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Indira Theresia Ongkowidjaja
Perbandingan antara risk of ovarian malignancy algorithm roma dengan risk of malignancy index RMI dalam memprediksi keganasan tumor ovarium epitelial 2012-2014 = Comparison of diagnostic value roma risk of ovarian malignancy algorithm with rmi risk of malignancy index to predict ovarian cancer epitelial type obstetric and gynecology faculty of medicine cipto mangunkusumo hospital 2012 2014
"Penelitian ini bertujuan untuk membandingkan ROMA dengan RMI dalam memprediksi keganasan tumor ovarium epitelial di RS dr. Cipto Mangunkusumo (RSUPNCM). Penelitian ini merupakan uji diagnostik dengan desain potong lintang yang dilakukan di Departemen Obstetri dan Ginekologi, RSUPNCM. Pada penelitian ini, dari 213 subjek diperoleh sensitivitas dan spesifisitas RMI 85.3%, dan 66.3%, Nilai Duga Positif dan Negatif RMI 79.7%, dan 74.3%, Rasio Kemungkinan Positif dan Negatif RMI 2.53, dan 0.22; dan sensitivas dan spesifisitas ROMA 95.4%, dan 32.5%, Nilai Duga Positif dan Negatif 68.9%, dan 81.8%, Rasio Kemungkinan Positif dan Negatif 1.41, dan 0.14. AUC ROMA lebih baik daripada RMI, tetapi tidak bermakna secara statistik (seluruh kelompok: AUC 69.56%>67.49%, perbedaan AUC 0.0207, p 0.526; kelompok pascamenopause: AUC 91.47%>88.97%, perbedaan AUC 0.0250, p 0.0571; kelompok premenopause: AUC 86.20%>78.16%, perbedaan AUC 0.0804, p 0.0571). Pada titik potong ideal (RMI 330, ROMA premenopause 30,4; dan pascamenopause 53.1), ROMA mempunyai sensitivitas dan spesifitas yang lebih baik dibandingkan RMI (sensitivitas 82.31% vs 74.62%; spesifisitas 78.31% vs 75.9%). Dapat disimpulkan bahwa tidak terdapat perbedaan antara ROMA dengan RMI, tetapi sensitivitas dan spesifisitas ROMA lebih baik daripada RMI pada titik potong ideal.
The purpose of this research is to compare ROMA with RMI to predict malignancy of ovarian tumor, epithelial type in Indonesia, especially at the Cipto Mangunkusumo hospital. It was a cross sectional study with a diagnostic design, which was performed in the Oncology Gyneology division. From 213 sampels, the RMI showed a sensitivity of 85.3%, a specificity of 66.3%, a PPV of 79.7%, a NPV of 74.3%, a LR+ of 2.53, LR- 0.22 and an accuracy of 0.77; while ROMA has a sensitivity of 95.4%, a specificity of 32.5%,a PPV 68.9% of, a NPV of 81.8%, a LR+ 1.41, LR- 0.14 and an accuracy of 0.71. Overall AUC ROMA indicated better results compared to those results using the RMI diagnostic method, (all groups: AUC 69.56%>67.49%, p 0.526; as with the postmenopause group: the AUC was 91.47%>88.97%, p 0.0571; and the premenopause group: the AUC 86.20%>78.16%, p 0.0571). At ideal the cut-off point (RMI 330, ROMA premenopause 30,4; and postmenopause 53.1), ROMA has shown better sensitivity and specificity than RMI (sensitivity 82.31% vs 74.62%; specificity 78.31% vs 75.9%). It can be concluded that there is no significantly different between ROMA and RMI, but at ideal cut off, sensitivity and specificity ROMA better than RMI."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
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Yuri Feharsal
Perbandingan performa diagnostik sistem skoring international ovarian tumor analysis dengan risk of malignancy index 4 dan indeks morfologi sassone dalam memprediksi keganasan ovarium prabedah = Comparison of diagnostic performance of scoring system of international ovarian tumor analysis with risk of malignancy index 4 and sassone morphology index to predict ovarian malignancy preoperatively
"Penelitian ini membahas perbandingan performa diagnostik sistem skoring International Ovarian Tumor Analysis (IOTA) dengan Risk of Malignancy Index-4 (RMI-4) dan indeks morfologi Sassone dalam memprediksi keganasan ovarium prabedah. Dilakukan uji diagnostik potong-lintang secara retrospektif dengan pasien neoplasma ovarium di RSUPN Dr. Cipto Mangunkusumo dari Januari hingga Desember 2013. Nilai diagnostik dari keempat metode skoring dihitung dengan luaran: sensitivitas, spesifisitas, nilai prediksi positif, nilai prediksi negatif, akurasi dan nilai AUC. Penelitian ini menyimpulkan IOTA simple-rules memiliki performa diagnostik lebih baik dibandingkan IOTA subgroup, RMI-4 dan indeks morfologi Sassone.
This study compared diagnostic performance of scoring system of International Ovarian Tumor Analysis (IOTA) with Risk of Malignancy Index-4 (RMI-4) and Sassone morphology index to predict ovarian malignancy preoperatively. A retrospective study was done involving subject with ovarian neoplasm at National General Hospital Dr. Cipto Mangunkusumo on January to December 2013. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and AUC value were calculated. This study concluded that diagnostic performance of IOTA simple-rules were significantly better than IOTA subgroup, RMI-4 and Sassone morphology index."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
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Shirley Mansur
Perbandingan sensitivitas dan spesifisitas dari Skor Gatot, modifikasi Skor Gatot dan Risk Malignancy Index dalam memprediksi Keganasan Ovarium = Comparison of sensitivity and specificity of Gatot Score and its modification also Risk Malignancy Index in predicting Ovarian Malignancies / Shirley Mansur
"Tujuan : Penelitian ini ditujukan untuk mengevaluasi sensitivitas dan spesifisitas dari beberapa metode penapisan keganasan pada tumor ovarium jenis epitelial dengan membandingkan Skor Gatot dan Risk Malignancy Index, serta mengajukan modifikasi Skor Gatot.
