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I Gusti N. Gunawan W
Akurasi tripel diagnostik pada pasien dengan Nodul Tiroid di Rumah Sakit Dr. Cipto Mangunkusumo (RSCM) = Accuracy of triple diagnostic in patients with Thyroid Nodule in Cipto Mangunkusumo Hospital / I Gusti N. Gunawan W
"ABSTRAK
Pendahuluan
Di Indonesia berdasarkan data dari Badan Registrasi Kanker Indonesia, karsinoma tiroid dengan frekuensi relatif 4,43%, menempati urutan ke 9 dari 10 keganasan yang sering ditemukan. Pada tindakan pembedahan tiroid, umum dilakukan pemeriksaan potong beku intra operatif untuk menentukan keganasan pada lesi tiroid serta menentukan tindakan definitif dan jenis operasi yang akan dikerjakan. Pemeriksaan potong beku itu sendiri memiliki beberapa kelemahan antara lain biaya yang lebih mahal, waktu pembiusan yang lebih lama dengan segala risikonya, serta ketidaksediaan pemeriksaan ini di setiap rumah sakit. Tujuan penelitian ini adalah untuk menilai akurasi pemeriksaan triple diagnostik pada nodul tiroid yang terdiri dari klinis, ultrasonografi, dan aspirasi jarum halus (bajah), yang dibandingkan dengan standar baku emas pemeriksaan histopatologi sehingga nantinya diharapkan triple diagnostik ini saja sudah cukup untuk dapat dipakai dalam merencanakan terapi definitif.
Metoda
Dilakukan pengumpulan data pasien dengan nodul tiroid dari rekam medis dari periode 2010-2011. Dilakukan penghitungan dan penentuan kriteria ganas atau jinak dari masing-masing unsur triple diagnostik, yang terdiri dari data klinis (anamnesis dan pemeriksaan fisik), USG tiroid, dan bajah. Dilakukan analisis uji diagnostik dari triple diagnostik yang dibandingkan dengan pemeriksaan histopatologi pasca operasi sebagai standar baku emas.
Hasil
Terdapat 223 pasien dengan nodul tiroid. Dari jumlah tersebut data rekam medis yang lengkap didapatkan sebanyak 161 kasus. Jenis histopatologi terdiri dari karsinoma papiler (90,3%), folikular (3%), meduler (0,7%), anaplastik (6%). Didapatkan sensitivitas dan spesifisitas dari triple diagnostik pada nodul tiroid sebesar 77 % dan 94 %. Nilai prediksi positif 98%, nilai prediksi negatif 51,6%, dan akurasi sebesar 80,9%. Kombinasi dari pemeriksaan klinis, ultrasonografi dan bajah memberikan probabilitas ganas sebesar 92%.
Kesimpulan
Triple diagnostik belum dapat digunakan sebagai pemeriksaan yang ideal menggantikan pemeriksaan potong beku dalam menangani kasus nodul tiroid, tetapi pada kasus dengan unsur-unsur triple diagnostik yang konkordan ganas memiliki nilai prediksi positif (98%) dan probabilitas ganas (92%) yang tinggi sehingga pada kasus demikian memungkinkan untuk dilakukan tindakan definitif dengan tetap mempertimbangkan sensitifitas dan spesifitas unsur-unsur triple diagnostik pada masing-masing senter
ABSTRACT
Background
In Indonesia, based on data from Indonesian Cancer Registration Council, thyroid carcinoma with relative frequency of 4,43% ranks the ninth from the ten most common cancers in Indonesia. In thyroid surgery, it’s common to perform frozen section examination intraoperatively to determine malignancy and definitive operation. Frozen section has several limitations, for example: higher expense, longer duration of anesthetization, and it’s unavaibility in all hospital. The aim of this research is to evaluate accuracy of triple diagnostic, which is consisted of clinical findings, ultrasonography, dan fine needle aspiration biopsy, compared to golden standard of histopathological result, so that triple diagnostic only is enough to plan definitive treatment in patients with thyroid nodule.
Method
Data were collected from medical records from the period of 2010-2011. Each element of triple diagnostic was classified into either malignant or benign. Diagnostic test study was performed to analyze triple diagnostic which was compared to post operative histopathological result as a golden standard.
