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Abstrak :
CA 19-9 merefleksikan derajat keparahan adenokarsinoma kaput pankreas ditunjukkan oleh beberapa studi berhasil menemukan korelasi peningkatan CA 19-9 dengan resektabilitas adenokarsinoma kaput pankreas. Penelitian ini bertujuan melakukan evaluasi hubungan dan nilai diagnostik CA 19-9 dalam memprediksi resektabilitas adenokarsinoma kaput pankreas. Penelitian dilakukan secara potong lintang mengambil data dari rekam medis Rumah Sakit dr. Cipto Mangunkusumo tahun 2016–2019. Pasien terdiagnosis adenokarsinoma kaput pankreas secara histopatologis atau pencitraan abdomen, berusia ≤65 tahun, dan memiliki catatan pemeriksaan kadar CA 19-9 diikutsertakan dalam penelitian ini. Selain kadar CA 19-9, peneliti juga menilai factor terkait operabilitas. Tercatat 54 subjek dengan rerata usia 53,78±11,13 tahun. Ditemukan adanya korelasi positif (0,850) dan signifikan antara tingginya kadar CA 19-9 dengan resektabilitas tumor kaput pankreas. Untuk operabilitas, ditemukan perbedaan bermakna kadar CA 19-9, albumin, dan skor Karnofsky pada kelompok pasien tumor kaput pankreas resectable dan unresectable. Titik potong kadar CA 19-9 tercatat sebesar 140,65 U/mL, dengan sensitivitas sebesar 82,76% (64,23%–94,15%), spesifisitas sebesar 72,00% (50,61%–87,93%), dan AUC sebesar 0,784. CA 19-9 berhubungan secara signifikan dengan resektabilitas tumor kaput pankreas. CA 19-9 memiliki nilai diagnostik yang baik dalam mempredisksi resektabilitas tumor ini. ......CA 19-9 reflects the degree of severity of pancreatic head adenocarcinoma shown by several studies to find a correlation of elevated CA 19-9 with resectability of pancreatic head adenocarcinoma. This study aimed to evaluate the relationship and diagnostic value of CA 19-9 in predicting resectability of pancreatic head adenocarcinoma. The study was conducted in a cross-sectional manner, taking data from the medical records of dr. Cipto Mangunkusumo 2016–2019. Patients diagnosed with adenocarcinoma of the head of the pancreas by histopathologic or abdominal imaging, aged ≤65 years, and who had a record CA level of 19-9 were included in this study. In addition to CA levels of 19-9, the investigators also assessed operability-related factors. There were 54 subjects with a mean age of 53.78 ± 11.13 years. Found a positive correlation (0, 850) and significant between high levels of CA 19-9 with resectability of head tumors of the pancreas. For operability, there were significant differences in CA 19-9 levels, albumin, and Karnofsky scores in the resectable and unresectable group of pancreatic head tumors. The cut-off point for CA 19-9 levels was recorded at 140.65 U / mL, with a sensitivity of 82.76% (64.23% -94.15%), a specificity of 72.00% (50.61% -87.93 %), and AUC of 0.784. CA 19-9 was significantly associated with pancreatic head tumor resectability. CA 19-9 has a good diagnostic value in predicting the resectability of these tumors. The cut-off point for CA 19-9 levels was 140.65 U / mL, with a sensitivity of 82.76% (64.23% -94.15%), a specificity of 72.00% (50.61% -87.93 %), and AUC of 0.784. CA 19-9 was significantly associated with pancreatic head tumor resectability. CA 19-9 has a good diagnostic value in predicting the resectability of these tumors. The cut-off point for CA 19-9 levels was 140.65 U / mL, with a sensitivity of 82.76% (64.23% -94.15%), a specificity of 72.00% (50.61% -87.93 %), and AUC of 0.784. CA 19-9 was significantly associated with pancreatic head tumor resectability. CA 19-9 has a good diagnostic value in predicting the resectability of these tumors

