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"Kanker kolorektal terus menyumbang jumlah kasus kanker dan kematian yang tinggi setiap tahunnya. Salah satu metode diagnosis progresi kanker ini adalah dengan interpretasi biopsi dari ahli patologi anatomi. Akan tetapi, seringkali terjadi misinterpretasi antar patolog karena lesinya yang kurang spesifik. Maka dari itu, perlunya ada alat bantu yang dapat menunjang pekerjaan ahli patologi anatomi dalam menginterpretasi progresi kanker kolorektal. Penelitian ini bertujuan untuk melihat kemampuan spektrofotometer untuk mengklasifikasikan jaringan kolorektal mencit. Data jaringan mencit yang sudah diklasifikasikan menurut ahli PA diuji menggunakan cahaya tampak dan akan dibaca oleh spektrofotometer reflektansi. Hasil dari spektrofotometer kemudian akan dibaca oleh Theremino Spectrophotometer. Semua data kemudian diuji normalitas menggunakan uji Saphiro Wilk, dilanjutkan dengan uji ANOVA atau Kruskal-Wallis, kemudian uji Post Hoc atau Mann-Whitney. Data juga dianalisis menggunakan supervised dan unsupervised machine learning. Dari uji hipotesis hanya didapatkan 2 panjang gelombang yang dapat membedakan jaringan normal dan prekanker secara signifikan (696,7 dan 699.8 nm). Sedangkan yang lainnya kurang dapat membedakan jaringan normal, radang, dan prekanker. Hasil dari machine learning menunjukkan sensitivitas, spesifisitas, AUC, akurasi, dan presisi yang rendah. Maka dari itu, dapat disimpulkan dari penelitian ini bahwa metode spektrofotometri reflektans cahaya tampak kurang cocok digunakan untuk membedakan jaringan kolon normal, radang, dan prekanker pada sediaan preparat mencit.

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Colorectal cancer continues to account for a high number of cancer cases and deaths every year. The gold standard of diagnosing this cancer progression is by interpretation of a biopsy from an anatomical pathologist. However, there is often misinterpretation among pathologists due to their unspesific lesions. Therefore, it is required to have a tool that can support the work of anatomical pathologists in interpreting the progression of colorectal cancer. This study aims to see the ability of the spectrophotometer to classify the colorectal tissue of mice. Mice tissue data that has been classified according to PA experts was tested using visible light and would be read by a reflectance spectrophotometer. The results of the spectrophotometer will then be read by the Theremino Spectrophotometer. All data were then tested for normality using the Saphiro Wilk test, followed by the ANOVA or Kruskal-Wallis test, then the Post Hoc or Mann-Whitney test. Data were also analyzed using supervised and unsupervised machine learning. From the hypothesis test, only 2 wavelengths were found that could significantly differentiate normal and precancerous tissue (696.7 and 699.8 nm). While others are less able to distinguish normal, inflammatory, and precancerous tissue. The results from machine learning show low sensitivity, specificity, AUC, accuracy, and precision to distinguish between the three categories. Therefore, it can be concluded from this research that the visible light reflectance spectrophotometric method is not suitable for distinguishing normal, inflammatory, and precancerous colonic tissue in mice preparations."

"Latar belakang: Menurut Global Cancer Statistics 2020 (GLOBOCAN), kanker kolorektal masih menduduki posisi ke-3 pada penyebab kanker tersering di dunia, dan posisi ke-2 pada penyebab kematian tersering akibat kanker (9.4%). Evaluasi histopatologi dari hasil biopsi jaringan kolorektal yang merupakan baku emas dalam diagnosis saat ini pun masih memiliki berbagai keterbatasan. Penentuan derajat keparahan dari kanker kolorektal, dilakukan secara subjektif oleh ahli patologi anatomik melalui observasi mikroskop, sehingga data yang dimiliki bersifat kualitatif. Studi menggunakan prinsip spektrofotometri sudah pernah dilakukan dalam upaya diagnostik kanker sebelumnya. Namun, hingga saat ini masih belum ada studi yang menggunakan spektrofotometer reflektansi VIS-NIR sebagai metode diagnostik kuantitatif dan objektif untuk kanker kolorektal.Tujuan: Penelitian ini adalah studi pendahuluan untuk mengetahui potensi dan kemampuan dari spektrofotometer reflektansi VIS-NIR dalam membedakan jaringan normal, prekanker, dan radang pada blok parafin jaringan kolon mencit.Metode: Penelitian ini memiliki desain eksperimental yang menggunakan sampel blok parafin jaringan kolorektal mencit Mus musculus. Sampel diklasifikasikan oleh ahli patologi anatomi menjadi tiga kategori berdasarkan derajat lesinya, yaitu normal, radang, dan prekanker. Sebanyak 30 sampel tersebut diukur intensitas cahaya reflektansinya pada 454 panjang gelombang berbeda yang termasuk dalam spektrum VIS-NIR. Hasil pengukuran dianalisis dengan perangakat lunak SPSS 26.0 untuk uji komparatif dan perangkat lunak Orange Data Mining untuk pengujian machine learning dalam pegelompokan sampel berdasarkan derajat lesinya.Hasil dan Pembahasan: Hasil uji komparatif membuktikan bahwa 429 dari 454 panjang gelombang cahaya VIS-NIR memiliki perbedaan intensitas cahaya reflektansi yang bermakna antarkelompok derajat lesi (p<0.05). Machine learning yang terbaik dalam pengelompokan sampel menurut derajat lesi berdasarkan data intensitas cahaya reflektansi adalah model SVM dengan nilai Area under the Curve (AUC) 98.3%, Classification Accuracy (CA) 86.7%, Skor F1 0.862, Precision 86.9%, Recall 86.7%, sensitivitas 70-100%, dan spesifisitas 90-95%.Kesimpulan: Spektrofotometri Reflektansi VIS-NIR dapat membedakan jaringan normal, radang dan prekanker kolorektal pada mencit Mus musculus dengan sensitivitas dan spesifisitas yang baik

