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"Latar belakang: Core biopsy transtorakal merupakan metode biopsi tumor intratorakal yang digunakan untuk mendapatkan sampel histopatologi demi menentukan penatalaksanaan. Core biopsy dipandu gambar pindaian CT toraks di ruang operasi dilakukan terutama bagi pasien yang tidak mampu berbaring, namun belum ada studi akurasi diagnostik baik di Indonesia. Tujuan: Mengetahui akurasi diagnostik core biopsy transtorakal dipandu gambar pindaian CT toraks di ruang operasi untuk tumor intratorakal. Metode: Uji diagnostik dengan studi potong lintang pada semua pasien yang menjalani core biopsy transtorakal di ruang operasi di Rumah Sakit Umum Pusat Persahabatan sejak Januari 2016-Desember 2019. Tindakan dipandu gambar pindaian CT toraks, menggunakan jarum core 18G, hasil dikelompokan menjadi ganas, jinak, dan non-diagnostik. Nilai sensitivitas, spesifisitas, akurasi, nilai duga positif, dan nilai duga negatif sebagai luaran untuk menilai akurasi diagnostik. Hasil: Penelitian melibatkan 105 subjek dengan hasil akurasi diagnostik 86,7%, sensitivitas 83,1%, spesifisitas 100%, nilai duga positif 100%, nilai duga negatif 71% dalam mendiagnosis keganasan tumor intratorakal. Komplikasi pneumotoraks 4,8%, hemotoraks 1%, tidak ada hemoptisis maupun mortalitas. Kesimpulan: Core biopsy transtorakal dipandu gambar pindaian CT toraks di ruang operasi memperlihatkan akurasi diagnostik 86,7% pada tumor intratorakal dan relatif aman.

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Background: Transthoracic needle core biopsy is one of biopsy method of intrathoracic tumors to gain histopathology sample for treatment decision. We performed CT image-guided transthoracic core biopsy in operation theatre for patient who are not able to/tolerate lie down position. Unfortunately, there are still no diagnostic accuracy study in Indonesia.

Objective: to aim diagnostic accuracy of CT image-guided transthoracic needle core biopsy in operating theatre for intrathoracic tumors.

Methods: All patients underwent CT image-guided transthoracic needle core biopsy since January 201-December 2019 are review retrospectively. Eighteen gauge automated core devices were used, and guided by CT image, core biopsy results were divide in to malignant, non-malignant, and non-diagnostic. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy are main outcome to describe diagnostic accuracies.

Results: This study enrolled 105 subjects which had sensitivity of 83,1%, specificity of 100%, positive predictive value of 100%, negative predictive value of 71%, and diagnostic accuracy of 86,7% for intrathoracic malignancies. Complications of pneumothorax are 4,8% and hemothorax are 1%. No mortality was reported.

Conclusion: CT image-guided transthoracic needle core biopsy in operating theatre for intrathoracic tumors had 86,7% of diagnostic accuracy, and a relatively safe procedure."