Abstrak :
CA 19-9 merefleksikan derajat keparahan adenokarsinoma kaput pankreas ditunjukkan oleh beberapa studi berhasil menemukan korelasi peningkatan CA 19-9 dengan resektabilitas adenokarsinoma kaput pankreas. Penelitian ini bertujuan melakukan evaluasi hubungan dan nilai diagnostik CA 19-9 dalam memprediksi resektabilitas adenokarsinoma kaput pankreas. Penelitian dilakukan secara potong lintang mengambil data dari rekam medis Rumah Sakit dr. Cipto Mangunkusumo tahun 2016–2019. Pasien terdiagnosis adenokarsinoma kaput pankreas secara histopatologis atau pencitraan abdomen, berusia ≤65 tahun, dan memiliki catatan pemeriksaan kadar CA 19-9 diikutsertakan dalam penelitian ini. Selain kadar CA 19-9, peneliti juga menilai factor terkait operabilitas. Tercatat 54 subjek dengan rerata usia 53,78±11,13 tahun. Ditemukan adanya korelasi positif (0,850) dan signifikan antara tingginya kadar CA 19-9 dengan resektabilitas tumor kaput pankreas. Untuk operabilitas, ditemukan perbedaan bermakna kadar CA 19-9, albumin, dan skor Karnofsky pada kelompok pasien tumor kaput pankreas resectable dan unresectable. Titik potong kadar CA 19-9 tercatat sebesar 140,65 U/mL, dengan sensitivitas sebesar 82,76% (64,23%–94,15%), spesifisitas sebesar 72,00% (50,61%–87,93%), dan AUC sebesar 0,784. CA 19-9 berhubungan secara signifikan dengan resektabilitas tumor kaput pankreas. CA 19-9 memiliki nilai diagnostik yang baik dalam mempredisksi resektabilitas tumor ini. ......This study would like to evaluate the relationship and diagnostic value of CA 19-9 in predicting the resectability of pancreatic head carcinoma. The cross-sectional study took data from the medical records at dr Cipto Mangunkusumo Hospital in 2015–2019. Patients diagnosed with pancreatic head carcinoma based on histopathologic or abdominal imaging, aged ≤75 years, and who had a recorded CA level of 19-9 were enrolled in the study. The investigators also assessed parameters of operability. Of 54 patients with similar characteristics were enrolled, with a mean age of 53.78 ± 11.13 years. It was found that there was a positive (0.850) and significant correlation between high levels of CA 19-9 and unresectable pancreatic head carcinoma. We found significant differences in levels of CA 19-9, albumin, and Karnofsky score in the resectable and unresectable groups of pancreatic head carcinoma. The cut-off point for CA 19-9 levels was 140.65 U / mL, with a sensitivity of 82.76% (64.23%-94.15%), specificity of 72.00% (50.61%-87.93 %), and AUC of 0.784. CA 19-9 was significantly associated with the pancreatic head carcinoma resectability. CA 19-9 has a good diagnostic value in predicting the resectability of these tumors.

Abstrak :
Latar Belakang: Kanker pankreas merupakan penyakit dengan kesintasan rendah dan kesulitan untuk melakukan diagnosis. Pemeriksaan Computed Tomography (CT)-Scan abdomen dan Ca 19-9 merupakan modalitas yang murah, mudah, dan terjangkau dalam diagnosis kanker pankreas. Endoscopic Ultrasound Fine Needle Aspiration (EUS-FNA) merupakan pemeriksaan baku emas untuk diagnosis kanker pankreas tetapi belum banyak tersedia di fasilitas kesehatan di Indonesia Tujuan: Penelitian ini bertujuan untuk mengetahui kemampuan diagnostik CT-Scan abdomen dan Ca 19-9 dibandingkan dengan EUS-FNA dalam diagnosis kanker pankreas. Metode: Desain studi ini adalah potong lintang dengan melihat rekam medis 62 pasien dengan kecurigaan kanker pankreas di RSCM pada tahun 2015-2019. Diambil pasien-pasien yang memiliki data Ca 19-9 dan CT-Scan abdomen yang kemudian dilakukan EUS-FNA untuk penegakan diagnosis kanker pankreas. Hasil: Sensitivitas dan spesifisitas CT-Scan abdomen masing-masing 76,27% dan 100%, sedangkan Ca 19-9 masing-masing 67,8% dan 33,33%. Nilai duga positif (NDP), nilai duga negatif (NDN), rasio kemungkinan positif (RKP), rasio kemungkinan negatif (RKN), dan akurasi CT-Scan abdomen masing-masing adalah 100%, 17.65%, tidak dapat dinilai, 0,24 , dan 77,42%. Nilai duga positif, NDN, RKP, RKN, dan akurasi untuk Ca 19-9 masing-masing adalah 95.24%, 5%, 1,02, 0,97, dan 66,13%. Kesimpulan: Kombinasi pemeriksaan CT-Scan Abdomen dan Ca 19-9 memiliki sensitivitas yang tinggi untuk kanker pankreas. Computed Tomography abdomen dapat digunakan untuk diagnosis kanker pankreas dengan sensitivitas dan spesifisitas yang baik.

