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"Penelitian observasional potong lintang sitologi cairan peritoneal di Departemen Patologi Anatomik FKUI/RSUPNCM

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"Latar belakang: Metastasis leptomeningeal (ML) merupakan penyebaran sel tumor ke leptomening dan ruang subarakhnoid, dengan insidens yang semakin meningkat dan prognosis yang buruk. Analisis cairan serebrospinal (CSS) merupakan pemeriksaan penting dengan sitologi sebagai standar baku emas untuk deteksi sel tumor di CSS.Metode penelitian: Studi potong lintang retrospektif multisenter untuk mengetahui gambaran analisis rutin dan sitologi CSS pada keganasan dengan kecurigaan ML yang dilakukan pungsi lumbal pada Januari 2018-Desember 2021. Dilakukan pencatatan data klinis, radiologis, jenis tumor, analisis rutin serta frekuensi pungsi lumbal, dan dianalisis hubungannya dengan sitologi CSS.Hasil: Terdapat 153 subjek dengan abnormalitas analisis rutin CSS(75,2%) berupa peningkatan jumlah sel >5/uL(47,1%) dengan median 5(1-3504)/uL; peningkatan protein CSS >45 mg/dl (52,9%) dengan median 50 (5-820)mg/dl serta penurunan glukosa CSS <50 mg(15%) dengan median 68 (3-269)mg/dl. Proporsi sitologi CSS positif sel ganas 20,3%. Proporsi flow cytometry immunophenotyping CSS positif pada keganasan hematologi dengan kecurigaan ML 25,6%. Terdapat hubungan bermakna antara peningkatan sel, jenis keganasan hematologi, dan gambaran MRI dengan sitologi CSS (p<0,001;p=0,03;p=0,03). Tidak terdapat hubungan bermakna antara manifestasi klinis dan frekuensi pungsi lumbal dengan sitologi CSS.Kesimpulan: Abnormalitas analisis rutin CSS didapatkan pada sebagian besar subjek keganasan dengan kecurigaan ML, dengan positivitas sitologi yang rendah. Gejala klinis yang bervariasi dan pengulangan pungsi lumbal tidak signifikan menaikkan kemungkinan sitologi CSS positif.

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Background: Leptomeningeal metastases (LM) is a condition where malignant cells spread to leptomeninges and subarachnoid space, with increasing incidence and poor prognosis. Cerebrospinal fluid (CSF) analysis is an important examination with cytology as the gold standard for malignant cells detection in CSF.

Methods: A multicenter cross-sectional retrospective study to describe CSF routine analysis and cytology in suspected LM on January 2018-December 2021. Clinical manifestations, radiological data, tumor type, CSF routine analysis, and lumbal puncture frequency were recorded, and their correlation with CSF cytology was analyzed.

Results: There were 153 subjects with abnormalities on CSF routine analysis(75,2%), consist of CSF cell count >5/uL(47,1%) with median 5(1-3504)/uL, CSF protein >45 mg/dL(52,9%) with median 50(5-820) mg/dL, and CSF glucose <50 mg/dL(15%) with median 68(3-629)mg/dL. Positive CSF cytology result was 20,3%. Positive CSF flow cytometry immunophenotyping in hematological malignancy with suspected LM was 25,6%. There was significant correlation between the increase in CSF cell count, hematological malignancy, and MRI results with CSF cytology (p<0,001;p=0,03;p=0,03). There was no significant correlation between clinical manifestations and lumbal puncture frequency with CSF cytology.

Conclusion: Abnormalities of CSF routine analysis were found in majority subjects with suspected LM but CSF cytology positivity rate was considered low. The presence of varied clinical symptoms and repeated lumbal punctures didn’t increase the likelihood of positive CSF cytology."