"ABSTRAK Latar belakang: Fibroadenoma dan tumor filodes jinak merupakan tumorfibroepitelial dengan gambaran histopatologik yang tumpang tindih. Saat inibanyak pengambilan jaringan tumor payudara secara core biopsy, termasuk padatumor fibroepitelial. Jumlah jaringan yang sedikit dan gambaran histopatologikyang tumpang tindih sering menyulitkan Dokter Spesialis Patologi Anatomikdalam menentukan diagnosis fibroadenoma dan tumor filodes jinak. Penelitian inibertujuan untuk mengetahui gambaran histopatologik apa saja yang bermaknauntuk mendiagnosis fibroadenoma dan tumor filodes jinak dan untuk mengujiapakah diagnosis fibroadenoma dan tumor filodes jinak pada core biopsy denganmenggunakan sistem skoring lebih baik dibandingan tanpa skoring.Bahan dan cara: Penelitian ini merupakan suatu uji diagnostik. 57 kasusfibroadenoma dan tumor filodes jinak yang memiliki slaid core biopsy danmastektomi/lumpektomi/eksisi dinilai ulang tanpa sistem skoring danmenggunakan skoring. Gambaran histopatologik yang dinilai pada sistem skoringadalah selularitas stroma, atipia inti, fragmentasi jaringan, infiltrasi lemak, mitosisdan heterogenitas stroma. Kemudian dilakukan analisis statistik, uji diagnostikdan uji kappa.Hasil: Selularitas stroma, heterogenitas stroma dan fragmentasi jaringan lebihsering ditemukan pada tumor filodes jinak dan berbeda bermakna (p=0,001;p=0,000; p=0,021). Spesifisitas pada sistem skoring meningkat sebesar 17,9%.Nilai duga positif dan nilai duga negatif pada sistem skoring meningkat sebesar11,9% dan 5,1%. Area under curve (AUC) meningkat 8,9%. Uji Cohen?s kappaantara diagnosis core biopsy tanpa dan dengan skoring bernilai rendah (0,545).Kesimpulan: Adanya peningkatan spesifisitas, nilai duga positif dan AUCmenunjukkan bahwa penilaian core biopsy sistem skoring lebih baikdibandingkan tanpa skoring dan dapat menjadi acuan untuk diagnosis fibroadenoma dan tumor filodes jinak.ABSTRACT Background: Fibroadenoma and benign phyllodes tumor are kinds of fibroepithelial tumor which have overlapping histopathological features. Recently, core biopsy is commonly performed to determine breast tumor, including fibroepithelial tumor. Small amount of tissue and overlapped histopathological features often complicate the Pathologist in diagnosing both. This study aims to describe the histopathological appearance which needed to diagnose fibroadenoma and benign phyllodes tumor and to verify if the diagnosis of fibroadenoma and benign phyllodes tumor in core biopsy using scoring system is more accurate than without scoring system.Method: This study was a diagnostic test, in which 57 cases of fibroadenoma and benign phyllodes tumor which had undergone core biopsy and mastectomy/excision were re-assessed using and without using scoring system. Histopathologic features which assessed using scoring system were stromal cellularity, nuclear atypia, tissue fragmentation, fat infiltration, mitotic figure, stromal heterogeneity. Analytical statistic, diagnostic test, accuracy test and Kappa test were done.Results: Stromal cellularity, stromal heterogeneity and tissue fragmentation mostly found in benign phyllodes tumor and significantly different (p=0,001; p=0,000; p=0,021).There were significant differences between stromal cellularity (p=0,001), stromal heterogeneity (p=0,000), and tissue fragmentation (p=0,021) in diagnosis of benign phyllodes tumor. Specificity in scoring system increased by17,9 %. Positive predictive value, negative predictive value and accuracy increased in scoring system (11,9% and 5,1%). Area under curve (AUC) increased by 8,9%. Cohen's Kappa test between core biopsy diagnosis without using and using scoring system had low result(0,545). Conclusion: The increasing of specificity, positive predictive value, accuracy and AUC proved that core biopsy with scoring system is more accurate than without scoring. This can be used as reference to diagnose fibroadenoma and benign phyllodes tumor.;Background: Fibroadenoma and benign phyllodes tumor are kinds of fibroepithelial tumor which have overlapping histopathological features. Recently, core biopsy is commonly performed to determine breast tumor, including fibroepithelial tumor. Small amount of tissue and overlapped histopathological features often complicate the Pathologist in diagnosing both. This study aims to describe the histopathological appearance which needed to diagnose fibroadenoma and benign phyllodes tumor and to verify if the diagnosis of fibroadenoma and benign phyllodes tumor in core biopsy using scoring system is more accurate than without scoring system.Method: This study was a diagnostic test, in which 57 cases of fibroadenoma and benign phyllodes tumor which had undergone core biopsy and mastectomy/excision were re-assessed using and without using scoring system. Histopathologic features which assessed using scoring system were stromal cellularity, nuclear atypia, tissue fragmentation, fat infiltration, mitotic figure, stromal heterogeneity. Analytical statistic, diagnostic test, accuracy test and Kappa test were done.Results: Stromal cellularity, stromal heterogeneity and tissue fragmentation mostly found in benign phyllodes tumor and significantly different (p=0,001; p=0,000; p=0,021).There were significant differences between stromal cellularity (p=0,001), stromal heterogeneity (p=0,000), and tissue fragmentation (p=0,021) in diagnosis of benign phyllodes tumor. Specificity in scoring system increased by17,9 %. Positive predictive value, negative predictive value and accuracy increased in scoring system (11,9% and 5,1%). Area under curve (AUC) increased by 8,9%. Cohen's Kappa test between core biopsy diagnosis without using and using scoring system had low result(0,545). Conclusion: The increasing of specificity, positive predictive value, accuracy and AUC proved that core biopsy with scoring system is more accurate than without scoring. This can be used as reference to diagnose fibroadenoma and benign phyllodes tumor.;Background: Fibroadenoma and benign phyllodes tumor are kinds of fibroepithelial tumor which have overlapping histopathological features. Recently, core biopsy is commonly performed to determine breast tumor, including fibroepithelial tumor. Small amount of tissue and overlapped histopathological features often complicate the Pathologist in diagnosing both. This study aims to describe the histopathological appearance which needed to diagnose fibroadenoma and benign phyllodes tumor and to verify if the diagnosis of fibroadenoma and benign phyllodes tumor in core biopsy using scoring system is more accurate than without scoring system.Method: This study was a diagnostic test, in which 57 cases of fibroadenoma and benign phyllodes tumor which had undergone core biopsy and mastectomy/excision were re-assessed using and without using scoring system. Histopathologic features which assessed using scoring system were stromal cellularity, nuclear atypia, tissue fragmentation, fat infiltration, mitotic figure, stromal heterogeneity. Analytical statistic, diagnostic test, accuracy test and Kappa test were done.Results: Stromal cellularity, stromal heterogeneity and tissue fragmentation mostly found in benign phyllodes tumor and significantly different (p=0,001; p=0,000; p=0,021).There were significant differences between stromal cellularity (p=0,001), stromal heterogeneity (p=0,000), and tissue fragmentation (p=0,021) in diagnosis of benign phyllodes tumor. Specificity in scoring system increased by17,9 %. Positive predictive value, negative predictive value and accuracy increased in scoring system (11,9% and 5,1%). Area under curve (AUC) increased by 8,9%. Cohen's Kappa test between core biopsy diagnosis without using and using scoring system had low result(0,545). Conclusion: The increasing of specificity, positive predictive value, accuracy and AUC proved that core biopsy with scoring system is more accurate than without scoring. This can be used as reference to diagnose fibroadenoma and benign phyllodes tumor.;Background: Fibroadenoma and benign phyllodes tumor are kinds of fibroepithelial tumor which have overlapping histopathological features. Recently, core biopsy is commonly performed to determine breast tumor, including fibroepithelial tumor. Small amount of tissue and overlapped histopathological features often complicate the Pathologist in diagnosing both. This study aims to describe the histopathological appearance which needed to diagnose fibroadenoma and benign phyllodes tumor and to verify if the diagnosis of fibroadenoma and benign phyllodes tumor in core biopsy using scoring system is more accurate than without scoring system.Method: This study was a diagnostic test, in which 57 cases of fibroadenoma and benign phyllodes tumor which had undergone core biopsy and mastectomy/excision were re-assessed using and without using scoring system. Histopathologic features which assessed using scoring system were stromal cellularity, nuclear atypia, tissue fragmentation, fat infiltration, mitotic figure, stromal heterogeneity. Analytical statistic, diagnostic test, accuracy test and Kappa test were done.Results: Stromal cellularity, stromal heterogeneity and tissue fragmentation mostly found in benign phyllodes tumor and significantly different (p=0,001; p=0,000; p=0,021).There were significant differences between stromal cellularity (p=0,001), stromal heterogeneity (p=0,000), and tissue fragmentation (p=0,021) in diagnosis of benign phyllodes tumor. Specificity in scoring system increased by17,9 %. Positive predictive value, negative predictive value and accuracy increased in scoring system (11,9% and 5,1%). Area under curve (AUC) increased by 8,9%. Cohen's Kappa test between core biopsy diagnosis without using and using scoring system had low result(0,545). Conclusion: The increasing of specificity, positive predictive value, accuracy and AUC proved that core biopsy with scoring system is more accurate than without scoring. This can be used as reference to diagnose fibroadenoma and benign phyllodes tumor."

