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"ABSTRAKBiomarka untuk memprediksi metastasis KGB lokoregional sampai saat ini belum akurat.Angka metastasis tersamar pada karsinoma laring bervariasi yaitu 165%. Dibutuhkanbiomarka tumor yang dapat memberikan informasi adanya metastasis KGB lokoregionalpada pasien KSS laring stadium lanjut tanpa keterlibatan KGB lokoregional (N0), sehinggadiharapkan menjadi acuan untuk dilakukan diseksi leher selektif. Beberapa biomarka yangberhubungan dengan agresivitas dan prediksi metastasis yaitu Epidermal Growth FactorReceptor (EGFR), Matrix Metallo-proteinase (MMP)-9, Tissue Inhibitor Metallproteinase(TIMP)-1, Vascular Endothelial Growth Factor (VEGF), Epithel Calcium Adhesi (Ekaderin)dan kolagen tipe IV serta HPV dapat digunakan untuk memprediksi luaran padastatus pasien tumor dengan dan tanpa metastasis.Penelitian ini ingin memeriksa peran infeksi HPV sebagai faktor onkogenesis dankejadian metastasis KGB leher pada keganasan laring berdasarkan biomarka sebagaipenetapan diagnosis metastasis KGB lokoregional.Dilakukan Cross-sectional, double blind study dengan pengumpulan data sekunder darirekam medis di Departemen THT-KL FKUI-RSCM. Pemeriksaan ekspresi biomarkadan status HPV dilakukan terhadap jaringan berupa blok parafin dari pasien karsinomalaring Ekspresi biomarka dilakukan dengan pemeriksaan imunohistokimia, dan identifikasivirus HPV dengan nested PCR, dilanjutkan dengan flow-through hybridization.Didapatkan proporsi HPV KSS laring sebanyak 28,7% dengan infeksi HPV risiko tinggisebanyak 9,15% dan HPV 16 merupakan tipe yang terbanyak. Analisis multivariatMantel-Haenszel didapatkan ekspresi tinggi biomarka EGFR, MMP-9 dan VEGFberperan terhadap kejadian metastasis KGB pada KSS laring stadium lanjut tanpainfeksi HPV dengan OR 3,38; 5,14. Keadaan tersebut tidak berperan lagi bila terdapatinfeksi HPV Dari penelitian ini didapatkan suatu algoritma penatalaksanaan KSS laringstadium lanjut khususnya untuk penentuan tatalaksana diseksi leher pada N0.Infeksi HPV didapati pada KSS laring stadium lanjut, HPV 16 merupakan tipe HPVyang terbanyak. Biomarka penanda metastasis didapatkan pada EGFR; MMP-9; VEGFdengan kekuatan 2;1;6.

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ABSTRACTBiomarkers to predict locoregional lymph nodes metastasis is not yet accurate untilnow. The number of occult metastasis in laryngeal carcinoma varies between 165%.A tumor biomarker that can give information on the existence of locoregional lymphnode involvement in patients with or without signs of clinical locoregional lymph nodeinvolvement, as guidelines whether selective neck dissection is needed in N0 cases. Forpatients that need additional treatment biomarkers that are correlated with aggresivityand metastasis prediction such as EGFR, MMP-9, TIMP-1, VGEF, E-cadherin, collagenType IV and HPV are also needed to predict the outcome of patients with or withoutlymph node metastasis.This study aimed to investigate the evidence of HPV infection in laryngeal carcinomaand the role of biomarkers EGFR, MMP-9, TIMP-1, VEGF, E-cadherin and collagentype IV, in a late stadium laryngeal SCC observed clinically, especially in N0 and alsoto predict diagnosis of a locoregional lymph node that has potential for metastasis.Cross-sectional, double blind study with planned data collection was performed in theDepartment of ENT FKUI-RSCM. Data were taken from Formalin Fixed ParaffinEmbedded (FFPE) of laryngeal cancer specimen after laryngectomies. Samples wereanalysed by nested Polymerase Chain Reaction (PCR) and continuous flow-throughhybridizationed for genotyping. Expression of EGFR, MMP-9, TIMP-1, VEGF, Ecadherin,and collagen Type IV as metastasis biomarker were evaluated byimmunohistochemistry.Overall HPV proportion in laryngeal cancer was 28.7%. A total of 9,15% laryngealcancer patients were infected with high risk HPV type and HPV 16 was the mostfrequently observed. Mantel-Haenszel multivariate analysis found that HPV infection didnot play role in neck metastasis eventhough there were positive evidence of metastasisbiomarker. In contrast, the absent of HPV infection, positif metastasis biomarker of EGFRand VEGF have risk for neck nodes metastasis with OR 3.38; 5.14 fold consecutively.The algorithm was formed from the PM model to determine the metastasis potential tolocoregional lymph nodes of late stadium laryngeal SCC with N0.HPV was found to be the oncogenic factor of the laryngeal SCC and HPV 16 was themost frequently observed type in laryngeal SCC. Biomarkers to predict locoregionallymph nodes metastasis are EGFR; VEGF with strenght 2;1;6."

