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"ABSTRACTThyroid nodule is a health problem which commonly found in daily practice, therefore clinical guidance is needed. This guideline was compiled by a multidisciplinary team and expected to be a guideline in diagnosing thyroid nodules on daily clinical practice."

"Keganasan tiroid dapat ditemukan sekitar 5% dari kasus dengan nodul tiroid. Untuk penatalaksanaan kasus nodul tiroid perlu membedakan kasus jinak dari yang ganas. Biopsi aspirasi jarum halus (BAJaH) dilakukan praoperasi sedangkan potong beku dilakukan pada saat operasi. Tujuan tulisan ini ialah mengevaluasi ketepatan diagnosis pemeriksaan BAJaH serta PB bersama sitologi imprint (PB+I) pada kasus-kasus nodul tiroid di Departemen Patologi Anatomik FKUI-RSCM. Penelitian ini merupakan uji diagnostik menggunakan data arsip klinikopatologik di Departemen Patologi Anatmik FKUI-RSCM selama tahun 1999-2003. Spesimen dengan kelengkapan data hasil pemeriksaan BAJaH; data hasil pemeriksaan potong beku disertai sediaan sitologi imprint, serta sediaan histologik terfiksasi formalin dari bahan biopsi / operasi tiroid yang sama, digunakan dalam penelitian ini. Sensitivitas, spesifisitas dan akurasi PB+I lebih tinggi daripada BAJaH (berturut-turut 86,8% vs 73,7% ; 99,0% vs 83,9% ; 94,8% vs 80,5%). Bila hasil BAJaH konkordan dengan hasil PB+I, akurasi gabungan ke dua pemeriksaan tersebut menjadi 95,1%. Evaluasi potong beku bersama sitologi imprint masih sangat bermanfaat, karena pemeriksaan ini secara bermakna menunjukkan akurasi yang tinggi dalam mendiagnosis keganasan tiroid. (Med J Indones 2007; 16:89-93).

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Thyroid malignancy can be found on 5% of thyroid nodules. In order to better managed of thyroid nodules, skills to differentiate benign from malignant cases were needed. Fine needle aspiration biopsy (FNAB) was done preoperatively while frozen section (FS) and imprint cytology (IC) should be done intra-operatively. The objective of this research paper is to evaluate the diagnostic accuracy of FNAB versus frozen section combined with imprint cytology (FS+IC) in thyroid nodules at the Anatomic-Pathology Department FMUI-CM Hospital, Jakarta. This diagnostic test, used data from clinico-pathological records in Anatomic Pathology Department, Faculty of Medicine University of Indonesia / Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia during 1999-2003. Specimens with complete data of FNAB results, data of FS and slides of IC. All formalin fixed`specimens were reevaluated and used as the golden standard. Sensitivity, spesificity and accuracy of FS+IC were higher than FNAB (86.8% vs 73.7% ; 99.0% vs 83.9% ; 94.8% vs 80.5% respectively). If the results of FNAB were concordant with the result of FS+IC, the combined examination yields accuracy of 95.1%. The evaluation of frozen section combined with imprint cytology is very useful, because this examination significantly showed high accuracy in diagnosing thyroid malignancy. (Med J Indones 2007; 16:89-93) ."

"Choledocoltthiasis may cause acute cholangitis which is life-threatening condition. It has non specific clinical signs from mild to severe condition such as septicemia. Diagnostic and treatment modalities had developed a great deal recently. Therapeutic options include endoscopic retrograde cholangio pancreatography (ERCP), common bile duct exploration (CEDE), laparoscopic CBDE and stone retrieval. The important thing is to choose the appropriate method for each patient. We reported a case of choledocolithiasis in 40 years old, male patients who was clinically diagnosed as acute cholangitis. Diagnostic approach to find the etiology was done. Abdominal USG and CT were performed and showed multiple stones in gallbladder and intrahepatic biliary duct, suspected mass at capul of the pancreas and hepatomegaly. The ERCP showed dilatation of intra and extra hepatic biliary ducts with multiple stone in common bile duct (CBD), hepatic duct and gallbladder. The slent was placed for biliary drainage. The patient underwent cholecystectomy per laparoscopy, but further evaluation of the cholangiography still showed the presence of stones in intrahepatic biliary duct. Laparotomy exploration of CBD was done and it revealed multiple stones and dilatation of distal CBD. Surgical treatment selected for this case was chole docojej unostomy."