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Background: According to the Global Cancer Statistics 2020 (GLOBOCAN), colorectal cancer is still the 3rd most common cause of cancer in the world and the 2nd most common cause of cancer death (9.4%). Histopathological evaluation of colorectal tissue biopsy results, which is currently still the gold standard in colorectal cancer diagnosis, has its limitations. Determining the severity of colorectal cancer is done subjectively by anatomical pathologists through microscopic observation. Results from this evaluation are qualitative data which can contribute to the high level of false positive and negatives of the diagnosis. Studies using spectrophotometric principles have been carried out in previous diagnostic efforts. However, to date, there are still no studies using the VIS-NIR reflectance spectrophotometer as a quantitative and objective diagnostic tool for colorectal cancer.

Objective: This is a pilot study to determine the potential and ability of the VIS-NIR reflectance spectrophotometer in differentiating normal, precancerous, and inflammatory parrafin-block of mouse colorectal tissues.

Method: This experimental study uses paraffin-block samples of colorectal tissue from Mus musculus mice. Samples were classified by anatomical pathologists into three categories based on the degree of lesion, namely normal, inflammatory, and precancerous. A total of 30 samples were measured by their light intensity reflectance at 454 different wavelengths included in the VIS-NIR spectrum. Results are evaluated using SPSS 26.0 for comparative testing and Orange Data Mining for machine learning to evaluate their competence in differentiating samples based on the degree of lesion.

Results and Discussion: Comparative test results proved that 429 of the 454 wavelengths in the VIS-NIR light spectrum had a significant difference in light intensity reflectance between the three degree groups of lesion (p<0.05). The best machine learning in differentiating samples according to the degree of lesions based on light reflectance intensity is the SVM model with the value of Area Under the Curve (AUC) 98.3%, Classification Accuracy (CA) 86.7%, F1 score 0.862, Precision 86.9%, Recall 86.7%, sensitivity 70-100%, and specificity 90-95%.

Conclusion: VIS-NIR Reflectance spectrophotometry can distinguish normal, inflammatory, and precancerous colorectal tissue in Mus musculus mice with good sensitivity and specificity."

"Kanker kolorektal adalah kanker yang berlokasi dibagian kolon atau rektum dengan indikasi awal adalah keberadaan polip non-kanker. Kanker kolorektal menempati urutan ketiga sebagai kanker ganas dan urutan kedua dengan tingkat mortalitas tertinggi di tingkat dunia. Peningkatan morbiditas kanker kolorektal tercatat pada orang dewasa berusia 30-40 tahun. Prevalensi dan urgensi deteksi dini kanker kolorektal diperlukan untuk mendapatkan hasil diagnosis kanker sebagai solusi pengobatan kanker. Gen MDR1 sebagai gen penghabisan obat membentuk resistensi terhadap pengobatan yang menyebabkan kegagalan dalam kemoterapi. Penelitian ini bertujuan untuk mengetahui ekspresi gen MDR1 pada kanker kolorektal. Penelitian ini menggunakan metode qPCR yang bersifat spesifik dan sensitif pada satu target. Berdasarkan hasil qPCR diperoleh di antara 10 penderita kanker kolorektal terdapat 6 penderita yang positif terdeteksi gen MDR1 dan 4 penderita tidak mengekspresikan gen MDR1. Khususnya, ekspresi mRNA tertinggi diamati pada penderita yang telah mengalami metastasis terutama menuju hepar. Secara statistik, pengujian menggunakan Shapiro-Wilk (0,049 < 0,05) menyatakan data tidak terdistribusi normal antara kelompok jaringan normal dan kanker kolorektal. Sedangkan, pada uji Mann Whitney U (0,065 > 0,05) tidak terdapat perbedaan signifikan antara jaringan normal dan jaringan kanker kolorektal. Rekomendasi selanjutnya adalah dengan menggunakan sampel lebih banyak untuk melihat pola ekspresi gen.

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Colorectal cancer is cancer located in the colon or rectum with the initial indication is the presence of non-cancerous polyps. Colorectal cancer ranks third as a malignant cancer and ranks second with the highest mortality rate in the world. The increase in colorectal cancer recorded in adults aged 30-40 years. The prevalence and urgency of early detection of colorectal cancer is obtained to get the results of a cancer diagnosis as a cancer treatment solution. The MDR1 gene as a drug efflux forms resistance to treatment causes failure in chemotherapy. This study aims to determine the expression of the MDR1 gene in colorectal cancer. This study uses the qPCR method which is specific and sensitive to one target. Based on the qPCR results, it was found that among 10 patients with colorectal cancer, there were 6 patients who were positive for the MDR1 gene and 4 patients were negative the MDR1 gene. In particular, the highest mRNA expression was observed in patients who had metastasized mainly to the liver. Statistically, the Shapiro-Wilk test (0.049 < 0.05) stated that the data were not normally distributed between the normal tissue groups and colorectal cancer. Meanwhile, the Mann Whitney U test (0.065 > 0.05) means that there is no significant difference between normal tissue and colorectal cancer tissue. The next recommendation is to use more samples to see the pattern of gene expression."