"Latar Belakang: Karsinoma sel skuamosa (KSS) lidah merupakan kanker rongga mulut (KRM) yang paling banyak ditemukan. Diseksi leher dikerjakan bersamaan dengan eksisi luas tumor karena tingginya angka occult metastasis yaitu sebesar 30% pada kelenjar getah bening (KGB) leher yang secara yang klinis tidak teraba (N0). Berdasarkan penelitian sebelumnya penanda epitelial E-cadherin dan penanda sel punca kanker CD44 dapat digunakan sebagai alat diagnostik prabedah untuk mengidentifikasi pasien yang mengalami metastasis KGB sehingga dapat menjadi salah satu modalitas yang membantu ahli bedah dalam mengambil keputusan tipe diseksi leher yang akan dikerjakan agar memberikan manfaat terbaik bagi pasien. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan ekspresi E-cadherin dan CD44 dengan metastasis KGB leher pada KSS lidah. Metode: Penelitian ini merupakan penelitian analitik dengan desain studi potong lintang. Pengambilan sampel dilakukan dengan cara consecutive sampling sesuai kriteria inklusi dan eksklusi. Kriteria inklusi adalah pasien KSS lidah tanpa metastasis jauh, dilakukan operasi eksisi luas tumor dan diseksi KGB leher, dan blok parafin yang layak diperiksa. Data sosiodemografi dan klinikopatologis diambil dari rekam medis. Pewarnaan imunohistokimia dengan E-cadherin dan CD44 dilakukan pada jaringan KSS lidah yang sudah terdapat di blok parafin tersimpan kemudian tingkat ekspresi E-cadherin dan CD44 dikelompokkan menjadi tinggi dan rendah sesuai kepustakaan. Analisis statistik dilakukan dengan program SPSS 24.0. Hasil: Didapatkan 30 dengan 15 subjek KSS lidah dengan metastasis KGB dan 15 subjek tanpa metastasis KGB. Dari analisis data, didapatkan terdapat hubungan yang bermakna antara ekspresi E-cadherin dengan metastasis KGB (p=0.000) dan terdapat hubungan yang bermakna antara CD44 dengan metastasis KGB (p=0.003). Kesimpulan: Ekspresi E-cadherin yang rendah dan CD44 yang tinggi memiliki hubungan bermakna dengan metastasis KGB pada KSS lidah.

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Background: Squamous cell carcinoma (SCC) of the tongue is the most common oral cavity cancer. Neck dissection was done simultaneously with wide excision of the tumor because of occult metastases high rate (about 30%) in clinically non-palpable neck lymph nodes (N0). Based on previous research, the epithelial marker E-cadherin and cancer stem cell marker CD44 could be used as pre-surgical diagnostic tools to identify patients who have lymph node metastases so that it could be a modality that helps surgeons in making decisions about neck dissection type to be performed to provide the best benefit for patients. Objective: To evaluate the association between E-cadherin and CD44 expressions and neck lymph node metastasis in SCC of the tongue. Methods: This research was an analytical study with a cross-sectional design. Samples were taken through consecutive sampling according to inclusion and exclusion criteria. Inclusion criteria were patients with SCC of the tongue without distant metastases, post wide excision of the tumor with neck lymph node dissection, and eligible paraffin block for examination. Sociodemographic and clinicopathological data were obtained from medical records. Immunohistochemistry staining was performed with E-cadherin and CD44 from stored paraffin blocks, then the expression levels of E-cadherin and CD44 were grouped into high and low according to the literature. Statistical analysis was conducted with SPSS 24.0. Results: Thirty samples of SCC of tongue were collected, consist of 15 subject with neck lymph node metastasis tongue and 15 subject without neck lymph node metastasis. From data analysis, a significant difference was found between E-cadherin and CD44 expressions with neck lymph node metastasis (p value was 0.000 and 0.003, respectively). Conclusion: Low expression of E-cadherin and high expression of CD44 was significantly associated with the occurence of neck lymph node metastasis in SCC of the tongue."