"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."

"ABSTRAKBACKGROUND: The incidence lung tumors and mediastinum tumors are the main causes of death due to malignancies with 12,9% of all malignancy cases. Lung tumors are more common in developing countries. Biopsy of lung tumors and mediastinal tumors is a frequent and multidisciplinary action. The minimally invasive technique that is mostly done is percutaneus transthoracic needle aspiration biopsy (PTNAB). Research states that PTNAB is a safe, effective, and accurate procedure.OBJECTIVE: This study aimed to assess the effect of needle biopsy size on the success of biopsy and the incidence of pneumothorax in intrathoracal tumor patients in Hasan Sadikin General Hospital for the period 2014-2016.METHODS: This study is a clinical epidemiological study and observational analytic with a cross sectional study design involving 232 data of patients who met the inclusion criteria and did not meet the exclusion criteria. Matching is done because there are differences in the number of research subjects in each group. The total number of research subjects is 158 patient data. The test used is chi square.RESULTS: The results showed that PTNABs actions using large and small needles had a success rate of 73,4% and 49,4%, respectively, and were significantly different (p <0,05). The success rate of PTNABs actions is not significantly different from lung tumors and mediastinum. The success rate of PTNABs actions in mediastinal tumors using large and small needles was 92,3% and 50%, respectively, and was significantly different (p <0,05). The incidence of pneumothorax after PTNABs action is zero in both groups so analysis cannot be performed.CONCLUSION: This study concluded that the success of PTNABs actions using large-sized needles on small-sized needles differed significantly."

"Pendahuluan: Lesi muskuloskeletal pelvis merupakan kasus langka dengan prognosis buruk. Prosedur diagnostik yang cepat, akurat dan resiko komplikasi minimal sangat dibutuhkan pada kondisi tersebut. CT guided biopsy menjadi salah satu pilihan utama. Untuk itu dilakukan studi demografi terhadap pasien dengan lesi muskuloskeletal pelvis di RSUPN dr Cipto Mangunkusumo serta evaluasi ketepatan diagnosis yang diperoleh melalui prosedur CT guided biopsy.Metode: Penelitian ini merupakan studi demografi dan uji diagnostik prosedur CT guided biopsy pada lesi muskuloskeletal pelvis di RSUPN dr Cipto Mangunkusumo, yang dilaksanakan secara cross sectional. Data dikumpulkan menggunakan rekam medis pasien selama periode Juni 2007-Juni 2017. Analisis uji diagnostik menggunakan Fischer exact test, dengan standar baku pembanding berupa hasil histopatologi dari biopsi terbuka berupa prosedur eksisi terhadap lesi.Hasil: Didapatkan 101 penderita lesi muskuloskeletal pelvis menjalani pengobatan selama periode 2007-2017. Ketepatan diagnosis CT guided biopsy dibanding hasil biopsi terbuka pada lesi muskuloskeletal pelvis adalah 86,36% dalam membedakan jenis, 90,9% dalam membedakan sifat keganasan, 85% dalam membedakan lesi primer muskuloskeletal maupun metastasis, dan 90% dalam membedakan lesi tulang maupun jaringan lunak. Berdasarkan lokasi lesi pada pelvis, ketepatan diagnosis CT guided biopsy tertinggi pada Zona I (83,3%), sedangkan berdasarkan ukuran, lesi berukuran >250ml memberikan ketepatan diagnosis 88,89-100%.Pembahasan: Data demografi menunjukkan gambaran mirip dengan literatur dan dapat digunakan sebagai data dasar dalam menegakkan diagnosis lesi muskuloskeletal pelvis. Dalam evaluasi ketepatan diagnosis, CT guided biopsy dibanding biopsi terbuka pada lesi muskuloskeletal pelvis memiliki ketepatan yang tinggi secara statistik sehingga menunjukkan reliabilitas kuat dan dapat diterapkan sebagai prosedur baku dalam menegakkan diagnosis.

