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"Angka kejadian kanker payudara yang ditemukan pads stadium dini meningkat, dilakukan Sentinel Lymph Node Biopsy (SLNB) untuk mendapatkan kontrol lokoregional yang balk dan morbiditas minimal. SLNB belum menjadi prosedur tetap di Indonesia, dasar SLNB adalah deteksi limfonodi sentinel sebagai prediktor status axilla. Penelitian ini adalah penelitian bersama bagian Radiologi dan Bedah FKUI - RSCM Jakarta dengan tujuan mengetahui akurasi metode radiokolloid (limfoskintigrafi dan gamma probe) serta blue dye dalam mendeteksi limfonodi sentinel pada kanker payudara stadium dini. Dilakukan uji diagnostik secara cross sectional, membandingkan akurasi metode radiokolloid dan blue dye dengan histopatologi sebagai baku emas pada 14 pasien dan didapatkan 163 limfonodi. Karakterikstik subyek: keseluruhan perempuan, usia 39 - 53 tahun, kebanyakan sudah menopause, multipara dan menyusui anaknya. Tumor primer mayoritas di kanan, kwadran lateral atas, 57,1% T2, basil histopatologi semuanya karsinoma duktal invasif, didapatkan emboli limfatik pada 71,4% kasus. Waktu injeksi sampai dilakukan operasi antara 4 sampai 24 jam. Deteksi limfonodi sentinel dengan limfoskintigrafi mempunyai akurasi 81,8%, sensitifitas 90,4%, spesifisitas 73,2%, NPV 98,1%, negatif palsu 1,8%, nilai kappa 0,37. Menggunakan gamma probe mempunyai akurasi 79%, sensitivitas 90,4%, spesifisitas 67,6%, NPV 97,9%, negatif palsu 2%, nilai kappa 0,31. Bila keduanya dilakukan mempunyai akurasi 83,6%, sensitivitas 90,4%, spesifisitas 76,8%, NPV 98,2%, negatif palsu 1,8%, nilai kappa 0,56. 14% limfonodi sentinel merupakan limfonodi mammaria interna. Akurasi metode blue dye tidak bisa dinilai pada penelitian ini, gambaran deteksi dengan metode blue dye 71,4% positif. Disimpulkan bahwa metode radiokolloid mempunyai akurasi dan kesesuaian yang tinggi dalam mendeteksi limfonodi sentinel pada kanker payudara stadium dini, terbukti metode radiokolloid dapat diaplikasikan sebagai dasar penggunaan SLNB.

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The incidence of breast cancer in the early stage increases, Sentinel Lymph Node Biopsy (SLNB) is conducted to obtain good locoregional and minimal morbidity. SLNB has not become the permanent procedure in Indonesia, the basic of SLNB is sentinel node detection as a axillary lymph node status predictor. This is a joint research of the Radiology and Surgery Department FKUI - RSCM Jakarta aiming to find out the accuracy of radiocolloid (lymphoscintigraphy and gamma probe) as well as blue dye method in detecting sentinel node in the early stage breast cancer. Diagnostic examination is conducted by means of cross sectional, comparing the accuracy of radiocolloid and blue dye methods with histopathology as the gold standard of 14 patients and gotten 163 nodes. Subject characteristics: all female, aged 39-53, mostly menopause, multipara and breast-feeding. Primary tumor mostly in the right, upper lateral quadrant, T2, histopathology result all carcinoma ductal invasife, emboli lymphatic found in 71,4% cases. The period of injection to surgery is between 4 until 24 hours. The detection of sentinel node with lymphoscintigraphy has 81,8% accuracy, sensitivity 90,4%, specificity 73,2%, NPV 98,1%, false-negative 1,8% and kappa value 0,37. Using gamma probe has 79% accuracy, sensitivity 90,4%, specificity 67,6%, NPV 97,9%, false-negative 2% and kappa value 0,31. When both are conducted, it has 83,6% accuracy, sensitivity 90,4%, specificity 76,8%, NPV 98,2%, false-negative 1,8% and kappa value 0,56. 14% sentinel node is internal mammary node. The accuracy of blue dye method cannot be calculated in this research, detection rate is 71,4%. It is concluded that radiocolloid method has high accuracy and suitability in detecting sentinel node in the early stage breast cancer, it is proven that radiocolloid method can be applied as the basic for using SLNB."