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Introduction: Pancreatic cancer is a disease with low survival rate and difficult to diagnose. Abdominal computed tomography (CT) and Ca 19-9 are diagnostic modalities which are easy, simple, and non-invasive in diagnosis of pancreatic cancer. Endoscopic Ultrasound Fine Needle Aspiration (EUS-FNA) is the gold standard for diagnosis of pancreatic cancer but it is not available in many health care facilities in Indonesia. Purpose: This study aims to know the diagnostic accuracy of abdominal CT and Ca 19-9 compared to EUS-FNA for diagnosis of pancreatic cancer. Methods: The design of this study is cross-sectional by searching medical record of 62 patients with clinical suspicion of pancreatic cancer in Cipto Mangunkusumo hospital from year 2015-2019. Patients who undergo EUS-FNA with clinical suspicion of pancreatic cancer and have abdominal CT and Ca 19-9 data is included. Results: The sensitivity and specificity of abdominal CT are 76.27% and 100%, respectively, and Ca 19-9 are 67.8% and 33.33%, respectively. Positive predictive value, NPV, positive likelihood ratio, negative likelihood ratio, and accuracy of abdominal CT are 100%, 17.65%, unmeasurable, 0.24 , and 77.42%, respectively. Positive predictive value, NPV, positive likelihood ratio, negative likelihood ratio, and accuracy of Ca 19-9 are 95.24%, 5%, 1.02, 0.97, and 66.13%, respectively. Conclusion: The combined sensitivity of abdominal CT and Ca 19-9 has high sensitivity to diagnose pancreatic cancer. Abdominal CT can be used to diagnose pancreatic cancer with good sensitivity and specificity.

Abstrak :
Kanker pankreas adalah penyakit di mana sel-sel tumor ganas (kanker) berkembang di jaringan pankreas, yaitu organ di belakang perut bagian bawah dan di depan tulang belakang, yang membantu tubuh menggunakan dan menyimpan energi dari makanan dengan memproduksi hormon untuk mengontrol kadar gula darah dan enzim pencernaan untuk memecah makanan. Biasanya, kanker pankreas jarang terdeteksi pada tahap awal. Salah satu tanda seseorang mengalami kanker pankreas adalah diabetes, terutama jika itu bertepatan dengan penurunan berat badan yang cepat, penyakit kuning, atau rasa sakit di perut bagian atas yang menyebar ke punggung. Di antara berbagai jenis kanker, kanker pankreas memiliki tingkat kelangsungan hidup terendah, yaitu hanya sekitar 3-6% dari mereka yang didiagnosis yang dapat bertahan hidup selama lima tahun. Jika pasien didiagnosis tepat waktu untuk perawatan, peluang mereka untuk bertahan hidup akan meningkat. Terdapat penanda tumor yang biasa digunakan untuk mengikuti perkembangan kanker pankreas, yaitu CA 19-9 yang dapat diukur dalam darah. Orang sehat dapat memiliki sejumlah kecil CA 19-9 dalam darah mereka. Kadar CA 19-9 yang tinggi seringkali merupakan tanda kanker pankreas. Tetapi kadang-kadang, kadar tinggi dapat menunjukkan jenis kanker lain atau gangguan non-kanker tertentu, seperti sirosis dan batu empedu. Karena kadar CA 19-9 yang tinggi tidak spesifik untuk kanker pankreas, CA 19-9 tidak dapat digunakan dengan sendirinya untuk skrining atau diagnosis. Ini dapat membantu memantau perkembangan kanker dan efektivitas pengobatan kanker. Dalam studi ini, metode Kernel-based Support Vector Machine digunakan untuk mengklasifikasikan hasil tes darah CA19-9 menjadi dua bagian; data pasien yang didiagnosis dengan kanker pankreas atau pasien normal (tidak terdiagnosis kanker pankreas). Metode ini memperoleh akurasi sekitar 95%.

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Pancreatic cancer is a disease in which malignant (cancerous) tumor cells develop in pancreatic tissue; organ behind the lower abdomen and in front of the spine, which helps the body use and store energy from food by producing hormones to control blood sugar levels and digestive enzymes to break down food. Usually, pancreatic cancer is rarely detected at an early stage. One sign of a person with pancreatic cancer is diabetes, especially if it coincides with rapid weight loss, jaundice, or pain in the upper abdomen that spreads to the back. Among various types of cancer, pancreatic cancer has the lowest survival rate of only about 3-6% of those diagnosed who can survive for five years. If patients are diagnosed on time for treatment, their chances of survival will increase. There is a tumor marker commonly used to follow the course of pancreatic cancer, namely CA 19-9 which can be measured in the blood. Healthy people can have small amounts of CA 19-9 in their blood. High levels of CA 19-9 are often a sign of pancreatic cancer. But sometimes, high levels can indicate other types of cancer or certain noncancerous disorders, including cirrhosis and gallstones. Because a high level of CA 19-9 is not specific for pancreatic cancer, CA 19-9 cannot be used by itself for screening or diagnosis. It can help monitor the progress of your cancer and the effectiveness of cancer treatment. In this study, the Kernel-based Support Vector Machine method is used to classify CA19-9 blood test results into two sections including data on patients diagnosed with pancreatic cancer or normal patients. This method will get an accuracy of around 95%.