Tesis

Tingkat Akurasi Node-RADS Berdasarkan CT Scan dalam Mendiagnosis Metastasis Kelenjar Getah Bening Terhadap Hasil Histopatologi pada Pasien dengan Karsinoma Sel Skuamosa Kepala dan Leher = The Accuracy of Node-RADS Based on CT Scan in Diagnosing Lymph Node Metastasis Compared to Histopathology in Patients with Head and Neck Squamous Cell Carcinoma.

Latar Belakang: Karsinoma sel skuamosa umumnya berkaitan dengan metastasis ke kelenjar getah bening regio servikal. Banyak upaya untuk menstandarisasi pelaporan radiologi pada kasus onkologi dengan penerapan sistem pelaporan yaitu Reporting and Data Systems (RADS). Node-RADS 1.0 untuk meningkatkan pelaporan kelenjar getah bening regional dan jauh pada pasien kanker dengan memberikan kriteria imaging ukuran dan konfigurasi, memfasilitasis sistem standarisasi dalam pelaporan kelenjar getah bening, namun belum terdapat laporan mengenai kesesuaian Node-RADS pada pasien karsinoma sel skuamosa kepala dan leher. Tujuan: 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.
Kata kunci: kelenjar getah bening, Node-RADS, metastasis, karsinoma sel skuamosa kepala dan leher


Background: 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 crosssectional 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.
Keywords: lymph node, Node-RADS, metastasis, squamous cell carcinoma of the head and neck.