"Latar Belakang: CXCR4 adalah reseptor kemokin G-protein 7-transmembran yang diekspresikan pada beberapa sel kanker payudara manusia pada tumor payududara primer dan metastasis yang menyebabkan migrasi sel hematopoietik dari sumsum tulang belakang ke kelenjar getah bening perifer. Penelitian-penelitian sebelumnya menunjukkan bahwa CXCR4 berkaitan dengan metastasis kelenjar getah bening aksilla. Namun, sampai sekarang, tidak ditemukan penelitian yang mengevaluasi peran CXCR4 dalam metastasis kelenjar getah bening sentinel pada kanker payudara stadium dini.Tujuan: Menentukan peran reseptor kemokin CXCR4 pada migrasi sel kanker payudara ke kelenjar getah bening sentinel.Metode: Digunakan desain studi potong lintang dengan mengevaluasi ekspresi CXCR4 pada 32 pasien kanker payudara stadium dini yang menjalani mastektomi di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSCM) pada periode Maret sampai Juni 2016. Pada seluruh kasus, ekspresi CXCR4 diperiksa dengan pemeriksaan imunohistokimia. Kemudian, dievaluasi hubungan antara ekspresi CXCR4 dengan metastasis kelenjar getah bening sentinel.Hasil: Ekspresi CXCR4 yang tinggi (cut off point ≥ 5) terdeteksi pada 19 dari 32 (59.4%) pasien kanker payudara stadium dini. Dari 19 pasien dengan metastasis kelenjar getah bening sentinel, 16 (84.21%) pasien memiliki ekspresi CXCR4 yang tinggi. Ekspresi CXCR4 berkorelasi signifikan dengan metastasis kelenjar getah bening (p < 0.01).Kesimpulan: Ekspresi CXCR4 yang tinggi berkorelasi signifikan dengan metastasis kelenjar getah bening sentinel pada pasien kanker payudara stadium dini.

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Background: CXCR4 is a 7-transmembrane G-protein chemokine receptor expressed in some human breast cancer cells in both primary breast tumors and metastases that allows for migration of hematopoietic cells from the bone marrow to the peripheral lymph nodes. Previous studies have shown that CXCR4 is associated with axillary lymph node metastases. However, up until now, no studies evaluating the role of CXCR4 in sentinel lymph node metastases in early stage breast cancer patients were found.

Aim: To determine the role of chemokine receptor CXCR4 in breast cancer cells migration to sentinel lymph nodes.

Methods: A cross sectional study design was used by evaluating CXCR4 expression of 32 early stage breast cancer patients that underwent mastectomy in Cipto Mangunkusumo Hospital during the period of March to June 2016. CXCR4 expression was assessed by immunohistochemistry in all cases. Associations between CXCR4 expressions and sentinel lymph node metastases were evaluated.

Results: High CXCR4 expression (cut off point ≥ 5) was dectected in 19 of 32 (59.4%) primary early stage breast cancer patients. Of 19 patients with sentinel lymph node metastases, 16 (84.21%) had high expression of CXCR4. The expression of CXCR4 is significantly associated with sentinel lymph node metastases (p < 0.01).

Conclusions: High expression of CXCR4 was significantly correlated with sentinel lymph node metastases in early stage breast cancer patients."