Results
There were 223 patients with thyroid nodule, but of all there were only 161 cases with complete medical record were compiled. Histopathological reports consisted of papillary carcinoma (90,3%), follicular (3%), medullary (0,7%), anaplastic (6%). Sensitivity and spesifity of triple diagnostic for thyroid nodule were 77% and 94%. Positive predictive value of 98%, negative predictive value of 51,6%, and accuracy of 80,9%. Combination of clinical findings, ultrasonography, and fine needle aspiration biopsy altogether gave probability of malignant of 92 %.
Conclusion: Triple diagnostic for thyroid nodule can not be used yet as ideal test to replace golden standard of histopatlogical result, but cases which concordant results of each triple diagnostic’s element have high both positive predictive value (98 %) and malignant probability (92 %). In cases as above, it is still possible to perform definitive operation while still considering both sensitivity and spesifity of all triple diagnostic’s elements in each center."
Fakultas Kedokteran Universitas Indonesia, 2012
T33095
UI - Tesis Membership  Universitas Indonesia Library
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Laila Rose Foresta
Korelasi perubahan kurva kinetik pada magnetic resonance imaging dengan perubahan ukuran tumor sebagai penanda respons tumor pasca kemoterapi neoajuvan pasien kanker payudara = correlation of kinetic curve gradient degree changes and tumor size changes in magnetic resonance imaging as a tumor response marker for neoadjuvant chemotherapy in breast cancer patients
"Penelitian ini bertujuan mencari penanda respons tumor yang lebih dini untuk kemoterapi neoajuvan pada kasus kanker payudara stadium lanjut, yaitu dengan mengkorelasikan derajat kemiringan washout fase delay kurva kinetik pada pemeriksaan DCE-MRI dengan perubahan ukuran tumor kanker payudara. Perubahan neovaskularisasi sudah dapat dinilai sejak 24 jam pertama setelah pemberian kemoterapi siklus pertama, sedangkan pengukuran tumor umumnya paling baik dinilai setelah kemoterapi neoajuvan siklus ketiga.
Penelitian ini merupakan studi deskriptif analitik dari data sekunder MRI payudara mulai Agustus 2011 hingga April 2013. Analisa korelasi perubahan derajat kemiringan washout fase delay kurva kinetik DCE-MRI dengan perubahan ukuran tumor sebelum dan sesudah pemberian kemoterapi neoajuvan awal, dilakukan dengan uji korelasi Pearson.
Hasil analisa menunjukkan tidak ada korelasi yang bermakna (r=0,151, p=0,622) antara perubahan sudut kemiringan washout fase delay kurva kinetik dengan perubahan ukuran tumor sebelum dan setelah pemberian kemoterapi neoajuvan, sehingga dapat disimpulkan bahwa parameter perubahan sudut kemiringan washout secara tunggal tidak dapat berfungsi sebagai penanda respons tumor kemoterapi neoajuvan. Hal ini dikarenakan respons tumor merupakan proses yang mutifaktorial sehingga perubahan sudut gradien washout saja secara langsung tidak dapat menunjukkan respons yang terjadi pasca kemoterapi neoajuvan.
This study assessed the possibility of a faster tumor response marker for neoadjuvant chemotherapy (NAC) by correlating the changes in kinetic curve washout gradient degree on the delayed phase of DCE-MRI after the first cycle, with changes in tumor size after the third cycle, as well as their roles in assessing tumor response for NAC. Studies show that changes in tumor size after the third NAC can be used to detect tumor response, whereas neovascularization changes with DCE-MRI can be detected as fast as 24 hours after the first cycle of chemotherapy.
This is an analytic study using breast MR data obtained between August 2011 until April 2013. Analysis of the correlation between changes in kinetic curve washout gradient with changes in tumor size before and after NAC was performed using the Pearson correlation test.
Based on the correlation analysis results, there is no significant correlation (r=0,151, p=0.622) btween the change in the angle of the washout kinetic curve gradient with the changes in tumor size before and after NAC. This concludes that changes in the degree of the washout angle alone cannot serve as a marker of tumor response to NAC, due of the multifactorial variables that take part in the process, and the kinetic curve alone is not sufficient to directly evaluate response."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
T58662
UI - Tesis Membership  Universitas Indonesia Library
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Shintia Christina
Penilaian respon terapi neoadjuvan pada kanker payudara lanjut lokal dengan sistem Miller-Payne dan penanda apoptosis TUNEL = Pathological response assessment of neoadjuvant chemotherapy in locally advanced breast cancer with MP system and TUNEL
"[ABSTRAK
Latar belakang : Kanker payudara lanjut lokal (KPLL) adalah kanker payudara stadium III.Modalitas terapi KPLL adalah pembedahan, kemoterapi, radioterapi, hormonal terapi dan terapi target. Respon kemoterapi neoadjuvan terdiri dari respon klinis dan respon patologi. Penilaian respon kemoterapi neoadjuvan penting untuk memprediksi angka ketahanan hidup dan dapat menjadi pedoman kemoterapi selanjutnya. Penilaian respon patologi selama ini bersifat kuantitatif dan sering tidak selaras dengan respon klinis. Perubahan jumlah selularitas dapat terlihat, tetapi kualitas sel tumor tersebut tidak dapat diketahui dengan pulasan Haematoxylin-eosin (HE) pada fase awal fragmentasi DNA, sehingga penilaian respon patologi perlu dilakukan secara kuantitatif dan kualitatif yaitu menilai selularitas sel tumor dan persentase apoptosis.
