ultrasound-guided fine-needle aspiration. Gastrointest Endosc. 1994; 40:694-9.
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