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"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."

"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."