Bahan dan cara : Dilakukan penelitian retrospektif analitik secara potong lintang pada kanker payudara lanjut lokal tahun 2010-2014 di Departemen Patologi Anatomi FKUI/RSCM dan divisi bedah onkologi RSCM. Sampel biopsi dan reseksi dibandingkan untuk mengevaluasi penurunan selularitas, kemudian diklasifikasikan ke derajat Miller- Payne (MP). Sampel reseksi dipulas dengan TUNEL dan dihitung persentase apoptosis. Penurunan selularitas antara biopsi dan mastektomi dengan TUNEL merupakan Modifikasi MP. Hasil : Perubahan respon patologi dengan Modifikasi MP menimbulkan peningkatan derajat pada 24 kasus. Tidak terdapat hubungan antara respon klinis dengan persentase apoptotis (p=0,108), respon klinis dengan MP (p=1,000) dan Modifikasi MP (p=0,655). Tidak didapatkan hubungan dan adanya korelasi yang lemah antara penyusutan massa tumor secara klinis dengan jumlah sel tumor yang mati dengan MP (p=0,177; r =0,212) dan Modifikasi MP (p=0,609; r = 0,081). Terdapat perbedaan signifikan antara jumlah sel mati yang dinilai dengan MP dan Modifikasi MP (p =0,000).
Kesimpulan : Persentase apoptosis tidak berhubungan dengan respon klinis. Modifikasi MP meningkatkan nilai derajat respon patologik, tetapi penilaian Modifikasi MP tetap tidak menunjukkan korelasi dengan respon klinik.ABSTRACT Background: Locally advanced breast cancer (LABC) is a stage III breast cancer. The management of LABC includes surgery, chemotherapy, radiotherapy, hormonal and targeted therapy. Responses to neoadjuvant (before surgery) chemotherapy consist of clinical and pathological responses. Evaluating chemotherapy response is essential to predict survival rate and it may become guidelines for the next chemotherapy in the future. Until now, the evaluation of pathological response only involves quantitative assessment and the clinical responses are often inconsistent with the pathological responses. Morphological changes of apoptotic cells can still be seen. However, the quality of the tumor cells is vague when the cells are stained with Hematoxylin-eosin (HE) during the first stage of DNA fragmentation. The evaluation of pathological responses; therefore, need to be performed by quantitative and qualitative methods, i.e. by evaluating the cellularity of tumor cells and the percentage of apoptosis.
Materials and method: A cross-sectional analytical retrospective study was conducted on the issue of locally advanced breast cancer between 2010 and 2014 at the Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital and Division of Surgical Oncology, Cipto Mangunkusumo Hospital. Specimens of biopsy and resection were compared to evaluate reduction in cellularity, which were subsequently categorized into stages of Miller-Payne (MP) classification. The specimens of resection were stained with TUNEL and the percentage of apoptosis was calculated. Reduction in cellularity between biopsy and mastectomy specimens with TUNEL staining is a modified MP methods.