Metode : Empat ratus satu pasien dengan kecurigaan keganasan ovarium tipe epithelial dimasukkan sebagai subjek penelitian, dilakukan prosedur anamnesis, pemeriksaan fisik, laboratoris dan ultrasonografi. Dari data tersebut, diambil variabel-variabel yang sesuai dengan Skor Gatot dan Risk Malignancy Index. Dilakukan analisa statistik berupa perhitungan sensitivitas dan spesifisitas serta ROC dan titik potong optimal.
Hasil : Dari 401 subjek penelitian, didapatkan bahwa Skor Gatot memiliki sensitivitas 73.7% dan spesifitas 45.6% (p = 0.000; LR 28.830) sedangkan RMI memiliki nilai sensitivitas 72.4%, spesifisitas 35.94% (p = 0.02, LR 9.588) untuk RMI 1 dan nilai sensitivitas 76%, spesifisitas 30.9% (p = 0.05; LR 7.984) untuk RMI 2. Dilakukan modifikasi pada Skor Gatot dengan pembobotan ulang pada tiap variabel, didapatkan hasil Modifikasi Skor Gatot 1 memiliki titik potong pada nilai 28.5 dengan sensitivitas sebesar 60.4% dan spesifisitas sebesar 61.4% (p= 0.000, LR 44.228) dan Modifikasi Skor Gatot 2 memiliki nilai potong pada titik 5.75 dengan kisaran nilai sensitivitas 49.3 – 69.6% dan sensitivitas 51.6-65.2% ( p = 0.000; LR 36.806).
Kesimpulan : Skor Gatot dan RMI memberikan hasil yang kurang memuaskan dalam melakukan prediksi keganasan ovarium. Dengan melakukan pembobotan ulang pada tiap variabel pada Skor Gatot, sensitivitas dan, terutama, spesifisitas dapat ditingkatkan dalam mendeteksi adanya keganasan ovarium tipe epitelial. Hal ini ditujukan agar dapat meningkatkan prediksi keganasan pada pasien dalam usia reproduksi.
Objective : The study was designed to evaluate the sensitivity and specificity of several methods in detecting ovarian epithelial malignancy by comparing Gatot Score and Risk Malignancy Index, and also proposing the modification of Gatot Score.
Method : Four hundred and one subjects with suspected epithelial ovarian malignancy entered the study and performed anamnesis, physical examinations, laboratories studies and ultrasonography. From the data, we took the variables according to Gatot Score and Risk Malignancy Index. We performed statistic analysis in term of sensitivity, specificity, ROC and optimal cut-off-point.
Results : From 401 observation subjects, revealed that Gatot Score possess the sensitivity of 73.7% and specificity of 45.6% (p = 0.000; LR 28.830), while RMI possess the sensitivity of 72.4% and specificity of 35.94% (p = 0.02, LR 9.588) for RMI 1, and the sensitivity of 76% and specificity of 30.9% (p = 0.05; LR 7.984) for RMI 2. Modification to Gatot Score was performed by re-weighting to its all variables, which resulted in Gatot Score Modification 1 with cut-off point of 28.5, sensitivity of 60.4% and specificity of 35.94% (p= 0.000, LR 44.228) and Gatot Score Modification 2 with cut-off point of 5.75, sensitivity range between 49.3 – 69.6% and specificity range between 51.6-65.2% ( p = 0.000; LR 36.806).
Summary : Both Gatot Score and RMI resulted in unsatisfactory output in predicting the malignancy of ovary. By reassigning the weighting of all variables in Gatot Score, especially the specificity was improved in detecting the malignancy of epithelial type ovary. This measure was directed for patients in reproductive ages, thus increasing the possibility of true malignancy."
Fakultas Kedokteran Universitas Indonesia, 2012
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Liva Wijaya
Prediksi keganasan ovarium dari skor gatot purwoto gp risk malignancy index rmi dan potong beku pada usia muda = Prediction of ovarian malignancy by gatot purwoto score rmi and frozen section in young age
"Penelitian ini bertujuan untuk mengetahui nilai diagnostik skor prabedah dan prosedur potong beku pada pasien keganasan ovarium usia muda. Selain itu, penelitian ini ingin mengetahui apakah potong beku menambah nilai prediksi skor prabedah. Penelitian ini dilakukan dengan mengambil data RSCM dari tahun 2006-2010. Kami mendapatkan 437 pasien dengan diagnosis neoplasma ovarium kistik. Seratus lima puluh tujuh pasien berusia dibawah 40 tahun. Nilai diagnostik skor GP pada keganasan usia muda berturut turut sensitivitas, spesifitas, nilai duga positif, nilai duga negatif, dan akurasi sebesar 77%, 49%, 61%, 68%, dan 63% sedangkan RMI memberikan nilai diagnostik berturut-turut 69%, 49%, 58%, 45%, dan 59%, hasil yang tidak jauh berbeda dengan skor GP. Nilai diagnostik prosedur potong beku pada keganasan usia muda dengan skor GP >4 berturut turut sensitivitas, spesifitas, nilai duga positif, nilai duga negatif, dan akurasi sebesar 81.7%, 87.2% , 90.7%, 75.6%, dan 83%, sedangkan untuk RMI >200 nilai diagnostik berturut-turut adalah 81%, 87%, 89%, 77%, dan 83%. Potong beku menambah 6% dari prediksi prabedah skor GP dan 12% dari prediksi prabedah RMI.