"Latar Belakang: Penegakkan diagnosis sedini dan setepat mungkin menjadi hal utama dalam penatalaksanaan kanker paru. Beberapa penelitian sebelumnya tentang biopsi transtorakal dengan panduan USG menunjukkan akurasi diagnosis yang cukup baik. USG dinilai sebagai modalitas radiologi yang mudah digunakan secara aman, bedside, real-time, mobile dan bebas pajanan radiasi. Saat ini di RSUP Persahabatan Jakarta belum terdapat penelitian tentang biopsi jarum halus transtorakal dengan panduan USG.Metode Penelitian:  Studi observasional dengan pendekatan potong lintang terhadap subjek dengan tumor paru atau tumor mediastinum yang dilakukan biopsi jarum halus transtorakal dengan panduan ultrasononografi toraks pada bulan April-September 2021. Pengambilan sampel dilakukan secara consecutive sampling. Peneliti melakukan observasi terhadap karakteristik lesi, karakteristik prosedur dan komplikasi. Diagnosis akhir berdasarkan hasil sitologi biopsi jarum halus transtorakal dengan panduan USG.Hasil Penelitian: Dari 46 subjek, rerata usia subjek adalah 52 tahun dan didominasi jenis kelamin laki-laki (69,6%) dan jenis tumor terbanyak adalah tumor paru (80,4%). Proporsi kepositifan sitologi biopsi jarum halus transtorakal dengan panduan USG toraks adalah 78,3%. Karakteristik lesi pada subjek dengan hasil sitologi TTNA positif antara lain memiliki rerata diameter lesi 9,61 ± 2,27 cm, lesi di anterosuperior paru (63,9%), memiliki gambaran ekogenitas hipoekoik heterogen (58,3%) dan memiliki kontak dengan pleura (77,8%). Karakteristik prosedur pada subjek dengan hasil sitologi TTNA positif antara lain dilakukan teknik aspirasi (77,8%), pengambilan TTNA sebanyak < 3 set (58,3%), rerata jumlah gelas objek yang terpakai adalah 15 ± 4 dan median kedalaman insersi adalah 4 (2 – 6) cm. Komplikasi pasca tindakan terjadi pada dua subjek yaitu hemoptisis (4%).Kesimpulan: Biopsi jarum halus transtorakal merupakan metode diagnostik yang invasif minimal dengan proporsi kepositifan yang tinggi (78,3%) dan angka komplikasi yang rendah (4%).

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Background: Treatment of multidrug-resistant tuberculosis (MDR-TB) using second-line drugs is known to have more side effects. Recent studies have shown concern about bedaquiline and delamanid that can cause a prolonged QT interval. This condition is a known risk factor for Torsades de Pointes, a lethal cardiac arrhythmia. This study sought to observe the condition among such patients treated in the study location.

Methods: This study was a prospective cohort study  of MDR-TB patients receiving bedaquilin in the outpatient clinic and inpatient ward of National Respiratory Referral Hospital Persahabatan, Jakarta, Indonesia between February 2020 to February 2021. Patients received 400 mg on week 0-2 (intensive phase) and followed by 200 mg 3 times per week (continuation phase) of bedaquiline. Sampling was carried out by consecutive sampling and data on subjects who met the inclusion criteria were taken from medical records.

Result: From a total of 71 subjects, all of them met the inclusion criteria. Prolonged QT interval was experienced in 18.3% patients. From eleven patients who experienced prolonged QT interval, two patients required hospitalization: one presented with nausea and gastric upset and one patient presented with dyspnea and palpitation. Prolonged QT interval occurred in initial phase and correlated with drug dosing. A mycobacterial culture conversion at month-6 was observed in those receiving multidrug regimens which include bedaquiline, quinolone, and clofazimine. There was a correlation between prolonged QT interval and hypocalemia. Treatment success rate was 46.5% without prolonged QT. Other outcomes included 4.2% died, 26.8% loss-to-follow up, and 4.1% treatment failed.

Conclusion: The use of bedaquiline MDR-TB appeared to be effective and safe across different settings, although the certainty of evidence was assessed as very low. Hypokalemia was correlated with the outcomes of patients receiving bedaquiline, particularly in those experienced prolonged QT interval."