"ABSTRAK Latar Belakang :Karsinoma kolorektal (KKR) merupakan penyebab kematian kedua di dunia dari seluruh jeniskanker. KKR dapat disebabkan oleh defek dari MMR DNA. Microsatellite instability (MSI)adalah penanda defek MMR DNA. KKR MSI-H memiliki gambaran karakteristik tertentu.Tumor-infiltrating-lymphocyte (TIL) merupakan faktor prognosis. Hilangnya ekspresi PMS2 danMSH6 dapat sebagai penanda MSI. Penelitian ini bertujuan untuk menilai terjadinya MSI padaKKR di sisi kiri dan sisi kanan kolon melalui Hilangnya ekspresi PMS2 dan MSH6, sertamengetahui hubungan antara TIL dengan MSI-H.Bahan dan Metode :Dilakukan pulasan IHK PMS2 dan MSH6, serta penghitungan TIL. Penilaian dilakukan denganmenghitung hilangnya ekspresi PMS2 dan MSH6 pada inti sel dan dikelompokkan ke dalamkelompok mutasi dan tidak mutasi .Penghitungan TIL juga dikelompokkan ke dalam TIL tinggidan rendah, berdasarkan nilai titik potong Hasil : Didapatkan 27,8% kasus menunjukkan hilangnya ekspresi PMS2 dan MSH6 dengan 14,4%kasus di distal kolon. TIL terbanyak di distal kolon 30% kasus. Tidak terdapat perbedaanbermakna antara mutasi PMS2 dan MSH6 dengan lokasi (p=0,829) dan TIL (p=0,187). Terdapatperbedaan bermakna antara usia dan lokasi (p=0,020) serta peningkatan ekspresi PMS2 denganMSH6 (p=0,06).Kesimpulan :MSI-H ditemukan pada 27,8% kasus. Penggunaan PMS2 dan MSH6 pada penelitian ini belumdapat menggantikan 4 panel IHK. Terdapat kecenderungan dimana adenokarsinoma NOSmemiliki frekuensi mutasi lebih tinggi dari adenokarsinoma musinosum.ABSTRACT Background : Colorectal carcinoma (CRC) is the world second leading cause of death from all types of cancer.CRC can be caused by a defect of MMR DNA. Microsatellite instability (MSI) is a marker ofDNA MMR defect. CRC MSI-H has a certain characteristic figures. Tumor-infiltratinglymphocytes (TIL) isone of prognostic factor. Loss expression of the PMS2 and MSH6 can beuse as a marker of MSI. This study aims to assess the occurrence of MSI in CRC on the left sideand the right side of the colon through the loss of expression of PMS2 and MSH6, anddetermine the relationship between TIL with MSI-H. Materials and Methods :Immunohistochemical staining using two marker, there is PMS2 and MSH6. We also countingthe number of TIL. Assessment by calculating the loss expression of PMS2 and MSH6 in the cellnuclei and divided into two groups, the mutations and non mutations . TIL result also groupedinto high and low, based on the cutoff point. Result :There are 27.8% of cases showed loss of expression of PMS 2 and MSH6 with 14.4% of cases inthe distal colon. About 30% TIL cases located in distal colon. There were no significantdifferences between PMS2 and MSH6 mutation with the location (p = 0.829) and TIL (p =0.187). There are significant differences between age and location (p = 0.020) and increasedexpression of PMS2 with MSH6 (p = 0.06). \ Conclusion :MSI-H was found in 27.8% of cases. The use of PMS2 and MSH6 in this study have not beenable to replace 4 panels of IHC. There is a tendency where the adenocarcinoma NOS have ahigher mutation frequency than mucinous adenocarcinoma. ;Background :Colorectal carcinoma (CRC) is the world second leading cause of death from all types of cancer.CRC can be caused by a defect of MMR DNA. Microsatellite instability (MSI) is a marker ofDNA MMR defect. CRC MSI-H has a certain characteristic figures. Tumor-infiltratinglymphocytes (TIL) isone of prognostic factor. Loss expression of the PMS2 and MSH6 can beuse as a marker of MSI. This study aims to assess the occurrence of MSI in CRC on the left sideand the right side of the colon through the loss of expression of PMS2 and MSH6, anddetermine the relationship between TIL with MSI-H. Materials and Methods :Immunohistochemical staining using two marker, there is PMS2 and MSH6. We also countingthe number of TIL. Assessment by calculating the loss expression of PMS2 and MSH6 in the cellnuclei and divided into two groups, the mutations and non mutations . TIL result also groupedinto high and low, based on the cutoff point. Result :There are 27.8% of cases showed loss of expression of PMS 2 and MSH6 with 14.4% of cases inthe distal colon. About 30% TIL cases located in distal colon. There were no significantdifferences between PMS2 and MSH6 mutation with the location (p = 0.829) and TIL (p =0.187). There are significant differences between age and location (p = 0.020) and increasedexpression of PMS2 with MSH6 (p = 0.06). \ Conclusion :MSI-H was found in 27.8% of cases. The use of PMS2 and MSH6 in this study have not beenable to replace 4 panels of IHC. There is a tendency where the adenocarcinoma NOS have ahigher mutation frequency than mucinous adenocarcinoma. ;Background :Colorectal carcinoma (CRC) is the world second leading cause of death from all types of cancer.CRC can be caused by a defect of MMR DNA. Microsatellite instability (MSI) is a marker ofDNA MMR defect. CRC MSI-H has a certain characteristic figures. Tumor-infiltratinglymphocytes (TIL) isone of prognostic factor. Loss expression of the PMS2 and MSH6 can beuse as a marker of MSI. This study aims to assess the occurrence of MSI in CRC on the left sideand the right side of the colon through the loss of expression of PMS2 and MSH6, anddetermine the relationship between TIL with MSI-H. Materials and Methods :Immunohistochemical staining using two marker, there is PMS2 and MSH6. We also countingthe number of TIL. Assessment by calculating the loss expression of PMS2 and MSH6 in the cellnuclei and divided into two groups, the mutations and non mutations . TIL result also groupedinto high and low, based on the cutoff point. Result :There are 27.8% of cases showed loss of expression of PMS 2 and MSH6 with 14.4% of cases inthe distal colon. About 30% TIL cases located in distal colon. There were no significantdifferences between PMS2 and MSH6 mutation with the location (p = 0.829) and TIL (p =0.187). There are significant differences between age and location (p = 0.020) and increasedexpression of PMS2 with MSH6 (p = 0.06). \ Conclusion :MSI-H was found in 27.8% of cases. The use of PMS2 and MSH6 in this study have not beenable to replace 4 panels of IHC. There is a tendency where the adenocarcinoma NOS have ahigher mutation frequency than mucinous adenocarcinoma. "

