Tesis

Kesesuaian Tripel Diagnostik dengan Histopatologis pada Kanker Payudara Stadium Awal di RSCM dan RSUPP = Accuracy of Triple Diagnostic In Early Stage Breast Cancer at CiptoMangunkusumo Hospital and Persahabatan Hospital.

Latar belakang Kanker payudara merupakan kanker terbanyak dengan insiden 40,3 per 100.000 perempuan dan angka mortalitas sebesar 16,6 per 100.000 perempuan di Indonesia. Pada stadium awal (I-II), penentuan terapi operatif (mastektomi) seringkali membutuhkan pemeriksaan potong beku intraoperatif untuk menilai keganasan, namun sering tidak tersedia di banyak rumah sakit. Tripel diagnostik (pemeriksaan fisik, ultrasonografi dan fine needle aspiration biopsy) merupakan metode diagnostik preoperatif yang juga dinilai akurat dan mudah dilakukan. Studi ini menilai kesesuaian tripel diagnostik dengan histopatologis khususnya pada benjolan yang curiga ganas di RSCM dan RSUPP selama Februari 2016-Agustus 2017. Metode Subjek dengan benjolan payudara curiga ganas pada stadium awal yang memenuhi kriteria inklusi di RSCM dan RSUPP dilakukan tripel diagnostik preoperatif, kemudian dilakukan pemeriksaan potong beku intraoperatif dan histopatologi pasca operasi. Menggunakan desain studi diagnostik statistik, dilakukan analisis kesesuaian tripel diagnostik maupun potong beku dibandingkan dengan histopatologi yaitu sensitivitas, spesifisitas, nilai prediksi positif (NPP), nilai prediksi negatif (NPN) dan akurasi. Hasil Didapatkan 33 subjek kanker payudara stadium awal (prevalensi 4,3%) dengan rerata umur 49,6 tahun dengan kelompok umur terbanyak di atas 40 tahun (78,8%). Sekitar 63,6% subjek memiliki ukuran tumor 2-5 cm dan jenis histopatologi terbanyak berupa karsinoma invasif (84,8%). Dibandingkan hasil histopatologi: a) Potong beku memiliki sensitivitas 96,8%, spesifisitas 100%, NPP 100%, NPN 66,7%, dan akurasi 97,0%; dan b) Tripel diagnostik mempunyai sensitivitas 77,4%, spesifisitas 100%, nilai prediksi positif tinggi (100%), nilai prediksi negatif 22,2% dan akurasi 78,8% (p = 0,016). Kesimpulan Tripel diagnostik merupakan metode diagnostik yang cukup akurat pada kanker payudara stadium awal sehingga dapat digunakan sebagai metode diagnostik alternatif di fasilitas pelayanan tipe B dan C di Indonesia di saat potong beku tidak tersedia.
Kata Kunci kanker payudara stadium awal, tripel diagnostik, potong beku, histopatologi.


Background. Breast cancer is the most common cancer with incidence rate 40.3 per 100.000 women and mortality rate 16.6 per 100.000 women in Indonesia. In early stage, decision for operative therapy (mastectomy) requires intraoperative frozen section to assess its malignancy, which is often unavailable in many hospitals. Triple diagnostic (physical examination, breast ultrasonography and fine needle aspiration biopsy) is an accurate and easily performed preoperative diagnostic method. This study assesses the suitability of triple diagnostic with histopathology results in suspicious malignant breast lumps at Ciptomangunkusumo and Persahabatan hospital during February 2016-August 2017. Method. Subjects with supicious malignant breast lump that met the inclusion criteria underwent preoperative triple diagnostic, intraoperative frozen section and postoperative histopathology examination. With statistic diagnostic study design, the suitability of triple diagnostic and frozen section were assesed in comparation to histologic examination (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Result. 33 subjects with early stage breast cancer were obtained (prevalence 4.3%) with average mean of age of 49.6 years, were above 40 years (78.8%). Around 63.6% had tumor size between 2-5 cm, and most histopathologic types were those with invasive carcinoma (84.8%). When compared to histopathologic result: a) Frozen section has 96.8% sensitivity, 100% specificity, 100% PPV, 66.7% NPV and 97.0% accuracy; and b) Triple diagnostic has 77.4% sensitivity, 100% specificity, high PPV (100%), 22.2% NPV and 78.8% accuracy. (p = 0.016). Conclusion. Triple diagnostic is a relatively accurate diagnostic method in early stage breast cancer, hence, can be used as an alternative diagnostic method at type B and C heatlhcare facilities in Indonesia whenever frozen section is unavailable.
Keywords: early stage breast cancer, triple diagnostic, frozen section, histopathology.