"Latar Belakang : Kanker ovarium adalah kanker ketiga terbanyak yang ditemukan pada perempuan di Indonesia. Pada saat diagnosis ditegakkan, sebagian besar pasien mencapai stadium III atau IV dengan penyebaran tumor ke rongga peritoneum dan organ-organnya. Perluasan peritoneal karsinomatosis dapat dinilai melalui Peritoneal Carcinomatosis Index (PCI). Perluasan peritoneal karsinomatosis pada lokasi kritikal seperti mesenterium usus halus atau lapisan serosa usus halus dapat menjadi faktor penyebab pasien mendapatkan tatalaksana optimal maupun suboptimal debulking. Sehingga, nilai PCI dapat menjadi salah satu faktor yang memengaruhi resektabilitas tumor. MRI sebagai modalitas non- invasif dapat menjadi alternatif dalam menentukan tatalaksana debulking.Tujuan : meningkatkan peranan MRI dalam menilai perbedaan antara nilai PCI, nilai ADC tumor dan nilai ADC peritoneal karsinomatosis pasien kanker ovarium dengan asites untuk memprediksi tatalaksana optimal maupun suboptimal debulking.Metode : Penelitian dilaksanakan dengan desain penelitian perbandingan potong lintang. Didapatkan 23 sampel MRI abdomen dalam rentang waktu bulan September 2020 hingga Juni 2023.Hasil : Pada uji Mann Whitney didapatkan nilai P 0,688 pada hubungan antara nilai ADC tumor dengan tatalaksana debulking, sementara pada hubungan antara nilai ADC peritoneal karsinomatosis dengan tatalaksana debulking didapatkan nilai P 0,450. Didapatkan nilai P 0,000 pada analisisi hubungan antara nilai PCI dengan tatalaksana debulking, dengan titik potong nilai PCI yang optimal sebesar 9 dengan sensitivitas 100% dan spesifisitas 100% untuk menentukan luaran tatalaksana suboptimal debulking.Kesimpulan : Didapatkan hubungan yang bermakna antara nilai PCI dengan tatalaksana debulking, namun tidak didapatkan hubungan yang bermakna antara nilai ADC tumor dan nilai ADC peritoneal karsinomatosis dengan tatalaksana debulking.

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Background: Ovarian cancer is the third most common cancer found in women in Indonesia. At the time of diagnosis, most patients reach stage III or IV with the spread of tumors to the peritoneal cavity and its organs. The extent of peritoneal carcinomatosis can be assessed using the Peritoneal Carcinomatosis Index (PCI). The expansion of peritoneal carcinomatosis in critical locations such as the mesentery of the small intestine or the serosal layer of the small intestine can be a factor in predicting debulking management. Therefore, PCI value can be one of the factors influencing tumor resectability. MRI, as a non-invasive modality, can be an alternative in determining debulking management.

Objective: To enhance the role of MRI in assessing the differences between PCI values, tumor ADC values, and peritoneal carcinomatosis ADC values in ovarian cancer patients with ascites to predict optimal or suboptimal debulking management.

Method: The study was conducted using a cross-sectional comparative research design. A total of 23 abdominal MRI samples were obtained between September 2020 and June 2023.

Results: The Mann-Whitney test showed a P value of 0.000 was obtained in the analysis of the relationship between the PCI value and debulking management, with an optimal PCI cutoff value of 9, showing 100% sensitivity and 100% specificity in determining the outcome of suboptimal debulking management.

Conclusion: There is a significant relationship found between PCI value and debulking management. However, no significant relationship was found between the tumor ADC value and the peritoneal carcinomatosis ADC value with debulking management."