"Kaitannya dengan ekspresi protein MLH1, MSH2, dan SMAD4, dan membandingkannya dengan pasien kanker kolorektal usia di atas 60 tahun.Metode: Data rekam medis pasien kanker kolorektal usia di bawah 40 tahun dan usia di atas 60 tahun , dikumpulkan dari 3 rumah sakit: Jakarta, Makasar, dan Bandung. Kelompok etnis dipilih dari suku bangsa Jawa, Makasar (Sulawesi Selatan, dan Minangkabau (Sumatera Barat) yang dikonfirmasi berdasarkan kuesioner. Pada spesimen tumor dilakukan pemeriksaan histopatologi, gradasi tumor, serta pemeriksaan imunohistokimia untuk penentuan ekspresi protein MLH1 dan MSH2 untuk menilai mutasi instabilitas mikrosatelit. Ekspresi protein SMAD4 diperiksa untuk memastikan bahwa jaringan tumor tidak berasal dari instabilitas mikrosatelit.Hasil: Telah dikumpulkan 121 penderita kanker kolorektal dari etnis Sunda, Jawa, Makasar, dan Minangkabau. Derajad keganasan antara pasien muda dan pasien tua berbeda secara bermakna (p = 0.001). Pewarnaan imunohistokimia untuk protein MSH2 dan MLH1 yang dilakukan pada masing-masing 92 dan 97 pasien, menunjukkan tidak terdapat perbedaan bermakna dalam hal ekspresi MLH1 dan MSH2 dan gradasi tumor, yang berarti tidak ada hubungan antara instabilitas mikrosatelit dan derajad tumor.Kesimpulan: Karakter kliniko patologi kanker kolorektal pada penduduk asli Indonesia, tidak berbeda antara pasien usia muda (< 40 tahun) dan pasien usia tua (>60 tahun) pada kelompok etnis yang sama. Juga tidak terdapat perbedaan dalam ekspresi protein MSH2 dan MLH1, yang merupakan indikator instabilitas mikrosatelit.

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Aim: To obtain clinicopathological characteristics of colorectal cancer among young native Indonesians and to assess MLH1, MSH2, and SMAD4 protein expressions, comparing them with a matched population of colorectal cancer patients aged 60 years old and older.

Methods: Medical records of colorectal cancer patients aged 40 years or younger and 60 years or older from several hospitals in three Indonesian cities ? Jakarta, Makassar, and Bandung - were reviewed. The ?native? ethnic groups were selected from those originating from Java, Makassar (South Celebes), Miinangkabau (West Sumatra). Ethnicity of 121 colorectal carcinoma patients was confirmed by fulfilling requirements in a questionnaire. Tumor specimens of those patients underwent evaluation for histopathology, tumor grading as well as immunohistochemical analysis to assess MLH1, MSH2 protein expressions to detect microsatellite instability mutation pathway and SMAD4 protein expression to reconfirm that the specimens were not microsatellite instability origin.

Results: There were 121 colorectal carcinoma cases of Sundanese, Javanese, Macassarese and Minangkabau ethnic group. This study indicated that colorectal cancer has statistically different grade (p = 0.001) between the young and the older patients. Immunohistochemical staining for MSH2 protein and MLH1 were done for 92 and 97 specimens respectively. There was no significant difference between the expressions of MLH1 and MSH2 on tumor grading, indicated there was no correlation between microsatellite instability and tumor grading in this study.

