Comparison of the diagnostic accuracy of the current guidelines for detecting insulinoma

Abstract

Objective: Insulinomas are rare pancreatic endocrine tumors characterized by hypoglycemia. Guidelines by the Endocrine Society (ES), the European (ENETS) and the North American (NANETS) Neuroendocrine Tumor Societies provide divergent diagnostic criteria. This study compared the diagnostic accuracy of these different criteria during the 72-h fasting test. Design: Retrospective cohort study. Methods: From 2000 to 2014, 64 patients with a suspected insulinoma underwent a 72-h fasting test and were included in the analysis. This study assessed the diagnostic sensitivity , specificity and accuracy based on venous blood glucose and corresponding insulin levels measured by electrochemiluminescence immunoassay (ECLIA). Results: Based on 64 individuals (18 with, 46 without insulinoma), the ES criteria provided a diagnostic sensitivity of 0.94 (0.73-1.00), specificity of 0.89 (0.76-0.96) and accuracy o f 0.91 (0.81-0.96). ENETS/NANETS criteria reached a diagnostic sensitivity of 0.78 (0.52-0.94), specificity of 1.00 (0.92-1.00) and accuracy of 0.94 (0.85-0.98). Conclusions: These results point to a higher diagnostic sensitivity with le ss specificity for diagnosing insulinoma using ES criteria and a higher specificity at lower sensitivity by usi ng ENETS/NANETS criteria. Before considering these results when applying the different criteria in clinical practice, the r esults should be confirmed in further studies comprising larger cohorts.