"ABSTRAKPemeriksaan sitologi aspirasi (jarum halus) merupakan sarana diagnostik yang efisien, dan mempermudah deteksi dini kanker payudara. Salah satu sitoteknologi maju yang merupakan penunjang diagnosis ialah imunositokimia. Pemeriksaan imunositokimia dapat memeriksa kandungan zat di dalam sel, misalnya onkoprotein CerbB-2 yang merupakan produk neu onkogen, sebagai perwujudan mutasi genetic. Zat lain ialah PCNA (proliferating cell nuclear antigen) yang digunakan untuk mengukur kecepatan proliferasi atau pertumbuhan tumor. Tujuan penelitian ini ialah untuk mengetahui korelasi analisis struktural dengan evaluasi fungsional sel. Analisis multivariabel diharapkan meningkatkan ketepatan diagnostik dan penilaian prognostik.Desain umum penelitian ialah pengamatan cross-sectional. Subyek penelitian ialah 24 pengidap tumor payudara, terdiri atas 12 kasus kanker dan 12 lesi jinak. Sediaan sitologi aspirasi dianalisis di Laboratorium Sitologi Bagian Patologi Anatomik Fakultas Kedokteran Universitas Indonesia, sejak Desember 1993 sampai dengan Mei 1994). Pewarnaan imunositokimia dilakukan dengan teknik imunoenzin (peroksidase -antiperoksidase). Antibodi primer anti- onkoprotein C-erbB-2 ialah antibodi nonoklonal dari clone CB11; sedangkan antibodi anti- PCNA ialah antibodi monoklonal dari clone 19A2 (Biogenex). Analisis sitomorfologik dilakukan dengan pewarnaan rutin Papanicolaou dan Giemsa.Hasil penelitian menunjukkan positivitas onkoprotein C-erbB-2 pada 60Z kasus kanker payudara, berupa pola butir pewarnaan di membran sel/plasmalemma. Lesi jinak pada pasien berusia muda tidak menunjukkan ekspresi onkoprotein, sedangkan pada yang berusia > 40 tahun terdapat 2 kasus yang menunjukkan positivitas fokal. Positivitas PCNA pada, kanker payudara bervariasi, menunjukkan variabilitas kecepatan pertumbuhan tumor. Lesi jinak berusia muda juga menunjukkan proporsi positivitas PCNA yang tinggi.Kesimpulan yang ditarik ialah : terdapat petunjuk peningkatan mutasi genetik sesuai dengan peningkatan usia, agaknya merupakan efek akumulatif. Perbedaan kecepatan pembelahan sel tidak dapat digunakan untuk membedakan keganasan tumor payudara, namun dapat digunakan sebagai variabel prognostik di antara kasus kanker.

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ABSTRACT(Fine-needle) Aspiration cytology examination is an efficient diagnostic tool, which will facilitate early detection of breast cancer. One of the advanced cytotechnology as diagnostic adjunct is immunocytochemistry. Inmunocytochenistry can detect cellular chemical contain, i.e_ C-erbB-2 oncoprotein, which is produced by neu oncogene as manifestation of genetic mutation. Another substance is PCNA (proliferating cell nuclear antigen), which can measure proliferation or growth of the tumor. This study aim is to evaluate correlation of structural and functional analysis of the cell. Multivariate analysis can enhance diagnostic accuracy and prognostic measure.General design of the study is cross-sectional observation. Research subject are 24 patient with breast tumor, 12 were cancer, other were benign lesion. Cytology specimen was examined in Cytology Laboratorium, Department of Anatomic Pathology, Faculty of Medicine, University of Indonesia, during December 1993 until Hei 1994. Imnunostaining was done with immunoenzyme (peroxidase - antiperoxidase) technique. The primary antibody anti- C-erbB-2 oncoprotein is monoclonal antibody from clone CB11; source of primary antibody anti- PCNA is monoclonal antibody from clone 19A2 (Biogenex). Cytonorphologic analysis was done with Papanicolaou staining slide and Giemsa staining.The result of this study is positivity oncoprotein c-erbB-2 in 60% of breast cancer cases, with membranous staining granule in the plasmalemma. Benign lesions do not overexpression oncoprotein, except 2 cases of the old patient with focal staining. PCNA positivity of breast cancer were variable amount, which are consistent with variability of the tumor growth. But the benign lesions were also expression PCNA, especially the young patient.Conclusion of this study is the overexpression of oncoprotein indicate of increase mutagenesis consistent with the age, as accumulative effect. Proliferation rate can not distinguish malignant or benign neoplasm of the breast, but this contribution is to prognostic factor among the cancer cases."