The aim of this paper is to know the diagnostic value of scoring system that taken before surgery and frozen section in the young age patient suspected malignancy. Using that result, we can also know whether the frozen section give additional value to clinical scoring system or not. This research was undergone by using RSCM’s medical record from 2006-2010. From 437 patients suspected ovarian malignancy, we took only 157 patients due to their age. Diagnostic value of GP score are 77%, 49%, 61%, 68%, 63%, while RMI are 69%, 49%, 58%, 45%, 59%, (sensitivity, spesifity, positive prediction value, negative predictive value, and accuracy respectively). Diagnostic value of frozen section in patient suspected malignancy using GP score >4 are 81.7%, 87.2%, 90.7%, 75.6%, 83%, while in patient with RMI > 200 are 81%, 87%, 89%, 77%, 83% (sensitivity, spesifity, positive prediction value, negative predictive value, and accuracy respectively). Frozen section only gave 6% additional value for GP score and 12% for RMI score."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
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Nasution, Hiro Hidaya Danial
Ekspresi Immediate Early Response Gene X-1 (IEX-1) Saliva Sebagai Prediktor Keganasan Pada Tumor Ovarium Epitelial Di RSUPN Dr. Cipto Mangunkusumo Jakarta = Salivary Immediate Early Response Gene X-1 (IEX-1) Expression as a Predictor of Malignancy in Epithelial Ovarian Tumors at RSUPN Dr. Cipto Mangunkusumo Jakarta
"Latar Belakang : Sampai saat ini kanker ovarium masih menjadi salah satu kanker dengan angka mortalitas yang tinggi pada wanita dikarenakan tidak dijumpainya gejala yang khas sehingga lebih banyak kasus terdiagnosis pada stadium lanjut. Belum adanya metode skrining menjadikan pentingnya metode diagnostik yang mempunyai sensitivitas dan spesifisitas yang tinggi. Evaluasi biomarker yang baru diperlukan untuk dapat mendeteksi tumor ovarium ganas pada stadium awal.
Objektif : Penelitian ini dilakukan untuk menilai ekspresi Immediate Early Response Gene X-1 (IEX-1) saliva sebagai prediktor keganasan pada tumor ovarium epitelial.
Metode : Merupakan penelitian uji diagnostik pada pasien tumor ovarium yang direncanakan operasi elektif dengan mengambil 3-5 ml saliva pasien sebelum tindakan operasi. Subjek penelitian yang memenuhi kriteria inklusi dan eksklusi dibagi menjadi dua kelompok berdasarkan hasil histopatologi yaitu tumor ovarium epitelial jinak dan ganas. Dilakukan pemeriksaan ekspresi IEX-1 saliva dengan metode Real Time qPCR.
Hasil : Hasil penelitian ini didapat dari 47 subjek, 22 subjek tumor ovarium epitelial ganas dan 25 subjek merupakan tumor ovarium epitelial jinak. Rerata ekspresi IEX-1 saliva lebih tinggi pada tumor ovarium epitelial jinak (1,976) dibandingkan ganas (0,554) (p<0,001). Didapatkan nilai AUC ekspresi IEX-1 0,949 (IK95% 0,894-1,000), nilai cut off point IEX-1 saliva ≥ 0.9115 dengan sensitivitas 84%, spesifisitas 86,4%, nilai duga positif 82,6% dan nilai duga negatif 87,5%. Terdapat hubungan yang signifikan antara ekspresi IEX-1 saliva dengan kejadian tumor ovarium epitelial ganas (OR 5,031, IK95% 2,039-12,41; p<0,001).
Kesimpulan : Terdapat hubungan yang bermakna antara penurunan ekspresi IEX-1 saliva dengan kejadian tumor ovarium epitelial ganas dengan sensitivitas dan spesifisitas yang cukup baik.
Backgound: Ovarian cancer is still one of the cancers with a high mortality rate in women because there are no typical symptoms so that more cases are diagnosed at an advanced stage. The absence of a screening method makes the importance of a diagnostic method that has high sensitivity and specificity. Evaluation of new biomarkers is needed to detect malignant ovarian tumors at an early stage.
Objectives: This study was conducted to assess the expression of salivary Immediate Early Response Gene X-1 (IEX-1) as a predictor of malignancy in epithelial ovarian tumors.
Methods: This is a diagnostic test study in ovarian tumor patients who are planned for elective surgery by taking 3-5 ml of patient's saliva before surgery. Research subjects who met the inclusion and exclusion criteria were divided into two groups based on the histopathological results, benign and malignant epithelial ovarian tumors. The salivary IEX-1 expression was examined using the Real Time qPCR method.
Results: The results of this study were obtained from 47 epithelial ovarian tumors subjects, 22 malignant tumors and 27 benign tumors. The mean salivary IEX-1 expression was higher in benign epithelial ovarian tumors (1.976) than in malignant (0.554) (p<0.001). The AUC expression value of IEX-1 was 0.949 (95% CI 0.894-1,000), salivary IEX-1 cut off point value was 0.9115 with sensitivity 84%, specificity 86.4%, positive predictive value 82.6% and negative predictive value 87, 5%. There was a significant relationship between salivary IEX-1 expression and the event of malignant epithelial ovarian tumors (OR 5.031, 95% CI 2.039-12.41; p<0.001).