Conclusion: Colorectal cancer in young native Indonesian patients (40 years old or less) was not different in clinicopathological characteristics compared to older patients (60 years old or more) in similar ethnic groups. There was also no difference in MSH2 and MLH1 protein expressions, important indicators of microsatellite instability."

"Latar belakang: Kanker kolorektal menduduki peringkat tiga sebagai kanker terbanyak di dunia, dan peringkat kedua sebagai kanker dengan angka mortalitas tertinggi, yaitu 862,000 kematian pada tahun 2018. Dalam alur penatalaksanaan kanker kolorektal, pemeriksaan histopatologi memiliki peranan penting dalam menentukan progresivitas kanker yang secara tidak langsung menentukan jenis terapi pada pasien. Subjektivitas dalam pemeriksaan patologi berpotensi untuk menjadi suatu masalah karena dapat menyebabkan diagnosis yang tidak tepat. Hal ini diakibatkan sifat pemeriksaan patologis yang operator dependent yang perlu diminimalkan agar pemeriksaan lebih objektif. Spektroskopi telah digunakan sebagai metode untuk membantu mengkuantifikasikan diagnosis kanker mulai dari quantitative mass sepctrometry, atau quantitative spectroscopic imaging. Namun penggunaan spektroskopi berbasis cahaya tampak belum banyak ditemukan.Tujuan: Studi ini bertujuan untuk mengetahui intensitas cahaya reflektansi dari spektrofotometer reflektans sederhana untuk membedakan jaringan kolon normal, prekanker, dan kanker, serta akurasinya dalam membedakan jaringan. Metode: Studi ini mengukur reflektansi pada jaringan kanker kolon dari mencit (Mus musculus) pada 126 panjang gelombang mulai dari 435-712.6 nm. Data reflektansi dianalisis menggunakan Uji Saphiro Wilk, Uji Kruskal Wallis, dan Uji One Way ANOVA. Kemudian Principle Component Analysis (PCA) dilakukan pada data, lalu dilanjutkan dengan 5-fold cross validation menggunakan algoritma machine learning. Pengukuran parameter akurasi kemudian dilakukan pada model yang dibuat menggunakan machine learning yang mencakup CA (Classification Accuracy), precision, recall, sensitivitas, dan spesifisitas. Hasil: Dalam membedakan 3 kelompok jaringan (normal, prekanker, dan kanker), ditemukan 41 panjang gelombang dengan setidaknya 2 kelompok berbeda bermakna, dan spektrofotometer memiliki akurasi yang rendah (CA 0.429-0.464, precision 0.446-0.481, recall 0.429-0.464). Untuk membedakan jaringan normal dan jaringan abnormal (prekanker dan kanker), ditemukan 57 panjang gelombang dengan perbedaan bermakna, dan spektrofotometer memiliki akurasi dengan skor CA 0.821-0.857, precision 0.819-0.60, recall 0.821-0.857, sensitivitas 88.8-100%, dan spesifisitas 50-70%.Simpulan: Studi ini menyimpulkan bahwa terdapat perbedaan reflektansi antara 3 kelompok jaringan. Spektrofotometer reflektans sederhana dapat membedakan jaringan normal dan jaringan abnormal (prekanker dan kanker) dengan cukup baik, namun tidak dapat untuk membedakan 3 kelompok jaringan.

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Bakcground: Colorectal cancer is the third most prevalent cancer worldwide and is the second place for cancers with the highest mortality (862,000 deaths in 2018. In the guidelines for colorectal cancer therapy, histopathological evaluations plays a major role in determining the progression of the cancer thus indirectly determining the therapy for each patient. Subjectivity in pathological evaluation might lead to problems which would resulted in misdiagnosis. This is due to the operator-dependent characteristic of pathological evalutaion that should be minimalized to increase its objectivity. Spectroscopy have been researched and used as a method to help to quantify cancer diagnosis such as quantitative mass spectroscopy and quantitative spectroscopic imaging. The usage of visible light spectroscopy is limited for now. Objectives: This study aims to evaluate the reflectance measured using simple reflectance spectrophotomoeter in order to differentiate normal colon, precancer lesion, and colon cancer tissue, and its accuracy in differentiating tissues.Methods: This study measures the reflectance of the Mus musculus rodents' colon tissue in 127 wavelength from 435-712.6 nm. The reflectance then analyzed using Saphiro Wilk test, One Way ANOVA, and Kruskal Wallis. PCA is conducted, then a 5-fold cross validation is done using machine learning algorithms. A accuracy testing including CA (Classification Accuracy), precision, recall, sensitivity, and specificity is done to the models made by machine learning algorithm.Results: In differentiating 3 tissue category (normal, precancer, and cancer) 41 wavelengths are identified with a p-value of <0.05. To differentiate 3 tissue category, simple spectrophotometer have low accuracy (CA 0.429-0.464, precision 0.446-0.481, recall 0.429-0.464. In differentiating abnormal tissue (precancer and cancer) from normal tissue, 57 wavelengths are identified with a p-value of <0.05. To differentiate these 2 categories, simple reflectance spectrophotometer have an accuracy with CA score equals 0.821-0.857, precision equals 0.819-0.60, recall equals 0.821-0.857, sensitivity equals 88.8-100%, and spesificity equals 50-70%.Conclusion: This study concludes that there is a significant difference in reflectance from 3 tissue samples. Simple reflectance spectrophotometer could differentiate normal and abnormal (precancer and cancer) tissue well but it is unable to differentiate normal, precancer, and cancer tissue to 3 different categories."