"Data epidemiologi menunjukkan bahwa dari semua keganasan tiroid, sekitar 80% hingga 85% di antaranya adalah karsinoma tiroid papiler (KTP). Biomarker untuk memprediksi metastasis KGB leher kini mulai banyak diteliti pada pasien KTP seperti matrix metalloproteinase (MMP) dan vascular endothelial growth factor (VEGF). Meskipun belum terdapat kesepakatan diagnostik terhadap MMP-9 dan VEGF-C sebagai prediktor metastasis KGB pada KTP, beberapa studi telah menunjukkan hubungan keduanya terhadap metastasis KGB. Penelitian ini bertujuan untuk mengetahui hubungan antara MMP-9 dengan VEGF-C pada metastasis KGB leher pada pasien KTP. Peneliti melakukan studi desain potong lintang di RSUPN Cipto Mangunkusumo, Jakarta Pusat. Pasien yang terdiagnosis KTP berdasarkan pemeriksaan histopatologi diinklusi dalam penelitian ini. Pasien yang telah terbukti memiliki metastasis jauh dan data tidak lengkap dieksklusi dalam penelitian. Ekspresi MMP-9 dan VEGF-C diteliti di Laboratorium Patologi Anatomi FKUI/RSCM. Sebanyak 62 pasien diinklusi dalam penelitian ini, dengan proporsi 80,6% perempuan dan 19,4% laki-laki. Ekspresi MMP-9 ditemukan lebih tinggi pada kelompok metastasis (p<0,001). Hal yang sama juga terjadi pada perbedaan median ekspresi VEGF-C, yang mana median ekspresi penanda ini pada kelompok metastasis lebih tinggi dibandingkan non-metastasis (p<0,001). Peneliti menemukan bahwa terdapat korelasi positif dan bermakna antara H-score MMP-9 dan VEGF-C, dengan koefisien korelasi 0,618. Terdapat hubungan yang bermakna antara ekspresi MMP-9 dan VEGF-C dengan kejadian metastasis KGB leher pada pasien KTP. Ekspresi MMP-9 dan VEGF-C ditemukan lebih tinggi pada kelompok metastasis. Peningkatan ekspresi MMP-9 juga berkorelasi positif dengan peningkatan ekspresi VEGF-C. 

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Approximately 80% to 85% of thyroid malignancies were papillary thyroid carcinoma (PTC). Biomarkers to predict cervical lymph node metastases have now begun to be widely studied in PTC patients, such as matrix metalloproteinase (MMP) and vascular endothelial growth factor (VEGF). Although there was no diagnostic agreement on MMP-9 and VEGF-C as predictors of lymph node metastasis in PTC, several studies have shown an association between the two for lymph node metastasis. This study aims to determine the relationship between MMP-9 and VEGF-C in cervical lymph node metastases in PTC patients. A cross-sectional design study was conducted at Cipto Mangunkusumo General Hospital, Jakarta. Patients diagnosed with PTC based on histopathological examination were included in this study. Patients with distant metastases were excluded from the study. The expression of MMP-9 and VEGF-C was investigated at the Anatomical Pathology Laboratory FKUI/RSCM. A total of 62 patients were included in this study, with 80.6% female and 19.4% male. The MMP-9 expression was found to be higher the metastatic group (p<0.001). The same results were also found in VEGF-C expression, where the median expression of this marker in the metastatic group was higher than the non-metastatic group (p<0.001). We found a significant and positive correlation between the H-score of MMP-9 and VEGF-C (correlation coefficient of 0.618). There is a significant relationship between the expression of MMP-9 and VEGF-C with the cervical lymph node metastases in PTC patients. The MMP-9 and VEGF-C expression was higher in the metastatic group. The increased MMP-9 expression is also positively correlated with increased VEGF-C expression."

"Latar Belakang: Karsinoma sel skuamosa laring (KSSL) dengan metastasis ke kelenjar getah bening (KGB) leher memiliki angka kelangsungan hidup 5 tahun kurang dari 50%. Banyak penelitian menunjukkan bahwa MMP-9 dan CCR7 berhubungan dengan metastasis ke KGB leher. Overekspresi MMP-9 dan CCR7 berhubungan dengan sifat sel tumor yang lebih agresif dan prognosis yang lebih buruk dikarenakan cenderung bermetastasis ke KGB leher. Tujuan: Penelitian ini bertujuan untuk mengetahui perbedaan ekspresi MMP-9 dan CCR7 pada KSSL yang bermetastasis dan tidak metastasis ke KGB leher. Metode: Penelitian analitik observasional dengan desain potong lintang pada sediaan operasi laringektomi parsial maupun total dengan diseksi leher di RSCM periode Desember 2017 sampai Desember 2019. Sampel penelitian dibagi menjadi 2 kelompok, yaitu KSSL dengan metastasis KGB leher dan tanpa metastasis. Pengambilan sampel penelitian dilakukan secara konsekutif dari kasus yang memenuhi kriteria inklusi dan eksklusi sesuai perhitungan besar sampel untuk masing-masing kelompok. Pemeriksaan imunohistokimia menggunakan antibodi primer MMP-9 dan CCR7. Data imunoekspresi dianalisis untuk mengetahui hubungannya dengan terjadinya metastasis ke KGB leher. Hasil: Kejadian metastasis KSSL ke KGB leher berhubungan dengan ekspresi MMP-9 (P<0,05). Ditemukan ekspresi MMP-9 yang tinggi pada KSSL-M sebesar 41,7% sedangkan KSSL-NM 8,3%. Ekspresi CCR7 juga berkorelasi dengan metastasis KSSL ke KGB leher (P<0,05), ekspresi CCR7 yang tinggi pada KSSL-M sebanyak 48,3% sedangkan KSSL-NM hanya 10%. Ditemukan pula hubungan antara ekspresi MMP-9 dan CCR7 dengan terjadinya metastasis KSSL ke KGB (p=0,001). Kesimpulan: Metastasis KSSL ke KGB berhubungan dengan ekspresi MMP-9 dan CCR7. Terdapat adanya hubungan antara ekspresi MMP-9 dan CCR7 pada kejadian metastasis KSSL ke KGB leher.