Conclusions: There is a significant correlation between decreased salivary IEX-1 expression and the event of malignant epithelial ovarian tumors with a good sensitivity and specificity."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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Yayi Dwina Bilianti Susanto
Perubahan arsitektur dan sitomorfologi sel pada cairan peritoneum sebagai penanda keganasan neoplasma epitelial ovarium = Architectural and cytomorphology changes in peritoneal fluid as a sign of malignancy in ovarian epithelial neoplasm / Yayi Dwina Bilianti Susanto
"[ABSTRAK
Latar belakang: Interpretasi cairan peritoneum yang tepat secara sitopatologi sangat
mempengaruhi tatalaksana dan prognosis pasien, padahal pemeriksaan sitopatologi cairan
peritoneum masih memiliki nilai negatif palsu dan positif palsu yang cukup tinggi, dan
hingga saat ini penelitian tentang arsitektur sitopatologi maupun penanda sitomorfologi yang
mengarahkan pada adanya sel neoplasma di cairan peritoneum masih menunjukkan hasil
yang beragam.
Bahan dan cara kerja: Penelitian potong lintang dengan data sekunder berupa slaid
dan formulir sediaan sitopatologi cairan peritoneum yang memiliki data berpasangan dengan
diagnosis histopatologi. Diagnosis klinis berupa neoplasma epitelial ovarium. Slaid dan
formulir diambil dari arsip Departemen Patologi Anatomik FKUI/RSCM tahun 2011 ? 2012,
dilakukan pembacaan ulang semua slaid sitopatologi dengan diagnosis akhir dikategorikan
sebagai positif atau negatif, peneliti membaca pula sediaan histopatologi untuk mengetahui
morfologi sel pada lesi, kemudiaan dilakukan penilaian terhadap arsitektur sitopatologi
berupa: selularitas, sel berkelompok, struktur papiler, intercelular windows, group contours,
jisim psamoma, dan penanda sitomorfologi berupa: atipia inti, inti bertumpuk, anak inti,
rasio inti:sitoplasma, ukuran inti, dan ukuran sel.
Hasil penelitian: Sampel penelitian sejumlah 47 sediaan sitopatologi dengan
diagnosis sitopatologi akhir 34 kasus (72.3%) negatif, 13 kasus (27.7%) positif. Terdapat
perbedaan bermakna arsitektur sitopatologi berupa: selularitas (p = 0.017), sel berkelompok
(p = 0.001), intercellular windows (p = 0.00), group contours (p = 0.00), dan gambaran
sitomorfologi berupa: atipia inti (p = 0.00), inti bertumpuk (p = 0.001), anak inti (p = 0.001),
rasio inti:sitoplasma (p = 0.00), ukuran inti (p = 0.00), ukuran sel (p = 0.00) antara cairan
peritoneum positif dan negatif. Melalui uji multivariat didapatkan penanda yang paling
berpengaruh terhadap diagnosis sitopatologi positif atau negatif yaitu: intercellular windows,
atipia inti, dan selularitas.
Kesimpulan: Terdapat tiga penanda yang paling berpengaruh terhadap diagnosis
positif ditemukannya sel neoplasma ganas dalam cairan peritoneum pada kasus dengan lesi
ovarium, secara berturut - turut yaitu: tidak ditemukannya intercellular windows pada
kelompokan sel, sel memiliki atipia inti sedang hingga berat, dan selularitas lebih dari 20
kelompok dari keseluruhan sediaan apus.
ABSTRACT
Background : Peritoneal fluid cytopathology interpretation profoundly influences patients
management and prognosis, however this practice still has high false positive and false
negative value, and until now research concerning the architectural and cytomorphology
features for detecting malignant cells in peritoneal fluid still has various result.
Materials and Methods : Cross sectional study using secondary data of peritoneal fluid
cytopathology and histopathology slides and form, from patients with clinical diagnosis of
ovarian epithelial neoplasm. The data was taken from the archive of Anatomical Pathology
Department Cipto Mangunkusumo Hospital 2011 ? 2012. The researchers examined the
cytopathology slides and also examined the histopatology slide for morphology comparison,
and then make a final cytopathological diagnosis of positive peritoneal fluid containing
neoplastic cells or negative. Architectural features including: cellularity, cells grouping,
papillary structure, intercellular windows, group contours, psamoma bodies, and
cytomorphology features including: nuclear atypia, overlapping nuclei, nucleoli, nuclei :
cytoplasm ratio, the dimension of the nuclei and cells were also examined.
Result : There were 47 samples with final cytopathology diagnosis: 34 cases (72.3%)
negative for neoplastic cells in the peritoneal fluid and 13 cases (27.7%) positive. There were
significant differences in cytopathology architectural including cellularity (p = 0.017), cells
grouping (p = 0.001), intercellular windows (p = 0.00), group contours (p = 0.00) and
cytomorphology features including nuclear atypia (p = 0.00), overlapping nuclei (p = 0.001),
nucleoli (p =0.001), nuclei : cytoplasm ratio (p = 0.00), the dimension of nuclei (p = 0.00),
the dimension of cell (p = 0.00) between the positive and negative peritoneal fluid
cytopathology. Using multivariate analysis there were 3 cytological features that have the
strongest association with positive or negative peritoneal cytopathology diagnosis, they were:
intercellular windows, nuclear atypia, and cellularity.