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Introduction: Pelvic musculoskeletal lesion is rare, mostly malignant with bad prognosis. Since early diagnosis of these cases require rapid, accurate, and safe diagnostic procedure, CT guided biopsy are common choice of treatment option. Since no data registered on pelvic musculoskeletal lession yet assembled, we performed demographic study on pelvic musculoskeletal lesion in Cipto Mangunkusumo hospital combined with diagnostic test of CT guided biopsy on pelvic musculoskeletal cases.Methods: This is a demographic study and diagnostic test on CT guided biopsy performed on pelvic musculoskeletal lesion, performed cross sectionally, using medical record from June 2007-June 2017. Sampling procedure performed based on inclusion and exclusion criteria, and evaluated with Fischer exact test, p value <0,05. Histopathologic result after open biopsy described as gold standard. Results: During present decade, 101 patients with pelvic musculoskeletal lesion treated in Cipto Mangunkusumo hospital. Compared to open biopsy, the accuracy of CT guided biopsy were 86,36% on determining type of lesion, 90,9% on determining type of malignancy, 85% on determining primary lesion to a metastasis lesion, and 90% on determining bone to a soft tissue lesion. Based on location of lesion, Zone I provide best accuracy (83,3%) while based on size, lesion sized >250% has best accuracy (88,89-100%). Discussion: Demographic data of this study found similar to literature. These distribution data help diagnostic procedure especially in Cipto Mangunkusumo hospital. High diagnostic accuracy of CT guided biopsy, support that the procedure is strongly reliable, and reasonably considered as a standard operational procedure on diagnostic of pelvic musculoskeletal lesion."