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Background: Laryngeal squamous cell carcinoma (LSCC) with metastasis to the lymph nodes of the neck has a 5-year survival rate of less than 50%. Many studies have shown that MMP-9 and CCR7 are associated with metastasis to cervical lymph nodes. Overexpression of MMP-9 and CCR7 are associated with a more aggressive cell tumour and poor prognosis because they are more likely to metastasis to cervical lymph nodes.

Purpose: This study aims to determine the expression of MMP-9 and CCR7 in metastasis and non-metastatis KSSL to cervical lymph nodes.

Methodology: An observational analytic study with a cross-sectional design on partial and total laryngectomy surgery preparations with neck dissection at RSCM for the period December 2017 to December 2019. The study sample was divided into 2 groups, namely KSSL with cervical lymph nodes metastasis and without metastasis. The research sample was taken by consecutive sampling from cases that met the inclusion and exclusion criteria according to the calculation of the sample for each group. Immunohistochemical examination using primary antibodies MMP-9 and CCR7. Immunoexpression data were analyzed to determine their relationship with metastasis to cervical lymph nodes.

Results: The incidence of SCC metastases to cervical lymph nodes was associated with MMP-9 expression (P<0.05). High MMP-9 expression was found in KSSL-M by 41.7% while in KSSL-NM 8.3%. CCR7 expression also correlated with KSSL metastases to cervical lymph nodes (P<0.05), high CCR7 expression in KSSL-M was 48.3% while KSSL-NM was only 10%. It was also found that there was a relationship between the expression of MMP-9 and CCR7 with the occurrence of SLCC to lymph node metastasis (p=0.001).

Conclusion: Metastasis SLCC to lymph node was associated with MMP-9 and CCR7 expression. There is a relationship between the expression of MMP-9 and CCR7 in the incidence of SCC metastases to cervical lymph nodes."

"Latar Belakang: Karsinoma ovarium merupakan tumor ganas ginekologik yang paling mematikan. Metastasis kelenjar getah bening ditemukan pada 78% kasus stadium lanjut yang dilakukan sampling atau diseksi kelenjar getah bening. Metastasis ini juga ditemukan pada kasus yang secara klinis sesuai dengan stadium I dan II. Faktor risiko terjadinya metastasis kelenjar getah bening pada karsinoma ovarium meliputi tipe histologik serosum, tumor high grade, dan kadar CA125 serum yang tinggi pada saat diagnosis. Pemeriksaan ulang kelenjar getah bening negatif pada kasus keganasan ginekologik lain menunjukkan adanya mikrometastasis hingga 8%- 14%. Tujuan: Penelitian ini dilakukan untuk mengetahui insidensi occult metastasis, baik berupa mikrometastasis maupun isolated tumor cells, pada kelenjar getah bening negatif dengan menggunakan pulasan imunohistokimia sitokeratin AE1/AE3 pada karsinoma ovarium dengan berbagai tipe histologik. Metode: Penelitian retrospektif dengan desain potong lintang pada sediaan kelenjar getah bening negatif dari operasi histerosalpingoovorektomi disertai limfadenektomi kasus karsinoma ovarium di RSCM periode Januari 2016 sampai Desember 2020. Pada seluruh blok parafin berisi kelenjar getah bening negatif berukuran >1 cm dilakukan potong dalam dua kali untuk masing-masing dipulas hematoksilin-eosin dan imunohistokimia sitokeratin AE1/AE3. Data imunoekspresi AE1/AE3 dianalisis untuk menentukan mikrometastasis/isolated tumor cells, dan mengetahui hubungannya dengan tipe histologik serosum. Hasil: Dari 57 sampel yang memenuhi kriteria inklusi dan eksklusi didapatkan rerata usia 49,5 tahun. Tipe histopatologik terbanyak (40,3%) adalah karsinoma sel jernih, 66,7% kasus memiliki tumor high grade, dan 57,9% kasus terdiagnosis pada stadium dini. Occult metastasis didapatkan pada 1 (1,75%) kasus dari seluruh sampel. Tidak ditemukan perbedaan kejadian occult metastasis pada kelompok karsinoma serosum dan non-serosum (p=1). Kesimpulan: Insidensi occult metastasis kelenjar getah bening sebesar 1,75% dari seluruh kasus karsinoma ovarium dalam penelitian ini. Tidak ditemukan perbedaan kejadian occult metastasis pada kelompok karsinoma serosum dan non-serosum.