"Latar belakang: Kanker payudara merupakan kanker dengan insiden tertinggi dan penyebab kematian utama akibat kanker pada perempuan di dunia. Penggunaan implan payudara pasca mastektomi maupun tujuan kosmetik juga ikut meningkat. Ultrasonografi, mamografi dan MRI adalah modalitas pencitraan utama dalam mendeteksi lesi kanker payudara pada pengguna implan payudara. Peranan USG dalam hal tersebut masih kontroversi; sensitivitas mamografi dilaporkan menurun sementara MRI terbatas penggunaanya akibat kendala ketersediaan dan biaya pemeriksaan tinggi. Telaah sistematis ini dibuat untuk menilai akurasi diagnostik USG, mamografi dan MRI dalam mendeteksi lesi kanker payudara pada pengguna implan payudara. Metode: Pencarian sistematis dilakukan pada Januari 2022 untuk mengidentifikasi studi yang menilai akurasi diagnostik USG, mamografi dan MRI dalam mendeteksi lesi kanker payudara dengan referensi baku pemeriksaan patologi anatomi dengan menggunakan data dasar Scopus, PubMed, jurnal dan riset nasional, hand searching serta grey literature. Nilai sensitivitas dan spesifisitas pada masing-masing uji indeks diekstraksi. Penilaian kualitas metodologi studi dilakukan menggunakan QUADAS-2. Hasil: Tiga belas studi diidentifikasi. Nilai sensitivitas USG terendah 62%, tertinggi 95%, spesifitas 93%. Nilai sensitivitas mamografi terendah 22%, tertinggi 80%, spesifitas 100%. Sementara itu, nilai sensitivitas MRI terendah 86%, tertinggi 100% dengan spesifisitas terendah 17%, tertinggi 75%. Sepuluh studi menunjukkan risiko bias tinggi pada salah satu domain, tiga studi di antaranya menunjukkan risiko bias tinggi pada domain yang lain. Kesimpulan: Akurasi diagnostik modalitas USG, mamografi dan MRI dalam mendeteksi lesi kanker payudara pada pengguna implan payudara sangat bervariasi.

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Background: Breast cancer is cancer with the highest incidence and leading cause of cancer death among women worldwide. Breast implant use for post mastectomy patients and for cosmetic purposes is also increasing. Ultrasonography, mammography and MRI are imaging modalities mostly used to detect breast lesions in patients with breast implants. Ultrasound role is still unclear; mammography has been reported to have lower sensitivity while MRI availibility is still limited and highly cost. This systematic review is written to analyze diagnostic accuracy of ultrasound, mammography and MRI in detecting breast cancer in patients with breast implants. Methods: Studies contained diagnostic accuracy of ultrasound, mammography and MRI in detecting breast cancer lesions with pathological examination as reference standard were identified. Scopus, PubMed, national journals and research, hand searching and grey literatures were systematically searched through January 2022. Sensitivity and specificity value of each index tests from eligible studies is extracted. Methodological quality was assessed using QUADAS-2. Results: Thirteen studies were identified. The lowest and the highest sensitivity value are 62% and 95 % for ultrasound, 22% and 80 % for mammography, 86% and 100% for MRI while specificity value are 93% for ultrasound, 100% for mammography, the lowest and the highest of MRI 17% and 75%, respectively. Ten studies demonstrated high risks of bias in one domain with three of them also have high risk of bias in another domain. Conclusion: Diagnostic accuracy of ultrasound, mammography and MRI to detect breast cancer in patients with breast implants is varied."

"Latar belakang: Kanker payudara merupakan kanker terbanyak dengan insiden 40,3 per 100.000 perempuan dan angka mortalitas sebesar 16,6 per 100.000 perempuan di Indonesia. Pada stadium awal I-II, penentuan terapi operatif mastektomi seringkali membutuhkan pemeriksaan potong beku intraoperatif untuk menilai keganasan, namun sering tidak tersedia di banyak rumah sakit. Tripel diagnostik pemeriksaan fisik, ultrasonografi dan fine needle aspiration biopsy merupakan metode diagnostik preoperatif yang juga dinilai akurat dan mudah dilakukan. Studi ini menilai kesesuaian tripel diagnostik dengan histopatologis khususnya pada benjolan yang curiga ganas di RSCM dan RSUPP selama Februari 2016-Agustus 2017. Metode: Subjek dengan benjolan payudara curiga ganas pada stadium awal yang memenuhi kriteria inklusi di RSCM dan RSUPP dilakukan tripel diagnostik preoperatif, kemudian dilakukan pemeriksaan potong beku intraoperatif dan histopatologi pasca operasi. Menggunakan desain studi diagnostik statistik, dilakukan analisis kesesuaian tripel diagnostik maupun potong beku dibandingkan dengan histopatologi yaitu sensitivitas, spesifisitas, nilai prediksi positif NPP, nilai prediksi negatif NPN dan akurasi. Hasil Didapatkan 33 subjek kanker payudara stadium awal prevalensi 4,3 dengan rerata umur 49,6 tahun dengan kelompok umur terbanyak di atas 40 tahun 78,8. Sekitar 63,6 subjek memiliki ukuran tumor 2-5 cm dan jenis histopatologi terbanyak berupa karsinoma invasif 84,8. Dibandingkan hasil histopatologi: a Potong beku memiliki sensitivitas 96,8, spesifisitas 100, NPP 100, NPN 66,7, dan akurasi 97,0 ; dan b Tripel diagnostik mempunyai sensitivitas 77,4, spesifisitas 100, nilai prediksi positif tinggi 100, nilai prediksi negatif 22,2 dan akurasi 78,8 p = 0,016. Kesimpulan: Tripel diagnostik merupakan metode diagnostik yang cukup akurat pada kanker payudara stadium awal sehingga dapat digunakan sebagai metode diagnostik alternatif di fasilitas pelayanan tipe C dan D di Indonesia di saat potong beku tidak tersedia.