"ABSTRAK Pendahuluan: Biopsi jarum inti dianggap memiliki hasil akurasi yang samadengan biopsi terbuka dan telah menjadi prosedur rutin untuk menegakkandiagnosis lesi muskuloskeletal. Namun demikian uji diagnostik biopsi jarum intidi Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN CM)belum dilaporkan. Tujuan dari analisis retrospektif ini adalah untuk mendapatkannilai ketepatan diagnosis biopsi jarum inti pada lesi muskuloskeletal.Metode: Dari Januari 2011 hingga Agustus 2015, semua pasien dengan lesi muskuloskeletal di RSUPN CM yang menjalani biopsi jarum inti dan eksisi tumor diidentifikasi dan diambil datanya. Ketepatan diagnosis dianalisis baik untukkesimpulan histopatologi maupun kesimpulan clinical pathology conference(CPC).Hasil: Sebanyak 86 sampel dikumpulkan dalam penelitian ini. Ketepatandiagnosis biopsi jarum inti dibandingkan dengan spesimen pasca eksisi adalah74,4%. Setelah dilakukan CPC, nilai ketepatan menjadi 83,7% dengan sensitivitas98%, spesifisitas 59%, NDP 87%, NDN 93% (p = 0.00). Ketepatan biopsi jaruminti setelah pulasan imunohistokimia naik menjadi 84,9% (p = 0,438). Ketepatanuntuk membedakan lesi jinak dan ganas adalah 97,1% (jinak) dan 82,7% (ganas)(p = 0.00). Ketepatan untuk membedakan lesi primer dan metastasis adalah 97,2%(primer) dan 85,7% (metastasis) (p = 0.00).Diskusi: Kami mendapatkan nilai ketepatan biopsi jarum inti yang sedikit lebihrendah karena dalam penelitian ini dituntut untuk membuat diagnosis sampaitingkat morfologi (ICD O dan ICD X). Namun demikian, dengan modalitas lainseperti imunohistokimia dan kesimpulan CPC, ketepatan menjadi meningkat.Ketepatan diagnosis untuk membedakan lesi jinak-ganas dan primer-metastasis tinggi. Biopsi jarum inti direkomendasikan untuk penegakkan diagnosis lesi muskuloskeletal.ABSTRACT Introduction: Core needle biopsy is considered to have similar results with openbiopsy in accuracy and already become a routine procedure to establish thediagnosis of musculoskeletal lesion. However, diagnostic test of core needlebiopsy application in Cipto Mangunkusumo Hospital has not been reported.Therefore, the aim of this retrospective analysis was to attain the accuracy ofmusculoskeletal lesion diagnosis using core needle biopsy. Methods: From January 2011 to August 2015, all patients with musculoskeletal lesion in Cipto Mangunkusumo Hospital underwent core needle biopsy andsubsequent tumour excision were indentified and enrolled. Diagnostic accuracywere calculated for both histopathology and clinical pathology conference (CPC)conclusion.Results: A total of 86 samples were indentified and enrolled in this study. Theaccuracy of core needle biopsy compared to subsequent excision is 74.4%. WithCPC conclusion, the accuracy is 83.7% with sensitivity 98%, specificity 59%,PPV 87%, NPV 93% (p=0.00). The accuracy with immunohistochemistry is84.9% (p=0.438). The accuracy to distinguish benign and malignant lesion is 97.1% (benign) and 82.7% (malignant) (p= 0.00). The accuracy to distinguishprimary and metastatic lesion is 97,2% (primary) and 85,7% (metastatic) (p=0.00). Discussion: We found slightly inferior results for core needle biopsy accuracycompared to literature due to high specificity diagnosis obligatory (ICD O andICD X morphology) in our study. However, with other modalities such asimmunohistochemistry and CPC, the accuracy is increased. The accuracy todistinguish between benign vs malignant and primary vs metastatic lesion is high.Core needle biopsy is recommended to establish diagnosis for selected musculoskeletal lesions.;Introduction: Core needle biopsy is considered to have similar results with openbiopsy in accuracy and already become a routine procedure to establish thediagnosis of musculoskeletal lesion. However, diagnostic test of core needlebiopsy application in Cipto Mangunkusumo Hospital has not been reported.Therefore, the aim of this retrospective analysis was to attain the accuracy ofmusculoskeletal lesion diagnosis using core needle biopsy. Methods: From January 2011 to August 2015, all patients with musculoskeletal lesion in Cipto Mangunkusumo Hospital underwent core needle biopsy andsubsequent tumour excision were indentified and enrolled. Diagnostic accuracywere calculated for both histopathology and clinical pathology conference (CPC)conclusion.Results: A total of 86 samples were indentified and enrolled in this study. Theaccuracy of core needle biopsy compared to subsequent excision is 74.4%. WithCPC conclusion, the accuracy is 83.7% with sensitivity 98%, specificity 59%,PPV 87%, NPV 93% (p=0.00). The accuracy with immunohistochemistry is84.9% (p=0.438). The accuracy to distinguish benign and malignant lesion is 97.1% (benign) and 82.7% (malignant) (p= 0.00). The accuracy to distinguishprimary and metastatic lesion is 97,2% (primary) and 85,7% (metastatic) (p=0.00). Discussion: We found slightly inferior results for core needle biopsy accuracycompared to literature due to high specificity diagnosis obligatory (ICD O andICD X morphology) in our study. However, with other modalities such asimmunohistochemistry and CPC, the accuracy is increased. The accuracy todistinguish between benign vs malignant and primary vs metastatic lesion is high.Core needle biopsy is recommended to establish diagnosis for selected musculoskeletal lesions.;Introduction: Core needle biopsy is considered to have similar results with openbiopsy in accuracy and already become a routine procedure to establish thediagnosis of musculoskeletal lesion. However, diagnostic test of core needlebiopsy application in Cipto Mangunkusumo Hospital has not been reported.Therefore, the aim of this retrospective analysis was to attain the accuracy ofmusculoskeletal lesion diagnosis using core needle biopsy. Methods: From January 2011 to August 2015, all patients with musculoskeletal lesion in Cipto Mangunkusumo Hospital underwent core needle biopsy andsubsequent tumour excision were indentified and enrolled. Diagnostic accuracywere calculated for both histopathology and clinical pathology conference (CPC)conclusion.Results: A total of 86 samples were indentified and enrolled in this study. Theaccuracy of core needle biopsy compared to subsequent excision is 74.4%. WithCPC conclusion, the accuracy is 83.7% with sensitivity 98%, specificity 59%,PPV 87%, NPV 93% (p=0.00). The accuracy with immunohistochemistry is84.9% (p=0.438). The accuracy to distinguish benign and malignant lesion is 97.1% (benign) and 82.7% (malignant) (p= 0.00). The accuracy to distinguishprimary and metastatic lesion is 97,2% (primary) and 85,7% (metastatic) (p=0.00). Discussion: We found slightly inferior results for core needle biopsy accuracycompared to literature due to high specificity diagnosis obligatory (ICD O andICD X morphology) in our study. However, with other modalities such asimmunohistochemistry and CPC, the accuracy is increased. The accuracy todistinguish between benign vs malignant and primary vs metastatic lesion is high.Core needle biopsy is recommended to establish diagnosis for selected musculoskeletal lesions."

"ABSTRAKLatar belakang. Karsinoma medular sulit dibedakan secara histopatologik dan imunohistokimia dengan karsinoma invasif NST dengan gambaran medular derajat 3, karena beberapa gambaran yang tumpang tindih. Pembedaannya sangat penting terkait perbedaan tatalaksana dan prognosis. Karsinoma invasif NST dengan gambaran medular derajat 3 dianggap varian dari karsinoma invasif NST derajat 3, sehingga dapat mewakilinya. Karsinoma medular menunjukkan indeks apoptosis yang lebih tinggi dibandingkan karsinoma invasif NST derajat 3. Tujuan penelitian ini adalah mengetahui apakah indeks apoptosis dapat digunakan untuk mempertajam diagnosis karsinoma payudara medular secara obyektif menggunakan indeks apoptosis. Bahan dan Cara. Dilakukan penelitian retrospektif observasional analitik secara potong lintang terhadap 20 kasus karsinoma medular dan 20 kasus karsinoma invasif NST derajat 3. Dilakukan penilaian indeks apoptosis dengan metode TUNEL (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate in situ nick endlabeling); selanjutnya membandingkan nilai keduanya dan menghitung titik potongnya. Dari titik potong yang didapat, selanjutnya dibandingkan indeks apoptosisnya pada sediaan simulasi core biopsy dan sediaan mastektomi/eksisinya pada kedua kasus. Hasil. Indeks apoptosis (IA) pada karsinoma medular lebih tinggi secara bermakna dibandingkan karsinoma invasif NST derajat 3 ( p 0,001). Berdasarkan kurva ROC, kami mendapatkan titik potong yang optimal pada IA 1.25. Uji kappa terhadap keselarasan sediaan core biopsy dan eksisi/mastektomi mendapatkan hasil 0,3. Kesimpulan. IA dapat digunakan untuk mempertajam diagnosis karsinoma meduler payudara pada sediaan eksisi/mastektomi. Didapatkan titik potong IA: dinyatakan ´medular´ apabila lebih besar/ sama dengan 1,25. IA potensial dapat membantu pada sediaan core biopsy jika >1.25 pada gambaran histopatologik yang memenuhi sebagian kriteria karsinoma medular.

