Tesis

Hubungan Pola Vaskular Mukosa Bronkus Bronkoskopi Gelombang Cahaya Spektrum Sempit terhadap Kanker Paru di Rumah Sakit Persahabatan = Relation Of Bronchial Mucosa Vascular Patterns by Narrow Band Imaging Bronchoscopy and Lung Cancer at Persahabatan Hospital.

Latar Belakang: Bronkoskopi gelombang cahaya spektrum sempit (GCSS) menggunakan gelombang cahaya biru dan hijau yang dapat menghasilkan gambar yang kontras antara pembuluh darah dan mukosa saluran napas. Penelitian ini bertujuan mengetahui hubungan pola vaskular mukosa bronkus pada bronkoskopi GCSS pada kanker paru. Metode: Penelitian ini merupakan uji observasional potong lintang pada pasien kanker paru di RS Persahabatan Jakarta, Indonesia. Rekrutmen subjek dilakukan terhadap pasien yang menjalani bronkoskopi elektif. Pola vaskular mukosa bronkus diamati menggunakan bronkoskopi GCSS Olympus EVIS EXERA III. Pola vaskular diamati berdasarkan hasil histopatologi. Karakteristik subjek diperoleh dari rekam medis elektronik. Analisis statistik bivariat dan multivariat dilakukan dengan SPSS Statistics. Hasil: Penelitian ini melibatkan 59 subjek dengan rerata usia 58,93 (± 10,35) tahun dan dominan laki-laki (76,3%). Sebagian besar subjek merupakan pasien kanker paru stage IV (79,7%). Didapatkan 42% subjek memiliki pola vaskular pada bronkoskopi GCSS. Secara rinci adalah 64,4% pola berliku, 6,8% pola titik dan 28,8% tidak ada pola vaskular. Dari 64,4% subjek adenokarsinoma menunjukkan 60,5% pola berliku, 5,3% pola titik dan 34,2% tidak ada pola vaskular. Dari 15,2% subjek karsinoma sel skuamosa (KSS) menunjukkan 44,4% pola berliku, 22,2% pola titik dan 33,3% tidak ada pola vaskular. Dari 18,6% subjek kanker paru karsinoma sel kecil (KPKSK) menunjukkan 90,9% pola berliku, 9,1% sisanya tidak ada pola vaskular. Subjek KPKSK hampir seluruhnya memiliki pola vaskular berliku dan tidak ada yang menunjukkan pola titik. Sebagian besar subjek adenokarsinoma dan KSS juga menunjukkan pola berliku. Meskipun demikian, dalam analisis bivariat tidak ditemukan hasil bermakna secara statistik antara histologi kanker paru dan pola vaskular mukosa bronkus pada bronkoskopi GCSS. Analisis bivariat dan multivariat karakteristik subjek pasien kanker paru dengan pola vaskular pada bronkoskopi GCSS menemukan bahwa metastasis ekstratorakal menunjukkan kemungkinan ditemukannya pola vaskular berliku (OR 3,8 [IK 95% 1,02 – 14,14], p = 0,04). Kesimpulan: Bronkoskopi GCSS perlu dilakukan pada pasien kanker paru lesi sentral untuk membantu memberikan informasi kemungkinan metastasis ekstratorakal yang dapat mempercepat tata laksana pasien secara komprehensif.
Kata kunci: bronkoskopi, gelombang cahaya spektrum sempit, kanker paru, pola vaskular mukosa bronkus


Background: Narrow band imaging (NBI) bronchoscopy utilizes blue and green light waves to produce contrast images of blood vessels and airway mucosa. This study aims to determine the relationship between bronchial mucosal vascular patterns in NBI bronchoscopy in lung cancer. Methods: This study was a cross-sectional observational study in lung cancer patients at Persahabatan Hospital, Jakarta, Indonesia. Subject recruitment was conducted in patients undergoing elective bronchoscopy. Bronchial mucosa vascular patterns were observed using Olympus EVIS EXERA III electronic bronchoscope with NBI technology. Vascular patterns were observed based on histopathology results. Subject characteristics were obtained from electronic medical record extraction. Bivariate and multivariate statistical analyses were performed using SPSS Statistics. Results: This study involved 59 subjects with an average age of 58.93 (± 10.35) years and most of them were male (76.3%). Most of the subjects were stage IV lung cancer patients (79.7%). It was found that 42% of subjects had a vascular pattern on NBI bronchoscopy. In detail, 64.4% had a tortuous pattern, 6.8% had a dot pattern and 28.8% had no vascular pattern. Of the 64.4% adenocarcinoma subjects, 60.5% showed a tortuous pattern, 5.3% had a dot pattern and 34.2% had no vascular pattern. Of the 15.2% squamous cell carcinoma (SCC) subjects, 44.4% showed a tortuous pattern, 22.2% had a dot pattern and 33.3% had no vascular pattern. Of the 18.6% of small cell lung carcinoma (SCLC) subjects, 90.9% showed a tortuous pattern, the remaining 9.1% had no vascular pattern. Almost all SCLC subjects had a tortuous vascular pattern, and none showed a dot pattern. Most subjects with adenocarcinoma and SCC also showed a tortuous pattern. However, in bivariate analysis, no statistically significant results were found between lung cancer histology and bronchial mucosal vascular pattern on NBI bronchoscopy. Bivariate and multivariate analysis of characteristics of lung cancer patients with vascular pattern on NBI bronchoscopy found that extrathoracic metastases showed a higher likelihood of finding a tortuous vascular pattern (OR 3.8 [95% CI 1.02–14.14], p = 0.04). Conclusion: NBI bronchoscopy should be performed in patients with central lesion lung cancer to help provide information about possible extrathoracic metastases which can advance the comprehensive patient management.
Keywords: bronchial mucosa vascular pattern, bronchoscopy, lung cancer, narrow band imaging