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Background: Breast cancer is the most common cancer with incidence rate 40.3 per 100.000 women and mortality rate 16.6 per 100.000 women in Indonesia. In early stage, decision for operative therapy mastectomy requires intraoperative frozen section to assess its malignancy, which is often unavailable in many hospitals. Triple diagnostic physical examination, breast ultrasonography and fine needle aspiration biopsy is an accurate and easily performed preoperative diagnostic method. This study assesses the suitability of triple diagnostic with histopathology results in suspicious malignant breast lumps at Ciptomangunkusumo and Persahabatan hospital during February 2016 August 2017.

Method: Subjects with supicious malignant breast lump that met the inclusion criteria underwent preoperative triple diagnostic, intraoperative frozen section and postoperative histopathology examination. With statistic diagnostic study design, the suitability of triple diagnostic and frozen section were assesed in comparation to histologic examination sensitivity, specificity, positive predictive value PPV, negative predictive value NPV and accuracy.

Result: 33 subjects with early stage breast cancer were obtained prevalence 4.3 with average mean of age of 49.6 years, were above 40 years 78.8. Around 63.6 had tumor size between 2 5 cm, and most histopathologic types were those with invasive carcinoma 84.8. When compared to histopathologic result a Frozen section has 96.8 sensitivity, 100 specificity, 100 PPV, 66.7 NPV and 97.0 accuracy and b Triple diagnostic has 77.4 sensitivity, 100 specificity, high PPV 100, 22.2 NPV and 78.8 accuracy. p 0.016.

Conclusion: Triple diagnostic is a relatively accurate diagnostic method in early stage breast cancer, hence, can be used as an alternative diagnostic method at type C and D heatlhcare facilities in Indonesia whenever frozen section is unavailable. "

"Latar Belakang : FGF2 merupakan ligan bagi Fibroblast Growth Factor Receptor2(FGFR2). Interaksi dengan reseptor ini memediasi dimerisasi reseptor, fosforilasi, dan aktivasi jalur pensinyalan, seperti jalur Ras-MAPK dan PI3K. Mutasi yang berlebihan melalui sumbu FGF / FGFR dapat menginduksi proliferasi sel kanker, memicu angiogenesis dan limfogenesis, yang mendorong terjadinya metastasis. Penelitian ini mencoba mengevaluasi peran FGF2 pada metastasis kelenjar getah bening aksila pada pasien kanker payudara stadium dini. Tujuan : Mengetahui hubungan nilai ekspresi FGF 2 pada tumor primer terhadap kejadian metastasis kelenjar getah bening aksila. Metode : Digunakan studi potong lintang dengan mengevaluasi ekspresi FGF2 pada 47 pasien kanker payudara stadium dini yang menjalani mastektomi di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSCM) pada periode Januari 2014 sampai Desember 2018. Ekspresi FGF2 diperiksa dengan pemeriksaan imunohistokimia, kemudian dievaluasi dan dihubungkan antara ekspresi FGF2 dengan metastasis kelenjar getah bening aksila. Hasil : Uji Chi Square memperlihatkan nilai p=0.044 (p<0.05) yang menunjukkan bahwa terdapat hubungan yang signifikan antara nilai FGF2 pada tumor payudara dengan kejadian metastasis kelenjar getah bening aksila. Odds ratio 4,22 (CI 95% 0,983-18,1). Kesimpulan : Peran FGF2 dalam metastasis kelenjar getah bening berhubungan dengan interaksi antara berbagai faktor limfangiogenik dalam mempromosikan limfangiogenesis dan metastasis limfatik. Ekspresi FGF2 yang tinggi memiliki korelasi signifikan dengan angka kejadian metastasis kelenjar getah bening aksila.