Results: The evaluation of pathological responses using the modified MP method has increased the value of MP grading in 24 cases. We found no association between clinical responses with percentage of apoptosis (p=0,108), MP pathological responses (p=1,000) and modified MP (p=0,655). There is no association and weak correlation between decreasing tumor mass with MP (p=0,177; r=0,212) and modified MP (p=0,609; r=0,081). There was a correlation between the dead cell evaluated by MP and by modified MP. (p=0.000)
Conclusion: Apoptosis percentage does not correlate with clinical responses. Modified MP increases the degree or grading of pathological responses, but it does not improve the correlation with clinical responses., Background: Locally advanced breast cancer (LABC) is a stage III breast cancer. The management of LABC includes surgery, chemotherapy, radiotherapy, hormonal and targeted therapy. Responses to neoadjuvant (before surgery) chemotherapy consist of clinical and pathological responses. Evaluating chemotherapy response is essential to predict survival rate and it may become guidelines for the next chemotherapy in the future. Until now, the evaluation of pathological response only involves quantitative assessment and the clinical responses are often inconsistent with the pathological responses. Morphological changes of apoptotic cells can still be seen. However, the quality of the tumor cells is vague when the cells are stained with Hematoxylin-eosin (HE) during the first stage of DNA fragmentation. The evaluation of pathological responses; therefore, need to be performed by quantitative and qualitative methods, i.e. by evaluating the cellularity of tumor cells and the percentage of apoptosis.
Materials and method: A cross-sectional analytical retrospective study was conducted on the issue of locally advanced breast cancer between 2010 and 2014 at the Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital and Division of Surgical Oncology, Cipto Mangunkusumo Hospital. Specimens of biopsy and resection were compared to evaluate reduction in cellularity, which were subsequently categorized into stages of Miller-Payne (MP) classification. The specimens of resection were stained with TUNEL and the percentage of apoptosis was calculated. Reduction in cellularity between biopsy and mastectomy specimens with TUNEL staining is a modified MP methods.
Results: The evaluation of pathological responses using the modified MP method has increased the value of MP grading in 24 cases. We found no association between clinical responses with percentage of apoptosis (p=0,108), MP pathological responses (p=1,000) and modified MP (p=0,655). There is no association and weak correlation between decreasing tumor mass with MP (p=0,177; r=0,212) and modified MP (p=0,609; r=0,081). There was a correlation between the dead cell evaluated by MP and by modified MP. (p=0.000)
Conclusion: Apoptosis percentage does not correlate with clinical responses. Modified MP increases the degree or grading of pathological responses, but it does not improve the correlation with clinical responses.]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Ho Natalia
Korelasi perubahan Apparent Diffusion Coefficient (ADC) pada Diffusion Weighted Magnetic Resonance Imaging (DWMRI) dengan respons Tumor pasca Kemoterapi Neoajuvan Kanker Payudara = Correlation of Apparent Diffusion Coefficient change (ADC) in Diffusion Weighted Magnetic Resonance Imaging (DWMRI) with Chemotherapy after Tumor response Neoajuvan Breast Cancer
"Tujuan: Penelitian ini dilakukan untuk mengetahui korelasi perubahan nilai ADC pada DWMRI dengan perubahan ukuran tumor pasca kemoterapi neoajuvan kanker payudara dalam menilai respons kemoterapi neoajuvan.
Metode: Penelitian studi deskriptif analitik dari data sekunder MRI pasien kanker payudara yang mendapat kemoterapi neoajuvan serta menjalankan pemeriksaan MRI. Pemeriksaan MRI dilakukan sebelum pasien mendapat kemoterapi neoajuvan, setelah pasien mendapat kemoterapi neoajuvan siklus pertama dan siklus ketiga. Pengukuran ukuran tumor dilakukan sesuai standar RECIST, sedangkan nilai ADC diperoleh pada nilai b800s/mm2.
Hasil dan diskusi: Dilakukan analisis bivariat dengan menggunakan korelasi Pearson untuk melihat korelasi perubahan nilai ADC kedua terhadap nilai ADC pertama dengan perubahan ukuran tumor pada pemeriksaan MRI ketiga terhadap pemeriksaan MRI pertama. Sebanyak 17 pasien penelitian dengan usia antara 40 tahun sampai 65 tahun dan ukuran tumor antara 5,41 cm sampai 13,41 cm. Terdapat 16 pasien yang mengalami peningkatan nilai ADC dan 1 pasien yang mengalami penurunan nilai ADC setelah pemberian kemoterapi neoajuvan siklus pertama. Sebanyak 17 pasien mengalami pengurangan ukuran tumor setelah kemoterapi neoajuvan siklus ketiga. Berdasarkan standar RECIST diperoleh sebanyak 7 pasien dengan pengurangan ukuran tumor lebih dari 30% (antara 31,55% sampai 56,25%) dan sebanyak 10 pasien dengan pengurangan ukuran tumor kurang dari 30% (antara 7,47% sampai 29,22%). Nilai korelasi yang diperoleh sebesar -0,499.
Kesimpulan: Terdapat korelasi yang bermakna antara perubahan nilai ADC pada DWMRI dengan perubahan ukuran tumor sebagai respons kemoterapi neoajuvan kanker payudara dengan kekuatan korelasi yang sedang dan arah negatif.