"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.

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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 cytological atypia, and cellularity more than 20 groups in all smear preparation."

"[ABSTRAKLatar belakang: Interpretasi cairan peritoneum yang tepat secara sitopatologi sangatmempengaruhi tatalaksana dan prognosis pasien, padahal pemeriksaan sitopatologi cairanperitoneum masih memiliki nilai negatif palsu dan positif palsu yang cukup tinggi, danhingga saat ini penelitian tentang arsitektur sitopatologi maupun penanda sitomorfologi yangmengarahkan pada adanya sel neoplasma di cairan peritoneum masih menunjukkan hasilyang beragam.Bahan dan cara kerja: Penelitian potong lintang dengan data sekunder berupa slaiddan formulir sediaan sitopatologi cairan peritoneum yang memiliki data berpasangan dengandiagnosis histopatologi. Diagnosis klinis berupa neoplasma epitelial ovarium. Slaid danformulir diambil dari arsip Departemen Patologi Anatomik FKUI/RSCM tahun 2011 ? 2012,dilakukan pembacaan ulang semua slaid sitopatologi dengan diagnosis akhir dikategorikansebagai positif atau negatif, peneliti membaca pula sediaan histopatologi untuk mengetahuimorfologi sel pada lesi, kemudiaan dilakukan penilaian terhadap arsitektur sitopatologiberupa: 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 dengandiagnosis sitopatologi akhir 34 kasus (72.3%) negatif, 13 kasus (27.7%) positif. Terdapatperbedaan bermakna arsitektur sitopatologi berupa: selularitas (p = 0.017), sel berkelompok(p = 0.001), intercellular windows (p = 0.00), group contours (p = 0.00), dan gambaransitomorfologi 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 cairanperitoneum positif dan negatif. Melalui uji multivariat didapatkan penanda yang palingberpengaruh terhadap diagnosis sitopatologi positif atau negatif yaitu: intercellular windows,atipia inti, dan selularitas.Kesimpulan: Terdapat tiga penanda yang paling berpengaruh terhadap diagnosispositif ditemukannya sel neoplasma ganas dalam cairan peritoneum pada kasus dengan lesiovarium, secara berturut - turut yaitu: tidak ditemukannya intercellular windows padakelompokan sel, sel memiliki atipia inti sedang hingga berat, dan selularitas lebih dari 20kelompok dari keseluruhan sediaan apus.

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ABSTRACTBackground : Peritoneal fluid cytopathology interpretation profoundly influences patientsmanagement and prognosis, however this practice still has high false positive and falsenegative value, and until now research concerning the architectural and cytomorphologyfeatures for detecting malignant cells in peritoneal fluid still has various result.Materials and Methods : Cross sectional study using secondary data of peritoneal fluidcytopathology and histopathology slides and form, from patients with clinical diagnosis ofovarian epithelial neoplasm. The data was taken from the archive of Anatomical PathologyDepartment Cipto Mangunkusumo Hospital 2011 ? 2012. The researchers examined thecytopathology slides and also examined the histopatology slide for morphology comparison,and then make a final cytopathological diagnosis of positive peritoneal fluid containingneoplastic cells or negative. Architectural features including: cellularity, cells grouping,papillary structure, intercellular windows, group contours, psamoma bodies, andcytomorphology 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 weresignificant differences in cytopathology architectural including cellularity (p = 0.017), cellsgrouping (p = 0.001), intercellular windows (p = 0.00), group contours (p = 0.00) andcytomorphology 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 fluidcytopathology. Using multivariate analysis there were 3 cytological features that have thestrongest 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 3cytological features that have the strongest association with finding neoplastic cells inperitoneal fluid, they were: the absent of intercellular windows, moderate to severecytological atypia, and cellularity more than 20 groups in all smear preparation, Background : Peritoneal fluid cytopathology interpretation profoundly influences patientsmanagement and prognosis, however this practice still has high false positive and falsenegative value, and until now research concerning the architectural and cytomorphologyfeatures for detecting malignant cells in peritoneal fluid still has various result.Materials and Methods : Cross sectional study using secondary data of peritoneal fluidcytopathology and histopathology slides and form, from patients with clinical diagnosis ofovarian epithelial neoplasm. The data was taken from the archive of Anatomical PathologyDepartment Cipto Mangunkusumo Hospital 2011 – 2012. The researchers examined thecytopathology slides and also examined the histopatology slide for morphology comparison,and then make a final cytopathological diagnosis of positive peritoneal fluid containingneoplastic cells or negative. Architectural features including: cellularity, cells grouping,papillary structure, intercellular windows, group contours, psamoma bodies, andcytomorphology 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 weresignificant differences in cytopathology architectural including cellularity (p = 0.017), cellsgrouping (p = 0.001), intercellular windows (p = 0.00), group contours (p = 0.00) andcytomorphology 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 fluidcytopathology. Using multivariate analysis there were 3 cytological features that have thestrongest 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 3cytological features that have the strongest association with finding neoplastic cells inperitoneal fluid, they were: the absent of intercellular windows, moderate to severecytological atypia, and cellularity more than 20 groups in all smear preparation]"

