Tesis

Hubungan Antara Rasio Volume Cairan Pemeriksaan Sitologi Dibandingkan Volume Cairan Torakosentesis Dengan Temuan Keganasan = The Association Between the Ratio of Cytology Volume to Thoracentesis Volume and Malignancy Detection.

Latar Belakang: Pemeriksaan sitologi efusi pleura merupakan metode utama untuk mengidentifikasi efusi pleura ganas. Volume cairan pemeriksaan sitologi dapat mempengaruhi temuan keganasan, namun hubungan rasio terhadap volume torakosentesis dengan temuan keganasan belum diketahui. Tujuan: Mengetahui hubungan rasio volume cairan sitologi dibandingkan volume torakosentesis dengan temuan keganasan. Metode: Penelitian observasional potong lintang di Rumah Sakit Cipto Mangunkusumo pada 1 Januari–31 Oktober 2023. Kriteria inklusi meliputi pasien dengan kecurigaan efusi pleura ganas yang menjalani torakosentesis dan pemeriksaan sitologi. Kriteria eksklusi meliputi pasien dengan riwayat efusi pleura ganas, riwayat pemeriksaan sitologi > 1 kali dengan hasil berbeda antar pemeriksaan, dan data laporan tidak lengkap. Analisis bivariat menggunakan uji Kruskal-Wallis, dilanjutkan analisis multivariat untuk mengontrol variabel perancu. Titik potong rasio diperoleh dari analisis kurva ROC. Hasil: Dari 174 subjek, proporsi temuan keganasan sebesar 26,4%. Adenokarsinoma (25,9%) dan mammae (12,1%) merupakan jenis dan lokasi keganasan dengan temuan terbanyak. Nilai AUC 0,629 dengan titik potong rasio cairan optimal 0,022 (sensitivitas 62%, spesifisitas 63%). Rasio cairan < 0,022 meningkatkan risiko temuan keganasan (PR 1,647; IK 95%: 1,204-2,252; p=0,002). Nilai titik potong volume torakosentesis > 680 mL pada volume sitologi 15 mL meningkatkan temuan keganasan. Kesimpulan: Terdapat hubungan antara rasio volume cairan sitologi terhadap volume torakosentesis dengan temuan keganasan. Nilai titik potong rasio cairan < 0,022 dan volume torakosentesis > 680 mL pada volume sitologi 15 mL berhubungan dengan peningkatan temuan keganasan.
Kata Kunci: rasio volume cairan, sitologi, torakosentesis, efusi pleura ganas


Background: Pleural effusion cytology is a primary method to identify malignant pleural effusion. While the volume of fluid submitted for cytology may influence malignancy detection, the relationship between the ratio of cytology fluid volume to thoracentesis volume and malignancy detection remains unclear. Objective: To assess the association between the ratio of cytology fluid volume to thoracentesis volume and malignancy detection. Methods: A cross-sectional observational study was conducted at Cipto Mangunkusumo Hospital from January 1 to October 31, 2023. Inclusion criteria were patients with suspected malignant pleural effusion who underwent thoracentesis and cytology examination. Exclusion criteria included a history of malignant pleural effusion, more than one cytology examination with discordant results, and incomplete data. Bivariate analysis used the Kruskal-Wallis test, followed by multivariate analysis to control confounders. The optimal fluid ratio cutoff was determined using ROC curve analysis. Results: Among 174 subjects, malignancy was detected in 26.4% of cases. Adenocarcinoma (25.9%) and breast cancer (12.1%) were the most frequently identified types and primary sites. The AUC was 0.629, with an optimal fluid ratio cut-off of 0.022 (sensitivity 62%, specificity 63%). A fluid ratio < 0.022 increased the risk of malignancy detection (PR 1.647; 95% CI: 1.204–2.252; p=0.002). A thoracentesis volume > 680 mL with a cytology volume of 15 mL was associated with increased detection. Conclusion: There is an association between the cytology fluid volume-to-thoracentesis fluid volume ratio with malignancy detection. A fluid ratio < 0.022 and thoracentesis volume > 680 mL with a cytology volume of 15 mL increase the likelihood of detecting malignancy.
Keywords: fluid volume ratio, cytology, thoracentesis, malignant pleural effusion