"Kanker kolorektal (KKR) menempati urutan ketiga sebagai kanker penyebab kematian tertinggi di dunia. Diperkirakan sekitar 63% kematian akibat KKR terjadi karena kurangnya screening dan keterlambatan diagnosis. Saat ini metode standar yang digunakan dalam diagnosis KKR adalah kolonoskopi dan biopsi jaringan. Namun metode tersebut memiliki risiko yang tinggi, besifat invasif, serta tidak efisien untuk monitoring perkembangan tumor. Gen Epidermal Growth Factor Receptor (EGFR) telah umum digunakan sebagai marka prognostik KKR, salah satunya melalui studi ekspresi gen pada Circulating Tumor Cells (CTCs). Namun CTC memiliki beberapa kelemahan, seperti konsentrasi yang rendah dan heterogenitas yang beragam. Di sisi lain, serum darah penderita kanker mengandung cell-free Nucleic Acid (cfNA) yang membawa informasi genetik dari jaringan tumor asal. Hal tersebut menjadikan cfNA berpotensi untuk dikembangkan sebagai salah satu metode alternatif untuk diagnosis dan monitoring KKR. Penelitian ini bertujuan untuk mendeteksi gen EGFR dari CTC dan serum darah penderita KKR menggunakan metode quantitative PCR with Melting Curve Analysis (qPCR MCA). Penelitian dilakukan terhadap 4 pasien KKR dengan karakteristik dan stadium kanker yang bervariasi. Hasil penelitian menunjukkan gen EGFR terdeteksi pada seluruh sampel serum dan hanya terdeteksi pada 1 sampel CTC. Oleh karena itu, dapat disimpulkan bahwa deteksi biomarker EGFR pada serum memiliki efektivitas yang lebih baik dibandingkan CTC.<

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Colorectal cancer (CRC) ranks as the third leading cause of cancer death in the world. It is estimated that around 63% of deaths from CRC occur due to lack of screening and delay in diagnosis. Currently, the standard methods used in the diagnosis of CRC are colonoscopy and tissue biopsy. However, this method has a high risk, invasive, and inefficient for tumor monitoring. The Epidermal Growth Factor Receptor (EGFR) has been commonly used as a prognostic marker for CRC through gene expression analysis of Circulating Tumor Cells (CTCs). However, CTC have some limitations such as heterogeneity and low concentrations. On the other hand, the blood serum of cancer patients contains cell-free Nucleic Acid (cfNA) which carries genetic information from the original tumor tissue. Hence, cfNA have great potential to be developed as an alternative method for CRC diagnosis and monitoring. This study aims to detect the EGFR gene from CTC and blood serum of CRC patients using the quantitative PCR with the Melting Curve Analysis (qPCR MCA). The study was conducted on 4 CRC patients with various characteristics and stages of cancer. The results showed that the EGFR gene was detected in all serum samples and only in 1 CTC sample. Therefore, the results suggest that the detection of EGFR biomarkers in serum has better effectiveness than CTC."

"ABSTRAKKanker kolorektal menduduki peringkat ketiga jenis kanker yang paling sering terjadi di dunia. Data mengenai gambaran tatalaksana kanker kolorektal di RSUP Fatmawati belum pernah tercatat dan belum pernah dievaluasi keberhasilanya. Untuk itu kami mengumpulkan data penderita kanker kolorektal sehingga kami bisa menggambarkan profil penderita kanker kolorektal di RSUP Fatmawati.Metode : Penelitian ini dirancang secara potong lintang retrospektif analitik, di RSUP Fatmawati Jakarta dengan mencatat rekam medis penderita kanker kolorektal yang mendapatkan tatalaksana pembedahan dan terapi adjuvan pada tahun 2010 – 2012.Hasil : Selama 3 tahun periode Januari 2010 sampai dengan 2012, kami dapatkan 122 penderita kanker kolorektal yang di tatalaksana di Departemen Bedah RSUP Fatmawati Jakarta, yang sesuai kriteria inklusi 85 penderita. prevalensi dari tahun ke tahun semakin tambah, dengan jenis kelamin pria lebih banyak (55%) dan wanita (45%). Kelompok usia terbanyak pada penderita usia 50 tahun ke atas (55%), dan. lokasi tumor terbanyak pada kolon kanan (21%). Sebagian besar datang mencari pertolongan dengan keluhan utama buang air besar yang berdarah dan berlendir (47%). Stadium klinis penderita datang dengan stadium I (1%), stadium II (20%), stadium III (50%), stadium IV (28%). Sebagian besar temuan histopatologi adalah adenokarsinoma, dengan differensiasi baik (42%), differensiasi baik-sedang (8%), differensiasi sedang (24%), differensiasi sedang-buruk (4%), differensiasi buruk (10%), dan musinosum (12%). Hanya 68% penderita kanker kolorektal yang mendapatkan kemoterapi adjuvan.Simpulan : Berdasarkan penelitian ini kami menyimpulkan bahwa RSUP Fatmawati dengan jumlah insidensi kanker kolorektal bertambah tiap tahunnya. Rerata pasien yang berkunjung ke pelayanan kami adalah penderita pada stadium III. Kecenderungan insidensi pada usia muda semakin bertambah, kemoterapi adjuvan atau paliatif belum maksimal, neoadjuvan kemoradiasi atau radiasi tidak ada pada pelayanan kami. Sebagian besar penderita diberikan kemoterapi capecetabine oral. Sebagian besar terdapat ketidaksesuaian antara staging klinis dengan staging histopatologis. Data yang didapatkan ini merupakan data pertama yang kami buat di Departemen Bedah RSUP Fatmawati.