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Background : FGF2 is a ligand for Fibroblast Growth Factor Receptor 2 (FGFR2). Interaction with this receptor mediate dimerization of receptor, phosphorilation, and activation of signaling pathway, such as Ras-MAPK and PI3K. Overmutation through FGF/FGFR induced proliferation of cancer cells, promoted angiogenesis, lymphogenesis, and metastasis. This study tried to evaluate the role of FGF2 in axillary lymph node metastasis in early-stage breast cancer patients.

Aim : To determined the relationship of FGF 2 expression values in primary tumors to the incidence of axillary lymph node metastases.

Methods :A cross-sectional study was used by evaluating the expression of FGF2 in 47 early-stage breast cancer patients who underwent a mastectomy at the Cipto Mangunkusumo National Center General Hospital (RSCM) from January 2014 to Desember 2018. FGF2 expression was examined by immunohistochemistry, then evaluated and linked between expression FGF2 with axillary lymph node metastases.

Results : The Chi Square test had a value of p=0.044 (p<0.05) that showed there was a significant relationship between FGF2 value in breast tumors with the incidence of axillary lymph node metastasis. Odds ratio 4.22 (95% CI 0.983-18.1).

Conclusions The role of FGF2 in lymph node metastasis is related to the interaction between various lymphangiogenic factors in promoting lymphangiogenesis and lymphatic metastasis. High expression of FGF2 has a significant correlation with the incidence of axillary lymph node metastasis."

"Faktor perturnbuhan cndote1 vaskular atau Vascular Endothelial Growth Factor (selanjutnya disebut VEGF) adalah suatu glikoprotein dimer yang dihasilkan oleh sel tumor dan jaringan yang memerlukan pasokan pembuluh darah baru. Beberapa penelitian membuktikan bahwa terdapat hubungan antara penyebaran ke kelenjar gctah bening ketiak dengan ekspresi VEGF C dan D terutama pada kanker payudara jenis duktal invasif. Ekspresi berlebihan dari VEGF disenai ekspresi berlebihan dari HER2 kanker payudara. Lebih jauh diketahui bahwa ekspresi VEGF berhubungan dengan penyebaran ke kelenjar getah bening ketiak. Pengaruh faktor ini mendorong peneliti untuk mempelajari kanker payudara stadium II dengan HER-2 posltif karena penyebaran ke kelenjar getah benlng ketiak pada sisi yang sama dengan kanker payudara, mulai ditemukan pada stadium II baik pada tumor ukuran di bawah 2 em ataupun pada tumor berukuran lebih dari 2 em. Dalam penelitian ini dinilai poia ekspresi VEGF pada subjek dengan penyebaran ke kelenjar getah bening (N l) dan pada keadaan belum adanya keterlibatan kelenjar getah bening (NO). Ekspresi VEGF dapat diamati dan diukur derajatnya pada jaringan kanker payudara dengan teknik imunohistokimia. Pola ekspresi yang didapatkan dari hasil penelitian ini diharapkan dapat melihat sifat biologik kanker payudara dalam hal penyebarannya ke kele11iar gctah bening ketiak dan dapat digunakan sebagai faktor prediksi dalam hal penyebarannya.

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Vascular Endotbelia1 Growth Factor (VEGF) is a chimeric glycoprotein produced by tumor cells and tissues that require ample blood supply. Some studies have suggested that there is an association between metastasis of cancer cells to the axillary lymph nodes and VEGF C and D especially in ductile invasive breast carcinoma. The over expression from VEGF together with HER-2 were found in 77.2 percent of breast cancer patients. Furthermore evidence suggest that VEGF expression is connected with the spread of cancer to the axillary lymph nodes. We examined breast cancer stage II with HER-2 positive, as the spread of cancer cells to the axillary lymph nodes from the same breast cancer side will only be found at stage H for both tumor under 2 em or more than 2 em. We examined VEGFC the its relationship with axillary lymph node. The results from this research is aimed at monitoring the spread of breast cancer to the axillary lymph nodes and to predict its spread and therefore to find the most effective treatment management for this type of cancer. We analyzed VEGF-C expression in 95 sample breast cancer stage ll with HER-2 positive from 1999 2009. There is no significant associated between VEGF-C expression and axillary lymph node (p = 0.089)."