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Background: Ovarian carcinoma is the most lethal gynecologic malignant tumor. Lymph node metastases were found in 78% of advanced stage cases that underwent lymph node dissection. These metastases were also found in cases with clinical stage I and II. Risk factors for lymph node metastasis in ovarian carcinoma include serous histologic type, high grade tumor, and high serum CA125 level at diagnosis. Reexamination of negative lymph nodes in cases of other gynecologic malignancies shows micrometastases in up to 8%-14%.

Aim: This study was conducted to determine the incidence of occult metastases, either in the form of micrometastases or isolated tumor cells, in negative lymph nodes by using cytokeratin AE1/AE3 immunohistochemistry in ovarian carcinomas of various histologic types.

Method: A retrospective study with a cross-sectional design on negative lymph node preparations from hysterosalpingoovorectomy surgery accompanied by lymphadenectomy for ovarian carcinoma cases at RSCM January 2016-December 2020. All paraffin blocks containing negative lymph nodes measuring >1 cm were cut in two sections and stained with hematoxylin-eosin and cytokeratin AE1/AE3. AE1/AE3 immunoexpression data were analyzed to determine micrometastases/isolated tumor cells, and their relationship with serous histological type.

Result: Of the 57 samples that met the inclusion and exclusion criteria, the mean age was 49.5 years. The most histopathological types (40.3%) were clear cell carcinomas, 66.7% cases had high grade tumors, and 57.9% cases were diagnosed at an early stage. Occult metastases were found in 1 (1.75%) cases of the entire sample. There was no difference in the incidence of occult metastases in the serous and non-serous carcinoma groups (p=1).

Conclusion: The incidence of occult lymph node metastases was 1.75% of all ovarian carcinoma cases in this study. There was no difference in the incidence of occult metastases in the serous and non-serous carcinoma groups.

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"Kanker payudara merupakan kanker paling sering pada wanita dan merupakan penyebab kematian kedua tersering dari seluruh kanker di dunia. Metastasis merupakan penyebab utama kematian pasien kanker payudara. Status kelenjar getah bening (KGB) digunakan untuk mengidentifikasi prognosis, stadium tumor, serta penentuan modalitas terapi. Nottingham Prognostic Index (NPI) juga dapat digunakan dalam memprediksi prognosis dan kesintasan pasien. Salah satu biomarker yang diharapkan dapat memprediksi adanya metastasis KGB dan memperkirakan kesintasan pasien yaitu CD133. Penelitian ini bertujuan untuk mengetahui ekspresi protein CD133, sehingga dapat digunakan sebagai faktor penanda kemungkinan terjadinya metastasis KGB dan memprediksi kesintasan pasien pada karsinoma payudara invasif no special type (NST). Penelitian ini menggunakan desain kasus kontrol terhadap kasus mastektomi karsinoma payudara invasif NST di RSCM periode Januari 2019 sampai Desember 2022. Sampel penelitian dibagi menjadi 2 kelompok, yaitu 30 kasus karsinoma payudara invasif NST dengan metastasis KGB dan 30 kasus tanpa metastasis KGB. Pengambilan sampel penelitian dilakukan secara consecutive sampling. Dihitung skor NPI. Didapatkan perbedaan bermakna ekspresi CD133 pada karsinoma payudara invasif NST dengan dan tanpa metastasis KGB. Ekspresi CD133 tinggi lebih banyak ditemukan, yaitu 24 kasus (80%). Didapatkan korelasi yang bermakna antara ekspresi CD133 dan skor NPI. Ekspresi CD133 tinggi lebih banyak ditemukan pada kasus dengan NPI >5,4 (buruk), yaitu 20 kasus (66,7%).

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Breast cancer is the most prevalent malignancy in women and the second largest cause of cancer-related death worldwide. The main cause of breast cancer’s high death rate is metastasis. Lymph node status is used to identify prognosis, tumor stage, and determine therapeutic modalities. Nottingham Prognostic Index (NPI) can be used to predict prognosis and patient survival. The biomarker that can predict lymph node metastasis and predict patient survival is CD133. This study aims to determine the expression of CD133 protein, which can be used as a marker for the possibility of lymph node metastasis and predict patient survival in invasive breast carcinoma of no special type. This study used a case control design on a mastectomy operation for invasive breast carcinoma NST cases at RSCM from January 2019 to December 2022. The study sample was divided into 2 groups, 30 cases of invasive breast carcinoma NST with lymph node metastasis and 30 cases without lymph node metastasis. The sample was taken by consecutive sampling. NPI score was calculated. There was a significant difference in CD133 expression in invasive breast carcinoma NST with and without lymph node metastasis. High CD133 expression was found more in invasive breast carcinoma NST with lymph node metastasis (24 cases or 80%). There was significant correlation between CD133 expression and NPI score. High CD133 expression was found more in invasive breast carcinoma NST with poor NPI (20 cases or 66,7%). "