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ABSTRACTBackground. Difficulties are often faced to differentiate between medullary breast carcinoma and invasive carcinoma of no special type with medullary features grade 3, due to morphology and immunohistochemistry overlapping features. It is important to differentiate between them due to differences in the treatment and prognosis . Invasive carcinoma NST with medullary features grade 3 is considered a variant of invasive carcinoma NST grade 3 so it can represent it. Some study showed that apoptotic index in medullary breast carcinoma is higher than invasive carcinoma of no special type grade 3. The aim of this study is to investigate whether apoptotic index can be more definitive in diagnosing medullary breast carcinoma. Patients and methods. This is a retrospective-analytic cross-sectional study using 20 cases of medullary breast carcinoma and 20 cases of invasive carcinoma of no special type grade 3. Apoptotic cell were assessed by TUNEL and the apoptotic index (AI) was calculated. Results. AI in medullary breast carcinoma is significantly higher than invasive carcinoma of no special type grade 3 (p 0,001). The cut off point of AI between medullary carcinoma and invasive carcinoma NST grade 3 is 1.25. Kappa test was done to determine the concordance between core biopsy simulation AI with the related excision/mastectomy and the result is 0,3. Conclusion. The AI can be used to improve diagnostic accuracy of medullary breast carcinoma in excision/mastectomy. The cut off point of the apoptotic index between medullary carcinoma and invasive carcinoma NST grade 3 is 1.25. Only if AI >1.25 can potentially be used to support the diagnosis of medullary carcinoma in core biopsy in case showing some of the medullary carcinoma morphologic criteria."

"Proses segmentasi organ secara manual memakan waktu dan hasilnya subyektif terhadap definisi batas-batas kontur. Pemanfaatan teknologi Machine Learning (ML) berjenis 3D convolutional neural network (3D CNN) untuk mensegmentasi organ secara otomatis dapat mempercepat dan menstandarisasi hasil segmentasi organ. Penelitian ini mengimplementasilan network ML berbasis VoxResNet dan memanfaatkan 60 dataset CT Scan toraks dari Grand Callenge AAPM 2017 untuk melatih, memvalidasi, dan menguji model-model ML dengan berbagai variasi hyperparameter. Pengaruh variasi hyperparameter terhadap hasil segmentasi model juga dipelajari. Dataset dibagi menjadi 3 yaitu, 36 untuk perlatihan, 12 untuk validasi, dan 12 untuk pengujian. Dalam penelitian ini paru-paru kiri dan paru-paru kanan dijadikan satu jenis OAR bernama paru-paru, esophagus dan spinal cord dijadikan satu OAR bernama ESP, sedangkan jantung tetap OAR tersendiri. Variasi hyperparameter adalah variasi ukuran patch, jumlah batch, dan weight class. Hasil segmentasi model-model dievaluasi dan diperbandingkan untuk mencari model terbaik dengan hyperparameter-nya yang mampu menghasilkan kualitas hasil segmentasi organ terbaik. Kemampuan network dalam proses perlatihan dan validasi dievaluasi menggunakan kurva pembelajaran. Kualitas hasil segmentasi model organ dievaluasi menggunakan boxplot distribusi populasi nilai metrik Dice Similiarity Coefficient (DSC) dan Housdorf Distance (HD) setiap slice. Peningkatan atau penurunan kinerja model akibat variasi hyperparameter dinilai menggunakan skor peningkatan metrik. Terakhir, metrik DSC dan HD95 secara 3D hasil segmentasi model terbaik dibandingkan dengan hasil segmentasi oleh interrater variability AAPM 2017 dan hasil segmentasi team virginia. Hasil kurva pembelajaran tidak mengalami underfitting menunjukkan bahwa network mampu mempelajari data perlatihan dengan baik. Overfitting terjadi pada model organ jantung dan ESP. Hasil eksperimen variasi ukuran patch menunjukkan bahwa besar ukuran patch tidak selalu linier dengan kinerja moukuran patch menunjukkan bahwa besar ukuran patch tidak selalu linier dengan kinerja model. Model ukuran patch tengah memberikan kualitas distribusi metrik dan skor paling baik dibandingkan model ukuran patch terkecil dan terbesar pada semua OAR dengan skor 11, 13, dan 13 dari 16. Hasil eksperimen variasi jumlah batch menunjukkan bahwa peningkatan jumlah batch tidak selalu berdampak positif terhadap kinerja model. Untuk model jantung ukuran patch terbesar, peningkatan batch dapat meningkatkan skor dari 2 menjadi 12. Untuk model ESP ukuran patch terbesar, peningkatan batch menurunkan skor dari 13 menjadi 2. Hasil eksperimen variasi weight class (W) menunjukkan bahwa baik model jantung maupun ESP cenderung memberikan distribusi metrik dan skor terbaik di sekitar W = [1,3.67] atau W = [1, C1 < 11]. Dibandingkan dengan interrater variability AAPM, model jantung terbaik menghasilkan nilai metrik yang comparable, yaitu untuk DSC 3D 0.932 ± 0.016 = 0.931 ± 0.015 dan untuk HD95 4.00 ± 0.25 < 6.42 ± 1.82. Sedangkan untuk model paru-paru memberikan metrik lebih baik, yaitu 0.964 ± 0.025 > 0.956 ± 0,019 dan 4,72± 0,21 < 6.71 ± 3,91. Dibandingkan dengan team virginia, model jantung terbaik berhasil memberikan nilai metrik yang lebih baik. yaitu 0.932 ± 0.016 > 0.925 ± 0.015 dan 4.00 ± 0.25 < 6.57 ± 1.50, sedangkan model ESP terbaik menghasilkan metrik yang comparable, yaitu 0.815 ± 0.049 = 0,810 ± 0,069 dan 4,68 ± 0,17 < 8,71 ± 10,59. Dari hasil-hasil ini memberikan potensi adanya perpaduan ukuran patch, jumlah batch, dan weight class tertentu yang dapat menyebabkan hasil segmentasi model ukuran patch lebih kecil dapat mengimbangi hasil segmentasi model ukuran patch lebih besar sehingga tuntutan akan perangkat dengan spesifikasi tinggi dan mahal dapat berkurang.