"Latar Belakang: Efusi pleura ganas menunjukkan prognosis yang buruk sehingga sitologi cairan pleura berperan penting dalam mempersingkat waktu diagnosis. Teknik barbotage diketahui bermanfaat dalam meningkatkan nilai diagnostik sitologi pada karsinoma urotelial, namun belum diketahui perannya pada keganasan rongga toraks. Penelitian ini bertujuan untuk mengetahui perbandingan deteksi sel ganas dan hitung jumlah sel tumor antara pungsi pleura konvensional dan dengan teknik barbotage pada keganasan rongga toraks.Metode: Penelitian ini merupakan uji kesesuaian dengan desain potong lintang yang dilakukan di IGD, poli intervensi paru dan ruang rawat inap RSUP Persahabatan pada bulan November 2022 – Juni 2023. Subjek penelitian adalah pasien keganasan rongga toraks dengan EPG yang dipilih sesuai kriteria inklusi dan eksklusi. Sitologi cairan pleura diperiksa menggunakan pewarnaan Papanicolaou dan Giemsa dari sampel pungsi pleura konvensional dan barbotage pada subjek yang sama. Data karakteristik klinis, radiologis, laboratorium dan histopatologis diambil dari rekam medis.Hasil: Pada penelitian ini didapatkan sebanyak 34 dari 84 subjek EPG menunjukkan sitologi positif pada keseluruhan teknik (40,5%). Teknik konvensional dan barbotage menunjukkan hasil serupa yaitu 39,3%. Deteksi sel ganas dengan teknik konvensional dan barbotage menunjukkan kesesuaian sangat baik yang bermakna (ĸ=0,950; p<0,001). Deteksi sel ganas dengan pewarnaan Papanicolaou dan Giemsa juga menunjukkan kesesuaian sangat baik (ĸ=0,899 dan 0,924; p<0,01). Hitung jumlah sel tumor antara kedua teknik dengan masing-masing pewarnaan menunjukkan kesesuaian cukup (ĸ=0,556 dan 0,520; p<0,01). Analisis multivariat menunjukkan bahwa lokasi lesi primer di paru (OR 4,61; IK 95% 1,33 – 16,03) dan cairan pleura yang keruh (OR 3,41; IK 95% 1,19 – 9,83) memengaruhi hasil sitologi positif cairan pleura.Kesimpulan: Studi ini merupakan studi pertama yang meneliti mengenai penggunaan teknik barbotage pada tindakan pungsi pleura. Pungsi pleura dengan teknik barbotage merupakan alternatif diagnostik yang secara umum aman dan setara dengan teknik konvensional.