"Latar Belakang: Kanker payudara merupakan jenis kanker yang paling umum terjadi pada wanita dan penyebab kematian kanker yang paling sering terjadi. Status kelenjar getah bening (KGB) amerupakan faktor prognostik dan penentu pilihan tatalaksana pasien kanker payudara. Biomarka untuk memprediksi metastasis KGB sampai saat ini belum akurat. Beberapa biomarka yang berhubungan dengan agresivitas dan prediksi metastasis yaitu CD44 (Cluster of Differentiation 44) dan MT1-MMP (Membrane Type 1- Matrix Metalloproteinase). Ekspresi CD44 dan MT1-MMP yang tinggi berhubungan dengan sifat yang lebih agresif dan prognosis yang buruk sehingga dibutuhkan biomarka tumor yang dapat memberikan informasi adanya metastasis KGB.Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan ekspresi CD44 dan MT1-MMP pada metastasis kelenjar getah bening karsinoma payudara invasif NST.Metode: Penelitian analitik observasional dengan desain potong lintang pada sediaan operasi mastektomi kasus karsinoma payudara invasif NST di RSCM periode Januari 2019 sampai Juni 2020. Sampel penelitian dibagi menjadi 2 kelompok, yaitu 24 kasus karsinoma payudara invasif NST dengan metastasis kelenjar getah bening dan 24 kasus karsinoma payudara invasive NST tanpa metastasis kelenjar getah bening. Pengambilan sampel penelitian dilakukan secara simple random sampling dari kasus yang memenuhi kriteria inklusi dan tidak termasuk kriteria eksklusi. Dilakukan pulasan imunohistokimia CD44 dan MT1-MMP dan dilakukan perhitungan jumlah sel yang terpulas positif. Analisis statistik Chi Square dan Kruskal Wallis dilakukan diantara dua kelompok tersebut.Hasil : Terdapat perbedaan bermakna ekspresi CD44 pada karsinoma payudara invasif No Special Type dengan dan tanpa metastasis kelenjar getah bening.(p=0,009). Terdapat perbedaan bermakna ekspresi MT1-MMP pada karsinoma payudara tipe invasive carcinoma of No Special Type dengan dan tanpa metastasis kelenjar getah bening(p=0,032). Serta adanya hubungan overekspresi CD44 dan MT1-MMP pada metastasis kelenjar getah bening (p=0,000)Kesimpulan : Terdapat hubungan bermakna antara ekspresi CD44 dan MT1-MMP pada karsinoma payudara invasif NST dengan status metastasis kelenjar getah bening.

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Background: Breast cancer is the most common type of cancer in women and the most common cause of cancer death. Lymph node status (KGB) is a prognostic factor and determinant of treatment options for breast cancer patients. The biomarker for predicting lymph node metastasis is not accurate until this time. Several biomarkers associated with aggressiveness and metastatic prediction are CD44 (Cluster of Differentiation44) and MT1-MMP (Membrane Type 1-Matrix Mettaloproteinase). The high expression of CD44 and MT1-MMP is associated with a more aggressive nature and poor prognosis. The tumor biomarkers are needed to provide information on the presence of lymph node metastases.

Aims: This study aims to determine the relationship between CD44 and MT1-MMP expression on lymph node metastases of invasive breast cancer NST.

Method: An observational analytic study with a cross-sectional design on a mastectomy operation for invasive breast carcinoma NST cases at RSCM from January 2019 to June 2020. The study sample was divided into 2 groups, 24 cases of NST invasive breast carcinoma with lymph node metastases and 24 cases of invasive breast carcinoma NST without lymph node metastases. The research sample was taken by simple random sampling of cases that met the inclusion criteria and did not include the exclusion criteria. CD44 and MT1-MMP immunohistochemical staining were performed and the number of cells stained positively was calculated. Chi-Square and Kruskal Wallis statistical analysis was performed between the two groups.

Results: There was a significant difference in the expression of CD44 in invasive breast carcinoma NST with and without lymph node metastases (p = 0.009). There was a significant difference in the expression of MT1-MMP in invasive carcinoma of No Special Type breast carcinoma with and without lymph node metastases (p = 0.032). And there is a relationship between CD44 and MT1-MMP overexpression in lymph node metastases (p = 0.000)

Conclusion: There was a significant relationship between CD44 and MT1-MMP expression in invasive breast carcinoma NST and lymph node metastasis status."