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The process of manual organ segmentation is time consuming and the results are subjective in term of definition of contour boundaries. The utilization of Machine Learning (ML) technology using 3D convolutional neural network (3D CNN) to segment organs automatically can speed up the procces as well as standardizing the results of organ segmentation. This study implements a VoxResNet-based ML network and utilizes 60 thoracic CT scan datasets obtained from Grand Callenge AAPM 2017 to train, validate, and test ML models with various hyperparameter variations. The effects of hyperparameter variations on the segmentation results of models are also studied. The dataset is divided into 3 parts, namely 36 for training, 12 for validation, and 12 for testing. In this study the left lung and right lung were combined into one type of OAR called the lung, the esophagus and spinal cord were combined into one OAR called ESP, while the heart remained a separate OAR. Hyperparameter variations are variations in patch size, number of batches, and weight loss. The segmentation results of the models are evaluated and compared each other to find the best model and it’s hyperparameters which is able to produce the best segmentation’s quality. The ability of the network in training and validation procceses is evaluated using learning curve. The quality of the organ model’s segmentation results is evaluated using boxplot of population’s distribution of the Dice Similiarity Coefficient (DSC) and Housdorf Distance (HD) metrics for each slice. The increases or decreases in model performance due to variations in hyperparameters are assessed using the metric improvement score. Finally, the 3D DSC and HD95 metrics of the best model’s segmentation results are compared to the results of segmentation by the AAPM 2017’s interrater variability and to the segmentation results by team virginia. There is no underfitting of learning curve indicates that the network is able to learn the training data. Overfitting occurs in the heart and ESP models. The experimental results from patch size variations show that the size of the patch is not always linear with the performance of the model. The middle patch sized models give the best metric distribution’s quality as well as scores compared to the smallest and largest patch sized models for all OARs with scores of 11, 13, and 13 out of 16. The experimental results from batch number variations show that an increase in batch does not always have a positive impact on model performance. For the largest patch sized heart’s model, the increase increases the score from 2 to 12. For the largest patch sized ESP's model, the increase reduces the score from 13 to 2. The results from variations in weight loss (W) experiment show that both heart’s and ESP's models tend to provide the best distributions in term of metrics and scores around W = [1, 3.67] or W = [1, C1 < 11]. By comparing with AAPM's interrater’s variability, the best heart model produces comparable metric's result, that is 0.932 ± 0.016 = 0.931 ± 0.015 for DSC 3D and 4.00 ± 0.25 < 6.42 ± 1.82 for HD95. The best lungs model produces better metrics, that is 0.964 ± 0.025 > 0.956 ± 0,019 and 4,72 ± 0,21 < 6.71 ± 3,91. By comparing with team virginia's results, the best heart model produces better results that is 0.932 ± 0.016 > 0.925 ± 0.015 and 4.00 ± 0.25 < 6.57 ± 1.50. Meanwhile the best ESP model produces comparable results that is 0.815 ± 0.049 = 0,810 ± 0,069 and 4,68 ± 0,17 < 8,71 ± 10,59. The results of this study suggests that there is a certain combination of patch size, batch, and weight class by which enables smaller patch sized model to produce comparable metric's result produced by larger patch sized model thus decreasing the need to use higher specificationed and expensive computer."