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Background: Malignant pleural effusion is a predictor of poor prognosis, therefore pleural fluid cytology is an important tool to shorten the time of diagnosis. Barbotage technique is known to increase diagnostic value in urothelial malignancy, but its role in thoracic malignancies is still unknown. This study aims to compare pleural fluid cytology positivity and tumour cell count between thoracentesis with conventional and barbotage technique in thoracic malignancies.

Methods: This study is a measurement of reliability using a cross-sectional design which was carried out in emergency department, pulmonary intervention clinic and ward of National Respiratory Center Persahabatan Hospital in November 2022 – June 2023. The subjects of this study were thoracic malignancy patients with MPE who met the inclusion and exclusion criterias. Pleural fluid cytology was examined using Papanicolaou and Giemsa stains from conventional and barbotage thoracentesis samples taken on the same subject. Clinical, radiological, laboratory and histopathology data were collected from medical records.

Results: Pleural fluid cytology using both techniques was diagnostic in 34 of 84 (40,5%) MPE patients and 39,3% in each conventional and barbotage technique. Thoracentesis with both techniques showed significantly almost perfect agreement in malignant cell detection (ĸ=0.950; p<0,001). Papanicolaou and Giemsa stains also showed significantly almost perfect agreement in malignant cell detection (ĸ=0.899 and 0.924; p<0.001). Tumour cell count between both techniques using each stain showed significantly moderate agreement (ĸ=0.556 and 0.520; p<0.01). Multivariate analysis showed that primary lesion in the lung (OR 4.61; 95% CI 1.33 – 16.03) and cloudy pleural fluid (OR 3.41; 95% CI 1.19 – 9.83) increased the odds of positive pleural cytology.

Conclusion: To the best of our knowledge, this is the first study to evaluate thoracentesis with barbotage technique. Thoracentesis with barbotage technique is a generally safe alternative procedure and equivalent to conventional technique."

"Penelitian ini bertujuan untuk membandingkan ROMA dengan RMI dalam memprediksi keganasan tumor ovarium epitelial di RS dr. Cipto Mangunkusumo (RSUPNCM). Penelitian ini merupakan uji diagnostik dengan desain potong lintang yang dilakukan di Departemen Obstetri dan Ginekologi, RSUPNCM. Pada penelitian ini, dari 213 subjek diperoleh sensitivitas dan spesifisitas RMI 85.3%, dan 66.3%, Nilai Duga Positif dan Negatif RMI 79.7%, dan 74.3%, Rasio Kemungkinan Positif dan Negatif RMI 2.53, dan 0.22; dan sensitivas dan spesifisitas ROMA 95.4%, dan 32.5%, Nilai Duga Positif dan Negatif 68.9%, dan 81.8%, Rasio Kemungkinan Positif dan Negatif 1.41, dan 0.14. AUC ROMA lebih baik daripada RMI, tetapi tidak bermakna secara statistik (seluruh kelompok: AUC 69.56%>67.49%, perbedaan AUC 0.0207, p 0.526; kelompok pascamenopause: AUC 91.47%>88.97%, perbedaan AUC 0.0250, p 0.0571; kelompok premenopause: AUC 86.20%>78.16%, perbedaan AUC 0.0804, p 0.0571). Pada titik potong ideal (RMI 330, ROMA premenopause 30,4; dan pascamenopause 53.1), ROMA mempunyai sensitivitas dan spesifitas yang lebih baik dibandingkan RMI (sensitivitas 82.31% vs 74.62%; spesifisitas 78.31% vs 75.9%). Dapat disimpulkan bahwa tidak terdapat perbedaan antara ROMA dengan RMI, tetapi sensitivitas dan spesifisitas ROMA lebih baik daripada RMI pada titik potong ideal.