"Latar belakang dan tujuan : CT scan merupakan modalitas pencitraan utama pada berbagai tumor primer kepala dan leher serta ketersedian modalitas CT yang lebih luas di Indonesia. Penelitian ini bertujuan untuk mendiskusikan peranan CT sebagai modalitas yang berpotensi membantu menegakkan diagnosis keterlibatan lokoregional kelenjar getah bening KGB leher sehingga didapatkan perencanaan tatalaksana karsinoma sel skuamosa KSS dengan nilai terapi dan prognosis terbaik. Penelitian ini modifikasi Choi dan meneliti kesesuaian antara kriteria diagnostik KGB metastasis pada CT scan dibandingkan dengan hasil histopatologik pada pasien KSS. Metode : Penelitian ini merupakan studi asosiatif secara potong lintang pada data primer kasus baru KSS-KL. Pengambilan data berlangsung dari bulan Februari 2018 hingga April 2018 di Poli Onkologi Departemen THT, Departemen Radiologi dan Departemen Patologi Anatomi RSUPN Cipto Mangunkusumo. Sebanyak 90 unit sampel dievaluasi lokasi, morfologi dan kemungkinan metastasis pada CT scan preoperatif menggunakan kriteria diagnostik, kemudian tiap unit sampel diberi label untuk menunjang kesesuaian node-per-node yang kemudian disesuaikan dengan KGB temuan intraoperasi. Operasi diseksi leher dilakukan dengan jarak kurang dari 1 minggu pasca CT scan preoperatif. Pasca diseksi, setiap KGB yang telah diberi label dilakukan pemeriksaan histopatologik. Kemudian asumsi kesesuaian temuan pada CT scan preoperatif dan histopatologik diuji hipotesis komparatif menggunakan uji McNemar. Hasil : Penelitian ini menunjukkan nilai p = 0,000 yaitu terdapat perbedaan bermakna antara kriteria diagnostik KGB maligna pada CT scan dengan histopatologik. Penilaian kesesuaian kriteria diagnostik KGB maligna pada CT scan dengan histopatologik menggunakan Kappa didapatkan R = 0,12 p=0,100 . Kriteria diagnostik KGB maligna pada CT scan pada penelitian ini memiliki nilai sensitivitas 33,3 dan nilai spesifisitas 61,7 dengan nilai spesifisitas ukuran aksis pendek, hipodensitas dan penyangatan heterogen masing-masing 100 dan nilai sensitivitas lokasi drainase primer 100 . Kesimpulan : Tidak terdapat kesesuaian antara kriteria diagnostik KGB maligna pada CT scan dengan hasil histopatologik. Adanya komponen kriteria diagnostik yang sangat sensitif tapi tidak spesifik dan yang sangat spesifik tapi tidak sensitif menyebabkan nilai sensitivitas dan spesifisitas kriteria diagnostik ini rendah.

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Background and Objective CT scan is the main imaging modality in various head and neck primary tumors and broader availability in Indonesia. This study aims to discuss CT as a modality that helps establish the diagnosis of lymph node metastases so the management of head and neck squamous cell carcinoma HNSCC can be done with the best therapeutic value and prognosis. This study of Choi modification is trying to research about association between diagnostic criteria of metastases lymph node in CT Scan and histopathologic in SCC Patients Methods This research is a cross sectional associative study on the primary data of the new case of HNSCC. Data collection took place from February 2018 to April 2018 at the Polyclinic Oncology Department of ENT, Department of Radiology and Department of Pathology Anatomy Cipto Mangunkusumo Hospital. A total of 90 sample units were evaluated for location, morphology and possible metastasis on preoperative CT scans using diagnostic criteria, then each sample unit was labeled to support node per node association which was then adjusted to intraoperative lymph node findings. Neck dissection surgery is performed less than 1 week after a preoperative CT scan. After the operation, every lymph node that has been labeled is carried out to histopathologic examination. Then the hypothesis of association of the findings on preoperative CT scans and histopathologic is tested using McNemar test. Results This study shows p value 0,000 so that there is a significant difference between the diagnostic criteria on CT scan and histopathologic examination. Assessment of the diagnostic criteria for malignant KGB on CT scans and histopathologic examination using Kappa obtained R 0.12 p 0.100 , which shows no suitability between them. The diagnostic criteria for malignant lymph node on CT scan in this study have a sensitivity value of 33.3 and a specificity value of 61.7 with a specificity value of the size of the short axis, hypodensity and heterogeneous enhancement respectively 100 and the sensitivity value of the primary drainage site 100 . Conclusion There is no agreement between the diagnostic criteria for malignant lymph nodes on CT scan with histopathologic examination. The existence of a highly sensitive but non specific and a highly specific but insensitive component of the diagnostic criteria might causes the sensitivity and specificity of these diagnostic criteria to be low."

"Faktor perturnbuhan cndote1 vaskular atau Vascular Endothelial Growth Factor (selanjutnya disebut VEGF) adalah suatu glikoprotein dimer yang dihasilkan oleh sel tumor dan jaringan yang memerlukan pasokan pembuluh darah baru. Beberapa penelitian membuktikan bahwa terdapat hubungan antara penyebaran ke kelenjar gctah bening ketiak dengan ekspresi VEGF C dan D terutama pada kanker payudara jenis duktal invasif. Ekspresi berlebihan dari VEGF disenai ekspresi berlebihan dari HER2 kanker payudara. Lebih jauh diketahui bahwa ekspresi VEGF berhubungan dengan penyebaran ke kelenjar getah bening ketiak. Pengaruh faktor ini mendorong peneliti untuk mempelajari kanker payudara stadium II dengan HER-2 posltif karena penyebaran ke kelenjar getah benlng ketiak pada sisi yang sama dengan kanker payudara, mulai ditemukan pada stadium II baik pada tumor ukuran di bawah 2 em ataupun pada tumor berukuran lebih dari 2 em. Dalam penelitian ini dinilai poia ekspresi VEGF pada subjek dengan penyebaran ke kelenjar getah bening (N l) dan pada keadaan belum adanya keterlibatan kelenjar getah bening (NO). Ekspresi VEGF dapat diamati dan diukur derajatnya pada jaringan kanker payudara dengan teknik imunohistokimia. Pola ekspresi yang didapatkan dari hasil penelitian ini diharapkan dapat melihat sifat biologik kanker payudara dalam hal penyebarannya ke kele11iar gctah bening ketiak dan dapat digunakan sebagai faktor prediksi dalam hal penyebarannya.