Objectives: To determine the correlation of changes in ADC values in DWMRI with changes in tumor size after neoadjuvant chemotherapy in breast cancer to assess neoadjuvant chemotherapy response.
Methods: Analytical descriptive study using secondary data from MRI of breast cancer patients receiving neoadjuvant chemotherapy as well as running an MRI. MRI examination performed before neoadjuvant chemotherapy, after received first cycle neoadjuvant chemotherapy and third cycle. Tumor size measurements carried out according to standard RECIST, whereas the ADC values obtained in the b800s/mm2. Bivariate analysis using Pearson correlation was conducted to determine the correlation of changes in the value of the second ADC to first ADC and changes of the tumor size on the third MRI to the first MRI examination.
Result and discussion: A total of 17 study patients, 40 years to 65 years old, tumor size between 5.41 cm to 13.41 cm. 16 patients experienced an increase in ADC values while 1 patient had decreased ADC values after the first cycle of neoadjuvant chemotherapy. Tumor size in all patients decreased after three cycles of neoadjuvant chemotherapy. Based on RECIST standards, 7 patients showed tumor size reduction of more than 30% (between 31.55% to 56.25%) and tumor size in 10 patients was reduced less than 30% (between 7.47% to 29.22% ). Correlation value of -0.499 obtained.
Conclusions: There is a significant moderate and negative correlation between in ADC value changes in DWMRI with tumor size changes in response to neoadjuvant chemotherapy."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
T31952
UI - Tesis Membership  Universitas Indonesia Library
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Tuti Handayani
Korelasi microvessel density prekemoterapi dengan perubahan apparent diffusion coefficient pasca kemoterapi neoajuvan kanker payudara = Correlation of pre chemotherapy microvessel density with apparent diffusion coefficient changes after neoajuvant chemotherapy in breast cancer
"Identifikasi dini respons kemoterapi neoajuvan merupakan hal penting dalam tatalaksana kanker payudara. Penelitian bertujuan untuk mengetahui korelasi antara nilai microvessel density (MVD) prekemoterapi dengan perubahan apparent diffusion coefficient (ADC) pada magnetic resonance imaging (MRI) dan perubahan ukuran tumor pasca kemoterapi neoajuvan.
Penelitian ini menggunakan desain potong lintang terhadap 16 pasien kanker payudara yang mendapat kemoterapi neoajuvan. Analisis bivariat menggunakan korelasi Pearson dengan (α)5%.
Hasil penelitian menunjukkan tidak terdapatnya korelasi bermakna antara nilai MVD prekemoterapi dengan perubahan ADC maupun dengan perubahan ukuran pasca kemoterapi neoajuvan. Diperoleh kesimpulan bahwa MVD prekemoterapi tidak dapat memprediksi perubahan ADC maupun perubahan ukuran pasca kemoterapi neoajuvan.
Early identification in neoajuvant chemotherapy response is important in the treatment of breast cancer. The purpose of this study was to determine the correlation between microvessel density (MVD) before chemoterapy with changes in apparent diffusion coefficient (ADC) in magnetic resonance imaging (MRI) and changes in tumor size after neoajuvant chemotherapy.
This study used a cross-sectional design of 16 breast cancer patients who received neoajuvant chemotherapy. Performed bivariate analysis using Pearson correlation ( α 5%).
There was no significant correlation between MVD value with ADC changes as well as with changes in size after neoajuvant chemotherapy. It concluded that MVD value can not predict ADC changes after neoajuvant chemotherapy nor changes in size after neoajuvant chemotherapy."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
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UI - Tugas Akhir  Universitas Indonesia Library
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Siregar, Trifonia Pingkan
Risiko kelainan payudara pada perempuan dengan riwayat keluarga kanker payudara menurut derajat histopatologis (kajian berdasarkan ultrasonografi payudara) = Risk of breast abnormalities in women with family history of breast cancer by histopathological grading (assessment based on breast ultrasound)
"Riwayat kanker payudara dalam keluarga memegang peranan penting terjadinya kelainan payudara maupun kanker payudara pada seorang individu. Penelitian ini bertujuan mendapatkan data gambaran radiologis payudara perempuan dengan riwayat kanker payudara dalam keluarga, dihubungkan dengan derajat histopatologis kanker payudara yang diderita oleh salah seorang anggota keluarga menggunakan modalitas USG payudara. Dari penelitian ini didapatkan risiko yang yang lebih tinggi akan terjadinya lesi di payudara pada perempuan yang memiliki hubungan keluarga dengan penderita kanker payudara derajat histopatologis tinggi dibandingkan dengan derajat histopatologis rendah.