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The purpose of this research is to compare ROMA with RMI to predict malignancy of ovarian tumor, epithelial type in Indonesia, especially at the Cipto Mangunkusumo hospital. It was a cross sectional study with a diagnostic design, which was performed in the Oncology Gyneology division. From 213 sampels, the RMI showed a sensitivity of 85.3%, a specificity of 66.3%, a PPV of 79.7%, a NPV of 74.3%, a LR+ of 2.53, LR- 0.22 and an accuracy of 0.77; while ROMA has a sensitivity of 95.4%, a specificity of 32.5%,a PPV 68.9% of, a NPV of 81.8%, a LR+ 1.41, LR- 0.14 and an accuracy of 0.71. Overall AUC ROMA indicated better results compared to those results using the RMI diagnostic method, (all groups: AUC 69.56%>67.49%, p 0.526; as with the postmenopause group: the AUC was 91.47%>88.97%, p 0.0571; and the premenopause group: the AUC 86.20%>78.16%, p 0.0571). At ideal the cut-off point (RMI 330, ROMA premenopause 30,4; and postmenopause 53.1), ROMA has shown better sensitivity and specificity than RMI (sensitivity 82.31% vs 74.62%; specificity 78.31% vs 75.9%). It can be concluded that there is no significantly different between ROMA and RMI, but at ideal cut off, sensitivity and specificity ROMA better than RMI."

"ABSTRAKDalam usaha untuk meningkatkan ketajaman diagnosis potong beku jaringan tiroid diperlukan beberapa pemeriksaan tambahan, antara lain dengan sitologi imprint. Pembuatan sediaan sitologi imprint ini cukup mudah dan cepat. Dengan sitologi imprint, sel ganas pada umumnya lebih mudah dikenali daripada sediaan potong beku, kecuali pada kelainan tertentu terutama Iasi folikuler. Tujuan penelitian adalah untuk mendapatkan nilai ketepatan keganasan dengan metode sitologi imprint pada jaringan tiroid terhadap diagnosis sediaan parafin dari kasus yang sama.Penelitian ini dilakukan dua tahap.Pertama meneliti semua sediaan imprint yang telah dipersiapkan selama dua tahun. Kedua meneliti sediaan parafin kasus yang sama. Semua sediaan imprint diteliti baik mengenai sel maupun latar belakangnya. Dibuat kriteria tertentu untuk tiap jenis kelainan tiroid.Untuk menilai ketepatan diagnosis sitologi imprint diperlukan analisa uji kemampuan yaitu menggunakan angka acak binomial dengan menirukan tabel 2 x 2 dan sediaan paraffin sebagai baku emas. Dari uji dengan sediaan paraffin sebagai baku emas menghasilkan: sensitifitas 75%, spesifisitas 100%, nilai ramalan positif 100%, nilai ramalan negatif 76% dan ketepatan 93,88%.Dari hasil penelitian tersebut disimpulkan bahwa sitologi imprint mempunyai ketepatan tinggi dalam hal membedakan antara kelainan tiroid jinak dan ganas. Sitologi imprint berguna sebagai pemeriksaan tambahan pada potong beku jaringan tiroid.

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ABSTRACT

To increase the ability diagnosis of frozen section of thyroid lesion we need some additional examinations, for example, imprint cytology. In making cytology preparation is not difficult. With imprint cytology, the detail of cell are better preserved than that in frozen section. Usually the malignant cell is rather well differentiated, except for follicular lesions.

The aim of research is to get a value of accuracy of imprint cytology diagnosis of thyroid malignancy, compared with paraffin section diagnosis from the same cases.

There are two investigations for this research. First we evaluated all imprint slides prepared in two years. All the imprint slides where examined of their cells and backgrounds. We made some criteria for each thyroid lesions. The second evaluation was about paraffin slides.

To evaluate the imprint cytology diagnosis accuracy, analysis of capability was necessary, using binomial random numbers, imitating table 2 x 2 and paraffin slide as gold standard.

From the analysis we found that sensitivity was 75%, spesificity was 100%, positive predictive value was 100%, negative predictive value was 76% and accuracy was 93,88%.

From this examination we conclude that imprint cytology has high accuracy in distinguishing malignancy lesions from benign ones. The imprint is valuable as an addition to the frozen section."