"This study aimed to compare the efficiency of isosulfan blue (ISB) and colloid methods in determining metastatic conditions of axillary lymph node in sentinel lymph node biopsy (SLNB). this prospective study was performed between April 2005 and July 2009 at Gulhane Medical Faculty, Department of General Surgery. a total of 102 female patients diagnosed with breast cancer were enrolled in the clinic of Gulhane School of Medicine. According to the diagnostic protocols of SLN, the patients were divided into three groups as follows: ISB (group I), colloid (group II), and ISB and colloid (group III). SLN was identified in 49 of 52 patients (94.2%) in the ISB group; the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and false negativity (FN) ratio were found to be 90.9%, 75.8%, 96.1%, 55.5%, and 9.1%, respectively. On the contrary, the sentinel lymph node was identified in 38 of 38 (100%) patients in the colloid group; the sensitivity, specificity, PPV, NPV, and FN were found to be 88.2%, 100%, 100%, 91.3%, and 11.8%, respectively. In ISB and colloid groups; SLN was identified in 12 of 12 (100%) patients in the ISB and colloid groups; the sensitivity, specificity, PPV, NPV, and FN were found to be 100%, 100%, 100%, and 0%, respectively. this study showed that the combined methods applied to heterogeneous groups of patients for SLNB in breast cancer cases were minimally invasive and effective and hence could be used for evaluating nodal metastases."

"Penelitian ini bertujuan untuk menguji hubungan tingkat pendidikan pasien dengan kanker payudara stadium dini di instalasi rawat inap Rumah Sakit Ciptomangunkusumo Jakarta tahun 2012 dengan menggunakan desain studi cross sectional. Teknik pengumpulan data dilakukan dengan menggunakan data rekam medik Rumah Sakit Ciptomangunkusumo. Hasil penelitian menunjukkan tingkat pendidikan pasien memiliki hubungan dengan stadium dini kanker payudara (OR 2,25) dan risiko meningkat (7,69) setelah dikontrol oleh status pekerjaan, penggunaan alat kontrasepsi hormonal, serta keikutsertaan jaminan kesehatan.

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The purpose of this research is to examine association between patient’s educational level with early diagnosis of breast cancer at inpatient care of Ciptomangunkusumo’s Hospital year 2012. This research applied cross sectional design. Data were collected from secondary sources, using medical record data. The result of the research shows that patient’s educational level associated with early diagnosis (OR=2,25) and that risk will be higher if it controlled with employment status, hormonal contraceptive use, and participation of health insurance. (OR=7,69)"

"Insidensi kanker payudara terus meningkat secara global setiap tahun. Di negara berpendapatan menengah ke bawah, meningkatnya insidensi ini diikuti dengan meningkatnya angka kematian akibat kanker payudara yang disebabkan oleh keterlambatan diagnosis yang sering terjadi, sehingga pengobatan dan perawatan kanker payudara tidak lagi efektif dilakukan. Pada penelitian ini dilakukan analisis metode peningkatan deteksi dini terencana kanker payudara yang telah dilakukan di beberapa negara berpendapatan menengah ke bawah dengan menggunakan systematic review. Systematic review dilakukan dengan melakukan identifikasi literatur dari Google scholar, ProQuest, ScienceDirect, Scopus, dan Pubmed dengan menggunakan kata kunci improve, early detection, screening, breast cancer, low middle-income countries, dan LMIC, lalu dilakukan pencarian lanjutan dengan teknik snowball dari literatur yang sudah didapatkan. Kriteria inklusi pada pencarian literatur adalah artikel full text berbahasa Inggris yang diterbitkan pada tahun 2010 – Juni tahun 2020 dan memiliki lokasi studi di negara berpendapatan menengah ke bawah. Sebelas artikel didapatkan dari pencarian dan proses seleksi menggunakan diagram alir PRISMA. Ditemukan 5 jenis program dalam upaya peningkatan deteksi dini kanker payudara di negara berpendapatan menengah ke bawah, yaitu program skrining berbasis populasi, program skrining oportunistik, program peningkatan pengetahuan dan kesadaran, program pengalihan tugas, dan pelaksanaan program nasional deteksi dini kanker payudara. Program-program tersebut diketahui berhasil meningkatkan deteksi dini kanker payudara pada latar negara berpendapatan menengah ke bawah. Program peningkatan pengetahuan dan kesadaran, dan program pengalihan tugas dinilai sebagai program yang paling sesuai untuk dilaksanakan di negara berpendapatan menengah ke bawah. Meski begitu, perlu dilakukan pilot studi dan evaluasi biaya untuk melihat keefektifan program deteksi dini ini.