Family history of breast cancer plays an important role in the incidence of breast abnormalities and breast cancer in an individual. This study aims to obtain radiological data of breast in women with family history of breast cancer, associated with histopathological grading of breast cancer suffered by a family member using breast ultrasound. This study revealed a higher risk of the incidence of lesions in the breast in high grade histopathological breast cancer group compared with low grade."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014
SP-Pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Shabrina Rizky Putri
Angka Kesintasan Karsinoma Sel Skuamosa Rongga Mulut di RS Cipto Mangunkusumo = Survival Rate of Oral Squamous Cell Carcinoma in Cipto Mangunkusumo Hospital
"

Pendahuluan: Karsinoma rongga mulut adalah keganasan tersering ke-6 di Asia. Mayoritas pasien karsinoma sel skuamosa rongga mulut (KSSRM) di RSCM datang dalam kondisi lanjut. Namun belum ada studi yang meneliti mengenai kesintasan penyakit ini di Indonesia. Penelitian ini bertujuan untuk menilai kesintasan KSSRM di RSCM berdasarkan stadium klinis AJCC ke-8.

Metode: dilakukan studi analisis kesintasan secara retrospektif dengan menggunakan data pasien KSSRM yang didiagnosis di Divisi Bedah Onkologi RSCM pada tahun 2014-2018. Luaran pasien didapatkan dari rekam medis dan menghubungi pasien via telepon. Data dianalisis menggunakan metode Kaplan-Meier.

Hasil: Mayoritas pasien adalah laki-laki (perbandingan laki-laki:perempuan adalah 1,03:1) dengan rerata usia  51,12±13,821 tahun. Tumor ditemukan paling banyak di daerah lidah (72,8%) dan kebanyakan pasien didiagnosis pertama kali pada stadium IV (83,4%). Kesintasan keseluruhan satu dan dua tahun adalah 58,6% dan 43,1%, dengan kesintasan spesifik-penyakit adalah 66,9%. Kesintasan satu dan dua tahun terendah adalah pada kelompok stadium IV (53,5% dan 36,1% secara berurutan). Namun tidak terdapat hubungan yang bermakna secara statistik antara kesintasan dan stadium klinis pada studi ini.

Simpulan:  Kesintasan KSSRM yang rendah di RSCM menunjukan tingginya patient delay. Penapisan dan edukasi mengenai penyakit ini dibutuhkan untuk meningkatkan angka kesintasan.

 

Introduction: Oral cancer carcinoma is the 6th most frequent malignancy in Asia. In Cipto Mangunkusumo Hospital, most patient comes in late stage. Yet, there is no survival study available for this disease in our country.

Objectives: This study aims on revealing the survival rate oral squamous cell carcinoma (OSCC) patients in Cipto Mangunkusumo based on the 8th AJCC staging.

Methods: We performed a retrospective survival analysis study from a database of OSCC patients diagnosed at Cipto Mangunkusumo Hospital in 2014-2018. Follow-up details were updated from medical record and by phone calls. Data was analysed using the Kaplan-Meier method.

Results: Majority of the patients were male (male-to-female ratio was 1.03:1) with the mean age was 51,12±13,821 years old. Tumors occurred mostly in the tongue (72,8%), and most patients were initially diagnosed as stage IV (83,4%). The one and two year overall survival rate were 58,6% and 43,1%, with a disease-specific survival rate was 66,9%. The worst one and two year survival rate was found constantly in the stage IV group (53,5% and 36,1%, consecutively). Though there was no statistically significant association between overall survival and clinical staging in this study (p>0,05).

Conclusion: The low OSCC survival rate in Cipto Mangunkusumo Hospital indicated a high level of patient delay. Screening and education regarding this disease are needed to increase the survival rate.