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ABSTRACTColorectal cancer was the third most frequent type of cancer that occurs in the world. Data of colorectal cancer management in Fatmawati hospital has not been recorded and has not been evaluated. we collected the data and we can describe the profile of colorectal cancer patients in Fatmawati hospital.Method : The study was designed as a cross-sectional retrospective analytic, in Fatmawati hospital Jakarta recorded base on colorectal cancer patient medical record who received surgery and adjuvant therapy in 2010-2012 .Result : During the 3 years, period from January 2010 to 2012, we got the 122 colorectal cancer patients in in the Department of Surgery Fatmawati hospital Jakarta, appropriate inclusion criteria 85 patients. Prevalence from year to year was increased, with more male gender (55%) and female (45%). The age group most in people aged 50 years and over ( 55 % ). Most tumor location in the right colon (21%). Most come for help with a chief complaint of bloody and mucus stool (47%). Clinical staging of patients with stage I came (1 %), stage II (20%), stage III (50%), stage IV (28%). Most of the findings histopathology is adenocarcinoma, with good differentiated (42%), well-moderate differentiated (8%), moderate differentiated (24%), moderate-poor differentiated (4%), poor differentiated (10%), and mucinous (12%). Only 68 % of patients with colorectal cancer who received adjuvant chemotherapy.Conclusion : Based on this study we conclude that the number of colorectal cancer patients in Fatmawati increased every each year. The most patients who visited our departement was in stage III. Tendency prevalence was increased at a young age, adjuvant or palliative chemotherapy is not maximized, neoadjuvant chemoradiation or radiation does not exist in our services. Most of the patients given oral chemotherapy capecetabine. Mostly there was a mismatch between clinical staging and histopathological staging. The data obtained was the first data that we created in the Department of Surgery Fatmawati hospital Jakarta ."

"ABSTRAKLatar Belakang: COX-2 adalah mediator sintesis prostaglandin yang kadarnyameningkat pada tumor kolorektal. Gen messenger RNA COX-2 diekspresikanberlebihan pada sebagian besar tumor kolorektal. MessengerRNA COX-2 tinjamerupakan modalitas non invasif untuk mendeteksi lesi neoplastik kolorektal.Tujuan: Mengetahui akurasi ekspresi mRNA COX-2 tinja dalam mendiagnosislesi neoplastik kolorektal.Metode: Studi potong lintang pada pasien yang dicurigai kanker kolorektal.Ekspresi mRNA COX-2 tinja diperiksa dengan nested PCR dan hasilnyadianalisis untuk mendapatkan akurasi uji diagnostik.Hasil: Terdapat total 96 sampel yang ikut serta dalam penelitian dengan reratausia 56,22 tahun. Sampel dengan jenis kelamin laki-laki sebanyak 51 orang danperempuan sebanyak 45 orang. Sebanyak 14 sampel merupakan pasien denganlesi neoplastik kolorektal dan 82 pasien bukan dengan lesi neoplastik kolorektal.Akurasi diagnostik mRNA COX-2 tinja adalah sebagai berikut, sensitivitas 35,71% (95% IK 0,04 ? 0,29), spesifisitas 95,12 % (95% IK 0,85 ? 0,97), nilai prediksipositif 55,55 % (95% IK 0,16 ? 0,75), nilai prediksi negatif 89,65 % (95% IK 0,61? 0,80), ratio kemungkinan positif 7,439 (95% IK 0,2 ? 16,34), ratio kemungkinannegatif 0,6758 (95% IK 0,72 ? 1,24).Kesimpulan: Pemeriksaan mRNA COX-2 tinja memiliki sensitivitas yang rendahdan spesifisitas yang tinggi untuk mendeteksi lesi neoplastik kolorektal.Kata kunci: Akurasi diagnostik; kanker kolorektal; mRNA COX-2 tinja.