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Vascular Endotbelia1 Growth Factor (VEGF) is a chimeric glycoprotein produced by tumor cells and tissues that require ample blood supply. Some studies have suggested that there is an association between metastasis of cancer cells to the axillary lymph nodes and VEGF C and D especially in ductile invasive breast carcinoma. The over expression from VEGF together with HER-2 were found in 77.2 percent of breast cancer patients. Furthermore evidence suggest that VEGF expression is connected with the spread of cancer to the axillary lymph nodes. We examined breast cancer stage II with HER-2 positive, as the spread of cancer cells to the axillary lymph nodes from the same breast cancer side will only be found at stage H for both tumor under 2 em or more than 2 em. We examined VEGFC the its relationship with axillary lymph node. The results from this research is aimed at monitoring the spread of breast cancer to the axillary lymph nodes and to predict its spread and therefore to find the most effective treatment management for this type of cancer. We analyzed VEGF-C expression in 95 sample breast cancer stage ll with HER-2 positive from 1999 2009. There is no significant associated between VEGF-C expression and axillary lymph node (p = 0.089)."

"Menilai tingkat akurasi Node-RADS dalam mendiagnosis metastasis kelenjar getah bening regio leher pada pasien dengan karsinoma sel skuamosa di kepala dan leher.

Metode: Sebanyak 221 sampel kelenjar getah bening dari 40 pasien yang memenuhi kriteria penelitian studi potong lintang yang menjalankan pemeriksaan CT scan leher dengan kontras, dilakukan operasi diseksi leher, dan memiliki hasil pemeriksaan histopatologi dari tahun 2020 hingga 2023. Dilakukan analisis bivariat antara Node-RADS dan histopatologi menggunakan Mc Nemar test dan Kappa Cohen R.

Hasil: Sistem skoring Node-RADS memiliki nilai diagnostik yang tidak terlalu berbeda dengan histopatologi dengan p = 0,76. Sistem skoring Node-RADS memiliki nilai Kappa Cohen 0,725, masuk kedalam substansial agreement. Hasil rasio konkordans pada skoring Node-RADS yang tinggi sebesar 88,2%, Sensitivitas 87,3%, Spesifisitas 88,6%, Nilai Duga Positif 75,3%, Nilai Duga Negatif 94,5%, LR+ 7,2, LR- 14%.

Kesimpulan: Node-RADS memiliki nilai akurasi yang cukup tinggi dan dapat dipertimbangkan sebagai metode diagnostik metastasis kelenjar getah bening regio leher pada pasien dengan karsinoma sel skuamosa di kepala dan leher.

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Squamous cell carcinoma is generally associated with metastases to the lymph nodes of the cervical region. Ricently,there have been attemts to standardize radiology reporting in oncology cases with the adoption of the Reporting and Data Systems (RADS). Node-RADS 1.0 aims to improve reporting of regional and distant lymph nodes in cancer patients by providing imaging criteria for size and configuration, facilitating a standardization system in reporting lymph nodes. However, there have been no reports regarding the suitability of Node-RADS in head and neck squamous cell carcinoma patients.

Objective: Assessing the accuracy of Node-RADS in diagnosing lymph node metastases in the neck region in patients with squamous cell carcinoma of the head and neck.

Method: A total of 221 lymph node from 40 patients who met the criteria for a cross-sectional research study, underwent a CT scan of the neck with contrast, neck dissection surgery, and had histopathological examination results from 2020 to 2023. Bivariate analysis was carried out between Node-RADS and histopathology using the McNemar test and Cohen's Kappa (κ).

Results: Node-RADS scoring system had a diagnostic value that was not significantly different from histopathology, with p = 0.76. The Node-RADS scoring system has a Cohen's Kappa value of 0.725, indicating substantial agreement. The concordance ratio results for Node-RADS scoring were high, with 88.2% concordance, a sensitivity of 87.3%, specificity of 88.6%, positive predictive value of 75.3%, negative predictive value of 94.5%, LR+ of 7.2, and LR- of 14%.

Conclusion: Node-RADS has a high accuracy value and can be considered as a diagnostic method for lymph node metastases in the neck region in patients with squamous cell carcinoma of the head and neck."