Conclusion: In peritoneal fluid cytopathology for examining ovarian lesion there were 3
cytological features that have the strongest association with finding neoplastic cells in
peritoneal fluid, they were: the absent of intercellular windows, moderate to severe
cytological atypia, and cellularity more than 20 groups in all smear preparation, Background : Peritoneal fluid cytopathology interpretation profoundly influences patients
management and prognosis, however this practice still has high false positive and false
negative value, and until now research concerning the architectural and cytomorphology
features for detecting malignant cells in peritoneal fluid still has various result.
Materials and Methods : Cross sectional study using secondary data of peritoneal fluid
cytopathology and histopathology slides and form, from patients with clinical diagnosis of
ovarian epithelial neoplasm. The data was taken from the archive of Anatomical Pathology
Department Cipto Mangunkusumo Hospital 2011 – 2012. The researchers examined the
cytopathology slides and also examined the histopatology slide for morphology comparison,
and then make a final cytopathological diagnosis of positive peritoneal fluid containing
neoplastic cells or negative. Architectural features including: cellularity, cells grouping,
papillary structure, intercellular windows, group contours, psamoma bodies, and
cytomorphology features including: nuclear atypia, overlapping nuclei, nucleoli, nuclei :
cytoplasm ratio, the dimension of the nuclei and cells were also examined.
Result : There were 47 samples with final cytopathology diagnosis: 34 cases (72.3%)
negative for neoplastic cells in the peritoneal fluid and 13 cases (27.7%) positive. There were
significant differences in cytopathology architectural including cellularity (p = 0.017), cells
grouping (p = 0.001), intercellular windows (p = 0.00), group contours (p = 0.00) and
cytomorphology features including nuclear atypia (p = 0.00), overlapping nuclei (p = 0.001),
nucleoli (p =0.001), nuclei : cytoplasm ratio (p = 0.00), the dimension of nuclei (p = 0.00),
the dimension of cell (p = 0.00) between the positive and negative peritoneal fluid
cytopathology. Using multivariate analysis there were 3 cytological features that have the
strongest association with positive or negative peritoneal cytopathology diagnosis, they were:
intercellular windows, nuclear atypia, and cellularity.
Conclusion: In peritoneal fluid cytopathology for examining ovarian lesion there were 3
cytological features that have the strongest association with finding neoplastic cells in
peritoneal fluid, they were: the absent of intercellular windows, moderate to severe
cytological atypia, and cellularity more than 20 groups in all smear preparation]"
2015
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Hari Sandi Sumardi Wiranegara
Analisis aktivitas superoxide dismutase dan malindaldehyde pada penderita keganasan ovarium dan tumor jinak ovarium = Analysis of activity of superoxide dismutase and malondialdehyde in patients with ovarian malignancy and ovarian benign tumors
"Kanker ovarium masih menempati urutan kedua terbanyak dalam keganasan ginekologi dan merupakan penyebab utama kematian akibat kanker pada perempuan. Banyak bukti menunjukkan bahwa kanker ovarium umunya dalam pengaruh stress oksidatif. Dalam penelitian ini bertujuan untuk mengetahui aktivitas stress oksidatif melalui pengukuran enzim Superoxide Dismutase (SOD) dan kadar Malondialdehyde (MDA) pada penderita keganasan ovarium dibandingkan dengan penderita tumor jinak ovarium. Penelitian dilakukan dengan uji potong-lintang yang dilaksanalan di Ruang Rawat Kebidanan Ginekologi RSCM Jakarta, RS Persahabatan Jakarta dan RS Fatmawati Jakarta pada Juli hingga Desember 2018. Seluruh penderita keganasan ovarium dan penderita tumor jinak ovarium yang memenuhi kriteria diikutsertakan dalam penelitian ini. Darah penderita tumor ovarium diambil sebelum dilakukan operasi, lalu sampel dilakukan pengukuran kadar SOD dan MDA. Terdapat 35 penderita keganasan ovarium dan 43 penderita tumor jinak ovarium yang diikutsertakan dalam penelitian ini. Rerata atau median kadar SOD dan MDA pada penderita keganasan ovarium adalah 1,23 (0,24-5,709) dan 0,803 ± 0,316 , sementara rerata atau median kadar SOD dan MDA pada penderita tumor jinak ovarium adalah 0,488 (0,101-1,86) dan 0,634 ± 0,266. Terdapat perbedaan kadar SOD dan MDA yang bermakna antara kedua kelompok. Terdapat perbedaan kadar SOD yang bermakna antara penderita keganasan ovarium stadium awal dengan penderita keganasan ovarium stadium lanjut. Sementara pada pemeriksaan MDA tidak terdapat perbedaan bermakna antara penderita stadium awal dengan stadium lanjut. Kesimpullan pada penelitian ini terdapat perbedaan kadar SOD dan MDA yang bermakna antara penderita keganasan ovarium dengan penderita tumor jinak ovarium.