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ABSTRACTBackground : COX-2 is the mediator of prostaglandin synthesis that increased incolorectal cancer. COX-2 has overexpressed in most of colorectal cancer. FecalmRNA COX-2 is the non-invasive modality to detect neoplastic lesion ofcolorectal.Objective:Analyzing the accuracy of fecal mRNA COX-2 in diagnosingneoplastic lesion of colorectal.Methods : This is a cross sectional study in patient who is suspected colorectalcancer. Expression of fecal mRNA COX-2 examined with nested PCR andanalyzed to get the diagnostic test accuration.Results: There were 96 total samples included in this research, with the mean ageof 56,22 years old. There were 51 male subjects and 45 female subjects, 14subjects with neoplastic lesion of colorectal and 82 subjects without neoplasticlesion of colorectal. Fecal mRNA diagnostic accuration is sensitivity 35,71 %(95% IK 0,04 ? 0,29), spesificity 95,12 % (95% IK 0,85 ? 0,97), positivepredictive value 55,55 % (95% IK 0,16 ? 0,75), negative predictive value 89,65 %(95% IK 0,61 ? 0,80), positive likelihood ratio 7,439 (95% IK 0,2 ? 16,34),negative likelihood ratio 0,6758 (95% IK 0,72 ? 1,24).Conclusion : Fecal mRNA COX-2 assay has low sensitivity and high specificityto detect neoplastic lesion of colorectal.Keyword: Colorectal cancer; diagnostic accuration; fecal mRNA COX-2."

"Latar Belakang: Kanker kolorektal merupakan perubahan patologis jaringan epitel kolon dan rektum normal menjadi massa jaringan yang abnormal, salah satunya disebabkan ekspresi berlebih pada protein siklin D1 sehingga menyebabkan proliferasi sel di kolorektal yang berlebihan. Upaya pencegahan dan pengobatan penyakit kanker kolorektal dapat dilakukan secara alami salah satunya dengan mengonsumsi ekstrak daun Annona muricata L. (sirsak). Sirsak diketahui banyak mengandung komponen fitokimia yang berperan sebagai anti-kanker. Metode: Penelitian ini menggunakan sel kultur kanker kolorektal HT-29 yang diberi paparan ekstrak etanol daun sirsak dan 5-Fluorourasil (5-FU) sebagai kontrol positif, kontrol pelarut, kontrol sel sebagai kontrol negatif untuk dicari konsentrasi optimumnya (CC50) dan dilanjutkan dengan konsentrasi ½ x CC50,1 x CC50, dan 2 x CC50. Parameter yang dinilai adalah viabilitas sel dengan MTT Assay dan analisis penambatan molekuler dari ekstrak etanol daun sirsak terhadap protein siklin D1 dengan molecular operating environment (MOE) 2013.08 software. Hasil: Konsentrasi optimum (CC50) ekstrak etanol daun sirsak sebesar 278 µg/mL dan 5-FU sebesar 88 µg/mL. Pemeriksaan viabilitas sel menunjukkan persentase sel HT-29 hidup menurun seiring dengan bertambahnya konsentrasi dan persentase terendah di konsentrasi 2 x dari cytotoxicity concentration 50 (CC50) setelah pemberian ekstrak etanol daun sirsak (40,4±1,3%) dibandingkan dengan 5-FU (52,8±4,3%), kontrol pelarut (97,2±1,4%) dan kontrol sel (100%). Analisis penambatan molekuler terhadap protein siklin D1 didapatkan molekul N-hexadecanoic acid dan phytol yang mempunyai energi bebas (ΔG) terendah, yaitu 9,7755 kkal/mol dan -7,2147 kkal/mol. Kesimpulan: Konsentrasi 5-FU memiliki CC50 tiga kali lebih rendah dibandingkan ekstrak etanol daun sirsak. Molekul N-hexadecanoic acid dan phytol mempunyai kemampuan berikatan dengan protein siklin D1.

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Introduction: Colorectal cancer is a pathological transformation of normal colon and rectum epithelial that becomes an abnormal tissue mass, due to the overexpression of cyclin D1 protein that inducing the high/excessive proliferation of colorectal cell. It accounted for about 1 million new cancer cases in 2002 (9.4% of the world total). The treatment and prevention of colorectal cancer could be done naturally by consuming leave extract of Annona muricata L. (soursop). Soursop is known for many phytochemical components that serve as an anti-cancer such as alkaloid, annonaceous acetogenin, megastigman, flavonoid glycosides, phenolic, and cyclopeptide.

Methods: The study was used HT-29 colorectal cancer cell that treated with ethanolic leave extract of soursop and 5-Fluorourasil (5-FU) as positive control to find the cytotoxicity concentration that can inhibit 50% of HT-29 cell population (CC50) and the ½ x CC50,1 x CC50, and 2 x CC50 concentrations of them were treated for next treatment with MTT assay. Analysis of molecular docking of ethanolic leave extract of soursop to cyclin D1 protein used molecular operating environment (MOE) 2013.08 software.

Results : Optimum concentration (CC50) of ethanolic leave extract of soursop is 278 μg/mL dan 5-FU is 88 μg/mL. Percentage of viable HT-29 cell line decrease in accordance with increasing concentration and the lowest percentage of viable cell is 2 x cytotoxicity concentration 50 (CC50) after ethanolic leave extract of soursop treatment (40,4±1,3%) was compared to 5-FU (30,68±0,93%), solvent control (97,2±1,4%), and cells control (100%). Analysis of molecular docking to cyclin D1 protein was obtained N-hexadecanoic acid and phytol molecules that have the lowest free energy (ΔG), that are 9,7755 kkal/mol and -7,2147 kkal/mol.

Conclusions 5-FU concentration is 3-fold lower than ethanolic leave extract of soursop. N-hexadecanoic acid and phytol molecules have ability to inhibit cyclin D1 protein."