"
Depok: Fakultas Kedokteran Universitas Indonesia, 2020
T-Pdf
UI - Tesis Membership  Universitas Indonesia Library
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Rachmawati
Nilai diagnostik pemeriksaan mutasi BRAF, NRAS, dan promoter tert pada keganasan tiroid dari spesimen Biopsi Aspirasi Jarum Halus (BAJAH) = Diagnostic value of BRAF, NRAS and tert promoter mutation in thyroid carcinoma from Fine Needle Aspiration Biopsy (FNAB) specimen
"ABSTRAK
Latar Belakang: Kanker tiroid merupakan keganasan endokrin yang paling sering ditemukan dan insidennya semakin meningkat. Meskipun metode biopsi aspirasi jarum halus memiliki sensitivitas yang baik dalam mendiagnosis nodul tiroid, sebanyak 10-40 masih memberikan hasil inkonklusif dalam penentuan keganasan. Hal ini sering merugikan pasien karena harus mengalami re-operasi apabila terdapat keganasan pada hasil histopatologi.Tujuan Penelitian: Mengetahui proporsi dan mendapatkan nilai diagnostik dari pemeriksaan mutasi BRAF, NRAS, dan promoter TERT pada spesimen BAJAH untuk meningkatkan akurasi diagnosis kanker tiroid.Metode Penelitian: Studi retrospektif dengan mengikutsertakan 50 pasien nodul tiroid yang memerlukan pembedahan. Spesimen diambil pada saat proses BAJAH atau pasca operasi. Deteksi mutasi BRAF, NRAS, dan promoter TERT menggunakan metode DNA sekuensing Sanger . Hasil mutasi akan dibandingkan dengan pemeriksaan baku emas histopatologi.Hasil: Dari 50 kasus yang ikut dalam analisis, terdapat 39 kasus 78 merupakan keganasan tiroid. Nilai proporsi mutasi BRAF, NRAS, dan pTERT berturut-turut sebesar 31 , 18 , dan 13 . Uji diagnostik mutasi BRAF menghasilkan sensitivitas, spesifisitas, nilai duga positif, dan nilai duga negatif berturut-turut 31 , 100 , 100 , 29 terhadap kanker tiroid. Untuk mutasi NRAS sebesar 18 , 100 . 100 , 26 . Sedangkan untuk mutasi pTERT sebesar 13 , 100 , 100 , 24 . Jika ketiga mutasi tersebut dikombinasikan, maka nilainya akan meningkat menjadi 49 , 100 , 100 , 35 . Kesimpulan: Pemeriksaan mutasi BRAF, NRAS dan promoter TERT pada kanker tiroid masing-masing memiliki spesifisitas yang tinggi. Jika ketiganya dikombinasikan maka akan meningkatkan sensitivitas untuk membantu dalam meningkatkan akurasi diagnosis keganasan tiroid.
ABSTRACT
Background Thyroid cancer is the most common endocrine malignancy and it rsquo s incidence is on the rise. Although the fine needle aspiration biopsy FNAB has a good sensitivity in the diagnosis of thyroid nodules, as much as 10 40 still gives inconclusive results in malignant determination. This is often detrimental to patients having to undergo re surgery if there is a malignancy in the histopathologic outcome.Aim To establish the proportion and diagnostic value of BRAF, NRAS, and TERT promoter mutation detection on FNAB specimens to improve the accuracy of thyroid cancer diagnosis.Methods The retrospective study by involving 50 patients with thyroid nodules surgery. Specimens were taken during the FNAB or postoperative process. Detection of BRAF, NRAS, and TERT promoter mutation using DNA sequencing method Sanger . The mutation results will be compared with the histopathologic gold standard examination.Resuts Of the 50 cases involved in the analysis, there were 39 cases 78 of thyroid malignancies. The proportion of BRAF, NRAS, and pTERT mutations was 31 , 18 , and 13 , respectively. BRAF mutation diagnostic test results in sensitivity, specificity, positive predictive value, and negative predictive value were 31 , 100 , 100 , 29 respectively. For NRAS mutation were 18 , 100 . 100 , 26 . As for pTERT mutation were 13 , 100 , 100 , 24 . If the three mutations are combined, then the value will increase to 45 , 100 , 100 , 35 .Conclusion Detection mutations of BRAF, NRAS and TERT promoters in thyroid cancer have a high specificity. If all three are combined it will increase the sensitivity to improve the accuracy of the diagnosis in thyroid malignancy."