Ovarian cancer is the leading cause of death due to gynecological malignancies among women. A lot of evidence shows that ovarian cancer is generally influenced by oxidative stress. In this study aims to determine the activity of SOD enzymes and MDA levels in patients with ovarian malignancies and patients with benign ovarian tumors. The study was conducted by cross-sectional tests carried out in the RSCM Jakarta Gynecology Obstetric Room and Persahabatan Hospital Jakarta and Fatmawati Hospital Jakarta in July to December 2018. All patients with ovarian malignancies and patients with benign ovarian tumors who met the criteria were included in this study. Blood from ovarian tumor patients taken before surgery, then the samples were measured for SOD and MDA levels. There were 35 ovarian malignancies and 43 patients with benign ovarian tumors included in the study. The mean or median level of SOD and MDA in patients with ovarian malignancy is 1.23 (0.24 - 5.709) and 0.803 ± 0.316, while the mean or median level of SOD and MDA in patients with benign ovarian tumors is 0.488 (0.101-1.86) and 0.634 ± 0.266. There were significant differences in SOD and MDA levels between the two groups. There were significant differences in SOD levels between patients with early-stage ovarian malignancies and those with advanced ovarian malignancies. While on MDA examination there were no significant differences between patients with early stages with advanced stages. Conclusion in this study were significant differences in SOD and MDA levels between ovarian malignancies and patients with benign ovarian tumors"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
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Vita Silvana
Penentuan titik potong optimal kadar serum Retinol Binding Protein-4 untuk memprediksi risiko kejadian resistensi insulin pada sindrom ovarium poli kistik dengan indeks masa tubuh normal = Serum Retinol Binding Protein-4 cut off level to predict the risk of insulin resistance on polycystic ovarian syndrome with normal body mass index
"ABSTRAK
Latar Belakang: Sindrom Ovarium Polikistik (SOPK) merupakan penyebab 40%
infertilitas pada wanita usia reproduksi. Resistensi insulin sebagai salah satu
patofisiolofi yang mendasari SOPK, berkaitan erat dengan jaringan adiposa
viseral dan ditemukan pada 30-50% pasien SOPK dengan indeks masa tubuh
normal serta lingkar pinggang kurang dari 80 cm. Retinol Binding Protein-4
(RBP-4) yang disekresi oleh jaringan adiposa viseral diketahui sebagai salah satu
adipokin yang menyebabkan resistensi insulin. Pengukuran IMT dan lingkar
pinggang tidak dapat mewakili akumulasi jaringan adiposa viseral pada SOPK
dengan IMT normal serta lingkar pinggang kurang dari 80 cm. Dengan
diketahuinya titik potong optimal kadar serum RBP-4 sebagai penanda jaringan
adiposa viseral, diharapkan dapat memprediksi risiko kejadian resistensi insulin
yang bermanfaat dalam menentukan penatalaksanaan kasus SOPK dengan IMT
normal terkait strategi pengurangan akumulasi jaringan adiposa viseral.
Tujuan: Diketahuinya titik potong optimal kadar serum RBP-4 sebagai penanda
jaringan adiposa viseral untuk memprediksi risiko kejadian resistensi insulin pada
penderita SOPK dengan IMT normal.
Metode: Studi observasional dengan desain potong lintang selama periode Juli
2014 hingga Maret 2015 di Poliklinik Yasmin, RSCM, Jakarta.
Hasil: Sejumlah 40 subjek SOPK dengan IMT normal yang memenuhi kriteria
inklusi didapatkan 16 subjek (40%) yang mengalami resistensi insulin dan 24
subjek (60%) nir resistensi insulin. Sejumlah 23 subjek (57.5%) memiliki lingkar
pinggang kurang dari 80 cm, dimana 6 subjek (26%) diantaranya mengalami
resistensi insulin. Kadar serum RBP-4 pada kelompok resistensi insulin bermakna
lebih tinggi dibandingkan nir resistensi insulin (p 0.008). Dengan analisis ROC
didapatkan AUC kadar serum RBP-4 78.8% (IK 95% -8445.59 ? -1447.98)
dengan nilai p 0.002. Titik potong optimal kadar serum RBP-4 adalah 24133
ng/mL dengan sensitivitas sebesar 75% dan spesifisitas sebesar 75%. Dengan
analisis regresi logistik biner didapatkan pemeriksaan serum RBP-4 menambah
nilai diagnostik dari parameter demografis dan klinis AUC 85.7% menjadi 91.1%.
Kesimpulan: Kadar serum RBP-4 sebagai penanda jaringan adiposa viseral dapat digunakan untuk memprediksi risiko kejadian resistensi insulin pada penderita SOPK dengan IMT normal. ABSTRACT Background: Polycystic ovarian syndrome (PCOS) contributes to fourty percent
of infertility?s issues on reproductive women. Insulin resistance as one of
important pathophysiology in PCOS, correlates with visceral adipose tissue and is
found on 30-50% PCOS patients with normal body mass index and waist
circumference less than 80 cm. Retinol Binding Protein-4 (RBP-4), which is
secreted by visceral adipose tissue, known as one of adipokines that cause insulin
resistance. The measurement of body mass index and waist circumference could
not represent visceral adiposity on PCOS with normal body mass index and waist
circumference less than 80 cm. Determination of serum RBP-4 cut off level as
visceral adipose tissue marker hopefully could predict the risk of insulin
resistance on polycystic ovarian syndrome with normal body mass index,
therefore it will be useful on its management related to reduction of visceral
adiposity.
Objective: To obtain serum RBP-4 cut off level as visceral adipose tissue marker
to predict the risk of insulin resistance on PCOS with normal body mass index.
Method: This was an observational study with cross sectional design conducted at
Yasmin Clinic, RSCM, Jakarta during a period of July 2014 until March 2015.