"Pendahuluan dan tujuan: Peradangan yang berasal dari batu buli dapat dikaitkan dengan tumor buli. Meskipun infeksi saluran kemih dan batu buli sebelumnya dianggap sebagai faktor risiko terjadinya tumor buli, hingga saat ini hubungan antara batu buli dan tumor masih belum jelas. Sehingga studi ini bertujuan untuk menganalisa faktor-faktor resiko apa saja yang mempengaruhi terjadinya tumor buli pada penderita batu buli.Metode: Penelitian ini adalah penelitian analitik dengan rancangan Study Crossectional Analitik untuk mengetahui faktor-faktor apa saja yang mempengaruhi kejadian kanker buli pada pasien Batu Buli di RSUP H. Adam Malik Medan. Populasi terjangkau pada penelitian ini adalah pasien yang dirawat inap di RSUP H. Adam Malik Medan tahun 2014 s/d 2018 dan pasien diambil secara total sampling berdasarkan data registrasi pasien batu buli yang dilakukan biopsi dasar batu pada periode trsebut. Jumlah pasien yang diperoleh sebanyak 32 pasien. Tes korelasi digunakan untuk mengetahui hubungan perbaikan fungsi ginjal dengan faktor-faktor terukur. Dilakukan analisa multivariat dengan regersi linier untuk memperoleh faktor mana yang memiliki pengaruh paling besar terhadap pencetus terjadinya kanker. Data yang diperoleh diolah menggunakan SPSS 23.0 dan disajikan dalam bentuk tabel dan narasi.Hasil: pasien berjenis kelamin laki-laki sebanyak 31 orang, atau 96,9% berbanding 1 pasien perempuan hanya 1 pasien (3,1%). Keseluruhan rata-rata usia pasien adalah 43,72 (±16,79) tahun. Karsinoma sel skuamosa 15 sampel (46,9%), sel radang 10 sampel (31,3%), dysplasia 3 sampel (9,4%), karsinoma sel transisional 2 sampel (6,3%), dan metaplasia skuamosa 2 sampel (6,3%). Rata-rata ukuran batu buli adalah 5,88 (±2,00) cm. Batu tunggal yang dijumpai pada 27 sampel (84,4%), sedangkan untuk batu multipel pada 5 sampel (15,6%). Infeksi saluran kemih dijumpai pada 12 sampel (37,5%). Lebih dari setengah sampel memiliki riwayat merokok, yaitu pada 20 pasien (62,5%). Tidak terdapat hubungan antara infeksi saluran kemih dengan tumor buli (p = 0,314), terdapat perbedaan yang signifikan (p = 0,001) antara pasien dengan riwayat merokok dengan kejadian kanker buli, tidak terdapat hubungan bermakna antara jumlah batu dengan kanker buli (p = 0,737). Pada kelompok dengan kanker buli, rerata dari ukuran batunya adalah 6,65 (±2,09) cm berbanding pada kelompok tanpa kanker buli dengan nilai rerata 5,00 (±1,51) cm.Kesimpulan: Pasien dengan batu buli memiliki risiko yang lebih besar untuk terkena tumor buli dan terdapat hubungan yang bermakna antara tumor buli dan riwayat merokok.

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Introduction and purpose: Inflammation of bladder origin can be associated with bladder tumors. Although urinary tract infections and bladder stones were previously considered a risk factor for bladder tumors, the relationship between bladder stones and tumors is still unclear. So this study aims to analyze what risk factors influence the occurrence of bladder tumors in patients with bladder stones.

Methods: This research is an analytical study with an analytical cross-sectional study design to determine what factors influence the incidence of bladder cancer in patients with bladder stones at H. Adam Malik Hospital, Medan. The affordable population in this study were patients who were hospitalized at H. Adam Malik Hospital Medan from 2014 to 2018 and patients were taken by total sampling based on the registration data of bladder stone patients who underwent a stone base biopsy during that period. The number of patients obtained were 32 patients. Correlation test was used to determine the relationship between improvement in kidney function and measurable factors. Multivariate analysis was performed with linear regression to obtain which factors had the greatest influence on the originator of cancer. The data obtained were processed using SPSS 23.0 and presented in the form of tables and narratives.

Results: 31 male patients, or 96.9% compared to 1 female patient, only 1 patient (3.1%). The overall mean age of the patients was 43.72 (±16.79) years. Squamous cell carcinoma 15 samples (46.9%), inflammatory cell 10 samples (31.3%), dysplasia 3 samples (9.4%), transitional cell carcinoma 2 samples (6.3%), and squamous metaplasia 2 samples (6.3%). The average bladder size is 5.88 (±2.00) cm. Single stones were found in 27 samples (84.4%), while for multiple stones in 5 samples (15.6%). Urinary tract infection was found in 12 samples (37.5%). More than half of the sample had a history of smoking, namely in 20 patients (62.5%). There was no relationship between urinary tract infections and bladder tumors (p = 0.314), there was a significant difference (p = 0.001) between patients with a history of smoking and the incidence of bladder cancer, there was no significant relationship between the number of stones and bladder cancer (p = 0.737) . In the group with bladder cancer, the mean stone size was 6.65 (±2.09) cm compared to the group without bladder cancer with a mean value of 5.00 (±1.51) cm.

Conclusion: Patients with bladder stones have a greater risk of developing bladder tumors and there is a significant relationship between bladder tumors and smoking history"