"Latar belakang dan tujuan : Nodul tiroid banyak ditemukan pada populasi dewasa. Kebanyakan merupakan lesi jinak yang tidak memerlukan tindakan lanjutan, namun 7-15% dapat ganas. Modalitas paling sensitif untuk evaluasi adalah ultrasonografi (USG), namun untuk memastikan jenis nodul tetap diperlukan diagnosis invasif dengan lini pertama yaitu pemeriksaan sitopatologi dengan fine needle aspiration biopsy (FNAB). Saat ini berkembang elastografi untuk menilai kekakuan jaringan, dengan teori semakin ganas nodul maka semakin padat jaringan dan elastisitas berkurang. Elastografi kualitatif menggunakan skoring dengan kriteria Rago berdasarkan warna nodul yang semakin gelap dengan meningkatnya kepadatan. Diharapkan elastografi dapat menjadi tambahan untuk evaluasi nodul tiroid. Tujuan penelitian untuk mengetahui kesesuaian antara pemeriksaan strain elastografi kualitatif kriteria Rago dengan hasil sitopatologi. Metode : Uji kesesuaian menggunakan data primer elastografi nodul tiroid berdasarkan sistem skoring Rago dengan hasil sitopatologi berdasarkan klasifikasi Bethesda, dengan desain potong lintang (cross sectional), di RSCM bulan Juli-Agustus 2018. Subjek penelitian adalah 39 nodul yang dikategorikan menjadi benign, intermediate, dan malignant. Analisis statistik menggunakan uji McNemar dan Kappa. Hasil : Didapatkan kesesuaian antara hasil strain elastografi dengan FNAB dengan hasil McNemar test p=0,214, nilai Kappa R=0,52 dan p=0,000. Kesimpulan : Terdapat kesesuaian antara elastografi menggunakan sistem skoring kategori Rago dengan sitopatologi dengan tingkat kesesuaian moderate sehingga elastografi dapat menjadi pemeriksaan tambahan untuk evaluasi nodul tiroid.

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Introduction : Thyroid nodule is common condition in adult populations, which mostly are benign. Nevertheless, malignancy can be found in 7-15% nodules. The most sensitive modality to evaluate thyroid nodule is ultrasonography (USG), although invasive examination is still necessary to confirm benignity or malignancy with first line is cytopathology with fine needle aspiration biopsy (FNAB). Elastography is developed to asses tissue elasticity, with theory that higher malignancy the cells are denser and elasticity is decreasing. In qualitative elastography there is Rago scoring system criteria based on colors appearing in nodules which darker as nodule grows denser. Elastography may become additional examination to evaluate thyroid nodules. The objective of this research is to acknowledge the concordance between qualitative strain elastography and cytopathology result.

Methods : This research is suitability test using primary data of thyroid nodules elastography and cytopathology results in RSCM between July to August 2018. The design is cross sectional. The subjects are 39 nodules and every nodule is grouped into three categories which is benign, intermediate, and malignant. Statistical analysis is performed using McNemar and Kappa test.

Result : Concordance can be found between scoring system strain elastography with FNAB results with McNemar test p=0,214, Kappa R=0,52 and p=0,000.

Conclusion : There is concordance between scoring system strain elastography using Rago criteria with FNAB results with moderate level of agreement. Thus, elastography can be used as additional examination to evaluate thyroid nodules."

"ABSTRAKLatar belakang Akurasi triple diagnostic USG guided FNAB untuk menentukan keganasan pada kasus nodul tirodi masih belum diketahui. Hal tersebut penting untuk diketahui sehingga tindakan definitif dan jenis operasi dapat ditentukan tanpa harus dilakukan pemeriksaan potong beku.Metode Penelitian dilakukan pada 131 pasien dengan pembesaran kelenjar tiroid pada periode Januari 2014 ndash; Desember 2014 dengan menggunakan desain potong lintang. Penelitian ini menghitung nilai sensitivitas, spesifisitas, nilai prediksi positif, nilai prediksi negatif, akurasi triple diagnostic dengan USG guided FNAB dibandingkan dengan histopatologi.Hasil Hasil penelitian ini menunjukan triple diagnostic yang concordant ganas memiliki sensitivitas 81,17 , spesifisitas 96,55 , nilai prediksi positif 98,57 , nilai prediksi negatif 36,36 , dan akurasi 85,08 .Kesimpulan Tingginya nilai prediksi positif yang didapatkan dalam penelitian ini, sehingga triple diagnostic dapat digunakan untuk terapi definitif tanpa dilakukan pemeriksaan potong beku intra operatif.