Result: Fourty PCOS patients with normal body mass index were participated on
this study. There were 16 subjects (40%) who were insulin resistance and 24
subjects (60%) who were not insulin resistance. There were 23 subjects (57.5%)
who had waist circumference less than 80 cm, where 6 of them (26%) were
insulim resistance. Serum RBP-4 level was significantly higher on insulin
resistance group (p 0.008). After ROC analysis was performed, AUC of serum
RBP-4 was 78.8% (CI 95% -8445.59 ? -1447.98, p 0.002). The cut off level of
serum RBP-4 was 24133 ng/mL with sensitivity 75% and specificity 75%. After
logistic regression analysis was performed, it was found that serum RBP-4 increase diagnostic value of demographic and clinical parameter with AUC 85.7% to 91.1%. ;Background: Polycystic ovarian syndrome (PCOS) contributes to fourty percent
of infertility?s issues on reproductive women. Insulin resistance as one of
important pathophysiology in PCOS, correlates with visceral adipose tissue and is
found on 30-50% PCOS patients with normal body mass index and waist
circumference less than 80 cm. Retinol Binding Protein-4 (RBP-4), which is
secreted by visceral adipose tissue, known as one of adipokines that cause insulin
resistance. The measurement of body mass index and waist circumference could
not represent visceral adiposity on PCOS with normal body mass index and waist
circumference less than 80 cm. Determination of serum RBP-4 cut off level as
visceral adipose tissue marker hopefully could predict the risk of insulin
resistance on polycystic ovarian syndrome with normal body mass index,
therefore it will be useful on its management related to reduction of visceral
adiposity.
Objective: To obtain serum RBP-4 cut off level as visceral adipose tissue marker
to predict the risk of insulin resistance on PCOS with normal body mass index.
Method: This was an observational study with cross sectional design conducted at
Yasmin Clinic, RSCM, Jakarta during a period of July 2014 until March 2015.
Result: Fourty PCOS patients with normal body mass index were participated on
this study. There were 16 subjects (40%) who were insulin resistance and 24
subjects (60%) who were not insulin resistance. There were 23 subjects (57.5%)
who had waist circumference less than 80 cm, where 6 of them (26%) were
insulim resistance. Serum RBP-4 level was significantly higher on insulin
resistance group (p 0.008). After ROC analysis was performed, AUC of serum
RBP-4 was 78.8% (CI 95% -8445.59 ? -1447.98, p 0.002). The cut off level of
serum RBP-4 was 24133 ng/mL with sensitivity 75% and specificity 75%. After
logistic regression analysis was performed, it was found that serum RBP-4 increase diagnostic value of demographic and clinical parameter with AUC 85.7% to 91.1%. "
Fakultas Kedokteran Universitas Indonesia, 2015
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Adithya Welladatika
Kesintasan 5 Tahun Pasien Kanker Ovarium Epitelial Stadium Lanjut yang Menjalani Operasi Sitoreduksi di RSUPN Cipto Mangunkusumo = Overall Survival of Advanced Stage of Epithelial Ovarian Cancer Patients Underwent Debulking Surgery at Ciptomangunkusumo Hospital.
"Latar Belakang: Kanker ovarium merupakan kanker kedelapan tersering, terhitung hampir 4% dari semua kanker pada perempuan di dunia. Kanker ovarium memiliki prognosis yang buruk dan angka kematian tertinggi. Setiap tahunnya terdapat 225.000 perempuan yang terdiagnosis kanker ovarium dan 140.000 perempuan meninggal disebabkan oleh penyakit ini. Berdasarkan jumlah tersebut, 90% kasus merupakan kanker ovarium epitelial. Bila berdasarkan stadium, lebih banyak pasien datang terdiagnosis dengan kanker ovarium stadium lanjut dibandingkan dengan stadium dini. Hal ini dikarenakan kanker ovarium bersifat asimtomatik, onset gejala yang terlambat dan belum adanya skrining yang terbukti efektif untuk kanker ovarium. Tujuan utama pengobatan kanker stadium lanjut adalah memperpanjang waktu untuk bertahan hidup dengan kualitas hidup yang baik dan tata laksana standarnya adalah operasi sitoreduksi. Di RSCM, evaluasi kesintasan dari pasien kanker ovarium epitelial stadium lanjut yang menjalani operasi sitoreduksi belum dianalisis.
Tujuan: Mengetahui kesintasan pasien kanker ovarium stadium lanjut yang menjalani operasi sitoreduksi di RSCM dan juga mengetahui kesintasannya berdasarkan hasil histopatologi dan pemberian kemoterapi ajuvan.
Metode: Penelitian ini merupakan penelitian kohort retrospektif dengan menggunakan data dari rekam medis. Pengambilan sampel dilakukan dengan cara consecutive sampling. Subjek penelitian adalah semua pasien kanker ovarium epitelial stadium lanjut yang menjalani operasi sitoreduksi pada bulan Januari 2013-Januari 2015 di RSCM.
Hasil: Dari 48 subjek yang diteliti, didapatkan sebanyak 23 (48%) subjek menjalani operasi sitoreduksi optimal dan 25 (52%) subjek menjalani operasi sitoreduksi suboptimal. Didapatkan kesintasan 5 tahun pada pasien yang menjalani operasi sitoreduksi optimal sebesar 43,5%, sedangkan untuk sitoreduksi suboptimal sebesar 32%. Pada pasien yang menjalani operasi sitoreduksi optimal, yang diberikan kemoterapi ajuvan didapatkan kesintasan 5 tahun sebesar 40%, sedangkan pada pasien yang tidak diberikan sebesar 46,2%. Pada pasien yang menjalani operasi sitoreduksi suboptimal, yang diberikan kemoterapi ajuvan didapatkan kesintasan 5 tahun sebesar 40%, sedangkan pada pasien yang tidak diberikan sebesar 20%. Pada pasien dengan hasil histopatologi seromusinosum didapatkan kesintasan 5 tahun sebesar 100%, sedangkan untuk serosa, musinosa, endometrioid dan sel jernih berturut-turut sebesar 50%, 33,3%, 25%, dan 21,4%.
