Perubahan arsitektur dan sitomorfologi sel pada cairan peritoneum sebagai penanda keganasan neoplasma epitelial ovarium = Architectural and cytomorphology changes in peritoneal fluid as a sign of malignancy in ovarian epithelial neoplasm / Yayi Dwina Bilianti Susanto

Yayi Dwina Bilianti Susanto, author

Perubahan arsitektur dan sitomorfologi sel pada cairan peritoneum sebagai penanda keganasan neoplasma epitelial ovarium = Architectural and cytomorphology changes in peritoneal fluid as a sign of malignancy in ovarian epithelial neoplasm / Yayi Dwina Bilianti Susanto

Yayi Dwina Bilianti Susanto; Lisnawati, supervisor; Siregar, Budiningsih; Diah Rini Handjari, examiner; Ening Krisnuhoni, examiner; Siregar, Nuryati Chairani, examiner ([Publisher not identified] , 2015)

Abstrak

[ABSTRAK

Latar belakang: Interpretasi cairan peritoneum yang tepat secara sitopatologi sangat

mempengaruhi tatalaksana dan prognosis pasien, padahal pemeriksaan sitopatologi cairan

peritoneum masih memiliki nilai negatif palsu dan positif palsu yang cukup tinggi, dan

hingga saat ini penelitian tentang arsitektur sitopatologi maupun penanda sitomorfologi yang

mengarahkan pada adanya sel neoplasma di cairan peritoneum masih menunjukkan hasil

yang beragam.

Bahan dan cara kerja: Penelitian potong lintang dengan data sekunder berupa slaid

dan formulir sediaan sitopatologi cairan peritoneum yang memiliki data berpasangan dengan

diagnosis histopatologi. Diagnosis klinis berupa neoplasma epitelial ovarium. Slaid dan

formulir diambil dari arsip Departemen Patologi Anatomik FKUI/RSCM tahun 2011 ? 2012,

dilakukan pembacaan ulang semua slaid sitopatologi dengan diagnosis akhir dikategorikan

sebagai positif atau negatif, peneliti membaca pula sediaan histopatologi untuk mengetahui

morfologi sel pada lesi, kemudiaan dilakukan penilaian terhadap arsitektur sitopatologi

berupa: selularitas, sel berkelompok, struktur papiler, intercelular windows, group contours,

jisim psamoma, dan penanda sitomorfologi berupa: atipia inti, inti bertumpuk, anak inti,

rasio inti:sitoplasma, ukuran inti, dan ukuran sel.

Hasil penelitian: Sampel penelitian sejumlah 47 sediaan sitopatologi dengan

diagnosis sitopatologi akhir 34 kasus (72.3%) negatif, 13 kasus (27.7%) positif. Terdapat

perbedaan bermakna arsitektur sitopatologi berupa: selularitas (p = 0.017), sel berkelompok

(p = 0.001), intercellular windows (p = 0.00), group contours (p = 0.00), dan gambaran

sitomorfologi berupa: atipia inti (p = 0.00), inti bertumpuk (p = 0.001), anak inti (p = 0.001),

rasio inti:sitoplasma (p = 0.00), ukuran inti (p = 0.00), ukuran sel (p = 0.00) antara cairan

peritoneum positif dan negatif. Melalui uji multivariat didapatkan penanda yang paling

berpengaruh terhadap diagnosis sitopatologi positif atau negatif yaitu: intercellular windows,

atipia inti, dan selularitas.

Kesimpulan: Terdapat tiga penanda yang paling berpengaruh terhadap diagnosis

positif ditemukannya sel neoplasma ganas dalam cairan peritoneum pada kasus dengan lesi

ovarium, secara berturut - turut yaitu: tidak ditemukannya intercellular windows pada

kelompokan sel, sel memiliki atipia inti sedang hingga berat, dan selularitas lebih dari 20

kelompok dari keseluruhan sediaan apus.

ABSTRACT

Background : Peritoneal fluid cytopathology interpretation profoundly influences patients

management and prognosis, however this practice still has high false positive and false

negative value, and until now research concerning the architectural and cytomorphology

features for detecting malignant cells in peritoneal fluid still has various result.

Materials and Methods : Cross sectional study using secondary data of peritoneal fluid

cytopathology and histopathology slides and form, from patients with clinical diagnosis of

ovarian epithelial neoplasm. The data was taken from the archive of Anatomical Pathology

Department Cipto Mangunkusumo Hospital 2011 ? 2012. The researchers examined the

cytopathology slides and also examined the histopatology slide for morphology comparison,

and then make a final cytopathological diagnosis of positive peritoneal fluid containing

neoplastic cells or negative. Architectural features including: cellularity, cells grouping,

papillary structure, intercellular windows, group contours, psamoma bodies, and

cytomorphology features including: nuclear atypia, overlapping nuclei, nucleoli, nuclei :

cytoplasm ratio, the dimension of the nuclei and cells were also examined.

Result : There were 47 samples with final cytopathology diagnosis: 34 cases (72.3%)

negative for neoplastic cells in the peritoneal fluid and 13 cases (27.7%) positive. There were

significant differences in cytopathology architectural including cellularity (p = 0.017), cells

grouping (p = 0.001), intercellular windows (p = 0.00), group contours (p = 0.00) and

cytomorphology features including nuclear atypia (p = 0.00), overlapping nuclei (p = 0.001),

nucleoli (p =0.001), nuclei : cytoplasm ratio (p = 0.00), the dimension of nuclei (p = 0.00),

the dimension of cell (p = 0.00) between the positive and negative peritoneal fluid

cytopathology. Using multivariate analysis there were 3 cytological features that have the

strongest association with positive or negative peritoneal cytopathology diagnosis, they were:

intercellular windows, nuclear atypia, and cellularity.

Conclusion: In peritoneal fluid cytopathology for examining ovarian lesion there were 3

cytological features that have the strongest association with finding neoplastic cells in

peritoneal fluid, they were: the absent of intercellular windows, moderate to severe