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ABSTRACT Background The triple diagnostic accuracy with Ultrasound guided FNAB to determine the risk of malignancy in cases of thyroid nodules remains unknown. It is important to know so that definitive measures and types of operations can be determined without the need for a frozen section. Methods The study was conducted using cross sectional design on 131 patients with thyroid nodule in the period of January 2014 December 2014. This study calculated the values of sensitivity, specificity, positive predictive value, negative predictive value, triple diagnostic accuracy with ultrasound guided FNAB compared with histopathological result.Results This study show triple diagnostic with malignant concordant has sensitivity of 81.17 , specificity of 96.55 , positive predictive value of 98.57 , negative predictive value of36.36 , and 85.08 accuracy.Conclusions The high positive predictive values obtained in this study, show that triple diagnostic can be used for definitive therapy without intraoperative frozen section"

"Latar Belakang: Peningkatan kasus kanker tiroid belakangan ini menimbulkan pertanyaan tentang overdiagnosis. ACR-TIRADS merupakan sistem stratifikasi yang dikembangkan untuk mengurangi overdiagnosis dalam mendeteksi kanker tiroid dengan menggunakan ultrasonografi. AI-TIRADS merupakan modifikasi baru dari ACR-TIRADS yang diklaim memiliki nilai diagnostik yang lebih baik, namun AI-TIRADS belum pernah diuji pada populasi Indonesia. Tujuan: Peneliti ingin mengetahui apakah AI-TIRADS memang benar lebih baik dibandingkan ACR-TIRADS dalam menentukan keganasan suatu nodul tiroid. Metode: Penelitian ini mengevaluasi 124 nodul tiroid yang terdiri atas 62 nodul jinak dan 62 nodul ganas berdasarkan ACR-TIRADS dan AI-TIRADS. Setiap penentuan keganasan didasarkan dari lima kategori yang dipakai oleh TIRADS (komposisi, ekogenisitas, bentuk, tepian dan fokus ekogenik). Hasil temuan kedua sistem stratifikasi risiko ini kemudian dibandingkan nilai diagnostiknya dengan pemeriksaan sitopatologi berdasarkan kriteria Bethesda. Hasil: AI-TIRADS secara umum menunjukkan nilai diagnostik yang lebih baik daripada ACR-TIRADS. Tingkat kesesuaian AI-TIRADS terhadap pemeriksaan sitopatologi lebih baik dibandingkan ACR-TIRADS (0,387 dan 0,242). Spesifisitas AI-TIRADS lebih baik (58,06% vs 41,94%; p< 0,00) dibandingkan ACR-TIRADS, namun sensitivitas AI-TIRADS sedikit lebih rendah dibandingkan ACR-TIRADS (80,65% vs 82,26%; p<0,00). AI-TIRADS juga memiliki nilai duga positif dan nilai duga negatif yang lebih baik dibandingkan ACR-TIRADS (AI-TIRADS: 65,79% dan 75% vs ACR-TIRADS: 58,62% dan 70,27%). Kesimpulan: AI-TIRADS memiliki nilai diagnostik yang lebih baik dan dapat mengurangi jumlah positif palsu, namun AI-TIRADS masih memiliki kesulitan dalam mendeteksi keganasan pada nodul tiroid yang padat kistik. Diperlukan pengembangan lebih lanjut dari AI-TIRADS untuk meningkatkan kemampuan diagnostik dalam menentukan keganasan nodul tiroid, khususnya pada nodul padat kistik.

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Background: The recent increase in thyroid cancer cases has raised questions about overdiagnosis. ACR-TIRADS is a risk stratification system developed to reduce overdiagnosis in thyroid cancer detection using ultrasound. AI-TIRADS is a recent modification of ACR-TIRADS claimed to have better diagnostic value, but it has not been tested in the Indonesian population. Objective: The author aimed to determine whether AI-TIRADS is indeed superior to ACR-TIRADS in assessing the malignancy of thyroid nodules. Methods: This study evaluated 124 thyroid nodules, consisting of 62 benign and 62 malignant nodules, based on ACR-TIRADS and AI- TIRADS. Malignancy determinations were based on five categories used by TIRADS (composition, echogenicity, shape, margins, and echogenic foci). The findings of both risk stratification systems were then compared with their diagnostic values in cytopathological examinations based on Bethesda criteria. Results: AI- TIRADS, in general, demonstrated superior diagnostic value compared to ACR- TIRADS. The concordance rate of AI-TIRADS with cytopathological examinations was better than that of ACR-TIRADS (0.387 and 0.242). AI-TIRADS exhibited better specificity (58.06% vs. 41.94%; p < 0.00) compared to ACR-TIRADS, although AI-TIRADS had slightly lower sensitivity (80.65% vs. 82.26%; p < 0.00) compared to ACR-TIRADS. AI-TIRADS also had better positive predictive values and negative predictive values (AI-TIRADS: 65.79% and 75% vs. ACR-TIRADS: 58.62% and 70.27%). Conclusion: AI-TIRADS has better diagnostic value and managed to reduces the number of false positives. However, AI-TIRADS still faces challenges in detecting malignancy in solid cystic thyroid nodules. Further development of AI-TIRADS is needed to enhance its diagnostic capabilities in determining the malignancy of thyroid nodules, especially in solid cystic nodules."