Kesimpulan: Operasi sitoreduksi optimal memiliki kesintasan 5 tahun yang lebih baik dibandingkan dengan operasi sitoreduksi suboptimal. Operasi sitoreduksi suboptimal dan tidak dilanjutkan dengan pemberian kemoterapi ajuvan memiliki kesintasan yang buruk. Jenis histopatologi seromusinosum memiliki kesintasan yang lebih baik dibandingkan dengan jenis serosum, musinosum, endometrioid dan sel jernih.
Background: Ovarian cancer is the eighth most common cancer, almost 4% of all cancers in women in the world. Ovarian cancer has a poor prognosis and the highest mortality rate. Every year 225,000 women are diagnosed with ovarian cancer and 140,000 women die from this disease. Based on this number, 90% of cases are epithelial ovarian cancer. Based on stadium, more patients diagnosed with advanced-stage ovarian cancer compared with early stage, because ovarian cancer is asymptomatic, delayed onset and there is no screening that has proven effective for ovarian cancer. The standard management for advanced stage ovarian cancer is debulking surgery. At RSCM, evaluation of survival of advanced stage epithelial ovarian cancer patients who were performed debulking surgery has not been analyzed.
Objective: Knowing the survival of patients with advanced-stage ovarian cancer who underwent debulking surgery at RSCM and also knowing their survival based on histopathological results and adjuvant chemotherapy.
Methods: This was a retrospective cohort study using data from medical records. Sampling was done by consecutive sampling. The subjects of this study were all patients with advanced-stage epithelial ovarian cancer patients who were performed debulking surgery in January 2013-January 2015 at RSCM.
Results: From the 48 subjects, 23 (48%) subjects were performed optimal debulking surgery and 25 (52%) subjects were performed suboptimal debulking surgery. Overall survival in patients undergoing optimal debulking surgery is 43.5% with a median survival rate of 39 months, while for suboptimal debulking surgery is 32% with a median survival rate of 29 months. In patients who underwent optimal cytoreduction surgery, those given adjuvant chemotherapy obtained a overall survival is 40%, whereas in patients who were not given is 46.2%. In patients who underwent suboptimal cytoreduction surgery, those who were given adjuvant chemotherapy found a overall survival rate of 40%, whereas in patients who were not given is 20%. In patients with histopathological results seromucinous obtained 5-year survival by 100%, while for serous, mucous, endometrioid and clear cells simultaneously were 50%, 33.3%, 25%, and 21.4%.
Conclusion: Optimal debulking surgery has a better 5-year survival compared to suboptimal debulking surgery. Suboptimal cytoreduction surgery and not followed by adjuvant chemotherapy has poor survival. The histopathological type of seromucinous has better survival compared with the types of serous, mucinous, endometrioid and clear cells."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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Muhammad Isa Fuad Affan
Gynecological malignancy with obstructive uropathy patient profile in Cipto Mangunkusumo Hospital: our 2-year experience = Profil pasien keganasan ginekologis dengan uropati obstruktif di Rumah Sakit Cipto Mangunkusumo: pengalaman 2 tahun
"Pendahuluan dan tujuan: Keganasan ginekologis adalah salah satu penyebab kematian tersering pada perempuan. Hidronefrosis atau uropati obstruktif merupakan salah satu temuan tersering pada pasien dengan keganasan ginekologis. Penelitian ini bertujuan menjelaskan profil pasien uropati obstruktif yang disebabkan oleh keganasan ginekologis yang ditatalaksana di Rumah Sakit Cipto Mangunkusumo tahun 2019 sampai 2021 Metode: Dari Januari 2019 sampai Januari 2021, pasien uropati obstruktif dengan keganasan ginekologis yang menjalani prosedur pemasangan DJ stent atau nefrostomi dimasukkan dalam studi prospektif ini. Pasien dengan riwayat diversi urin maupun penyakut lain yang mungkin menyebabkan obstruksi saluran kemih dieksklusi dari penelitian. Hasil: Terdapat 121 pasien keganasan ginekologis dengan uropati obstruktif yang diteliti pada penelitian ini. Persentase pasien dengan pemasangan DJ stent bilateral, kanan, dan kiri adalah 72%, 18%, dan 10%. Mayoritas kasus adalah pasien dengan hidronefrosis grade 3 atau grade 4. Nefrostomi dilakukan pada 69,4% kasus, dan hanya 17% diantaranya yang mengalami episode polyuria. Kesimpulan: Mayoritas kasus uropati obstruktif disebabkan oleh keganasan serviks, dengan dominansi obstruksi bilateral. Nefrostomi adalah metode diversi urin pilihan pada penelitain ini.
Introduction and Objectives: Gynecological malignancies are one of the most common causes of death from cancer in women. Hydronephrosis or obstructive uropathy is the most common finding in patients with gynecological malignancy. This study aimed to describe the profile of obstructive uropathy patients causes of gynecology malignancies treated in our center from 2019 to 2021. Method: From January 2019 to January 2021, obstructive uropathy patients with gynecological malignancies who underwent DJ stent or nephrostomy insertion procedures at Cipto Mangunkusumo Hospital were included in this prospective study. Patients with a history of urinary diversion or other diseases that may cause urinary tract obstruction were excluded. Results: One hundred and twenty-one patients with gynecological malignancies with obstructive uropathy were included. The percentages of bilateral, right-, and left-sided stent positions were 72%, 18%, and 10%, respectively. Most of them were grade 3 or grade 4 hydronephrosis. Percutaneous nephrostomy was mainly used for 69,4%, and only 17% of patients experienced a polyuria episode. Conclusion: Most cases of obstructive uropathy were caused by cervical malignancies, with bilateral obstruction due to cervical cancer occurring in most cases. Nephrostomy is the method of choice for urinary drainage in our center."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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