2017
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Alif Rizky Soeratman
Metastasis Kelenjar Getah Bening pada Karsinoma Papiler Tiroid, Kajian Terhadap Mutasi BRAF V600E dan Promoter TERT = Lymph Node Metastasis in Papillary Thyroid Carcinoma, A Study of BRAF V600E and TERT Promoter Mutation Abstract
"Tujuan. Penelitian ini dibuat untuk mengetahui peranan mutasi BRAF V600E dan TERT dalam kejadian metastasis kelenjar getah bening (KGB) leher pada pasien kanker tiroid papiler (KTP)
Metode. Penelitian ini merupakan studi potong lintang, melibatkan pasien KTP di RSUPN Dr. Cipto Mangunkusumo, DKI Jakarta. Data-data diperoleh secara retrospektif berdasarkan catatan rekam medis, kecuali untuk mutasi BRAF V600E dan Promoter TERT. Spesimen jaringan tumor pasien kanker tiroid papiler ditransfer ke Laboratorium Terpadu FKUI. DNA diekstrasi menggunakan QIAamp DNA FFPE Tissue Kit sebanyak 3-8 potongan dengan ketebalan FFPE 5-10 mikrometer. Multiplikasi gen BRAF dilakukan dengan KOD One Polymerase Chain Reaction (PCR) Master Mix (Toyobo KMM–201), sementara multiplikasi gen TERT dilakukan dengan PCR Master Mix (2X MyTaq HS Red Mix, primer forward, reverse, dan Nuclear-free water). Analisis data dilakukan dengan SPSS versi 20. Hasil. Peneliti menginklusi 42 pasien KTP dengan 19 (45%) mengalami mutasi BRAF, 20 (48%) mengalami mutasi TERT, dan 20 (48%) mengalami metastasis KGB. Mutasi BRAF ditemukan berhubungan dengan kejadian metastasis KGB [p<0,001, OR = 25,333 (IK95% 4,924–130,340)], sementara mutasi TERT ditemukan tidak berhubungan. Pasien yang mengalami mutasi BRAF tanpa TERT memiliki risiko 18,000 (IK95% 2,012–161,051) lebih tinggi untuk mengalami metastasis KGB dibandingkan pasien tanpa kedua mutasi. Lebih lanjut, adanya mutasi TERT yang berbarengan dengan mutasi BRAF membuat risiko meningkat menjadi 60,000 (4,718–763,043) lebih tinggi dibandingkan pasien tanpa kedua mutasi. Kesimpulan. Mutasi BRAF berhubungan dengan metastasis KGB pasien KTP, namun tidak dengan mutasi TERT. Namun, kehadiran mutasi TERT pada pasien KTP dengan mutasi BRAF meningkatkan risiko metastasis KGB.
Objective. This study was designed to determine the role of BRAF V600E and TERT mutations in the incidence of neck lymph node (LN) metastasis in patients with papillary thyroid cancer (PTC). Methods. This was a cross-sectional study, involving KTP patients at Dr. Cipto Mangunkusumo Hospital, DKI Jakarta. Data were obtained retrospectively based on medical records, except for BRAF V600E and TERT promoter mutation. Tumor tissue specimens of PTC’s patients were transferred to the Laboratorium Terpadu FKUI. DNA was extracted using QIAamp DNA FFPE Tissue Kit for 3-8 pieces with FFPE thickness of 5-10 micrometers. BRAF gene multiplication was performed with KOD One Polymerase Chain Reaction (PCR) Master Mix (Toyobo KMM-201), while TERT gene multiplication was performed with PCR Master Mix (2X MyTaq HS Red Mix, primers forward, reverse, and Nuclear-free water). Data analysis was performed with SPSS version 20. Results. We included 42 PTC’s patients with 19 (45%) patients had BRAF mutation, 20 (48%) patients had TERT mutation, and 20 (48%) patients had LN metastasis. BRAF mutation was associated with the LN metastasis [p<0.001, OR = 25.333 (95% CI 4.924-130.340)], while TERT mutation was not. Patients with BRAF+ and TERT- had an 18,000 (IK95% 2,012-161,051) higher risk of LN metastasis than patients with BRAF- and TERT-. Furthermore, the presence of TERT mutation along with BRAF mutation increased the risk to 60,000 (4,718-763,043) higher than patients with BRAF- and TERT-. Conclusion. BRAF mutation was associated with LN metastasis in PTC’s patients, but not TERT mutations. However, the presence of TERT mutation in PTC’s patients with BRAF mutation increased the risk of LN metastasis.
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Depok: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library
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Muhammad
MMP-9 dan VEGF-C Sebagai Prediktor Terjadinya Metastasis Kelenjar Getah Bening pada Karsinoma Tiroid Papiler = MMP-9 and VEGF-C as Lymph Node Metastases Predictor of Papillary Thyroid Carcinoma
"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. 
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."
Depok: Fakultas Kedokteran Universitas Indonesia, 2021
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