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Incidence of breast cancer keeps increasing globally every year, and in low-and middle-income countries it followed by increased mortality rate. This phenomenon could be associated with late-stage diagnosis that made treatments no longer effective. This study aimed to analyse methods to increase early detection for breast cancer that has been done in several low-and middle-income countries by using systematic review. Systematic review was carried out by identifying literatures from online databases such as Google scholar, ProQuest, ScienceDirect, Scopus, and Pubmed using “improve”, “early detection”, “screening”, “breast cancer”, “low middle-income countries", and “LMIC” as keywords, and followed by manually searching literatures using snowball technique from the literatures that had been identified earlier. Inclusion criterias in this study were English full text that were published between 2010 – June 2020 with low-and middle-income countries setting. Eleven articles were obtained using PRISMA flow diagram and 5 types of programs were found to increase early detection for breast cancer in low-and middle-income countries; population-based screening program, oportunistic screening program, program to improve knowledge and awareness about breast cancer and early detection, task shifting program, and implementation of national breast cancer early detection program. These programs were known to be able to improve early detection in their respective study location. Improving knowledge and awareness, and task shifting program were the most suitable program to be executed in low-and middle-income countries setting. These countries shall do some pilot studies and cost evaluation to identify and analyse the effectivity of these programs before implementing it widely."

"Latar Belakang : Kanker payudara sampai saat ini masih merupakan masalah bagiwanita di seluruh dunia. Meskipun telah banyak kemajuan dalam hal skrining, deteksidini dan penatalaksanaannya, progresivitas penyakit ini tetap berlanjut. Kankerpayudara masih menjadi penyebab kematian utama akibat kanker pada seluruh wanitadan merupakan kanker yang paling sering terdiagnosa pada wanita di 140 dari 184negara di seluruh dunia termasuk negara berkembang seperti Indonesia dimana 87 berada pada stadium lanjut stadium IIIA, IIIB, IV. Keberadaan pasien yang datangberobat pada stadium lanjut, menimbulkan berbagai masalah morbiditas dan mortalitasyang menurunkan kualitas hidup, serta survival rate. Untuk memperkirakanprogresivitas dan perkembangan kanker diperlukan biomarker tertentu sebagaipenanda prognosis dan prediktif. Berbagai faktor prediktif dan prognostik telahdigunakan dalam penanganan kanker payudara. PAI-1 Plasminogen activatorInhibitor-1 sebagai bagian dari sistem aktivator plasminogen telah diketahuimerupakan faktor prognostik independen yang kuat untuk disease-free survial andoverall survival. Peningkatan kadar dan ekspresi PAI-1 pada penelitian klinissebelumnya sering menunjukkan prognosis buruk. Tetapi pada penelitian invivomenunjukkan bahwa PAI-1 memiliki peran ganda. Di satu sisi PAI-1 berperan dalammenekan perkembangan kanker dengan memblok angiogenesis, tetapi disisi lain jugadapat mempromosikan perkembangan kanker dengan meningkatkan angiogenesis danmemblok apoptosis. Tetapi apakah PAI-1 dapat menekan perkembangan kankerataukah sebaliknya mempromosikan perkembangan kanker, hal ini yang menjadipertanyaan penulis. Untuk itu penulis akan mencoba meneliti seberapa jauh peranPAI-1 dalam memprediksi kemungkinan survival rate dihubungkan dengan faktorklinikopatologi pada kanker payudara stadium lanjut. Metode penelitian : Penelitian ini merupakan penelitian prognostik yang menilaisurvival rate dengan metode hystorical cohort analitik pada pasien Kanker payudarastadium IIIB dan IV. Sebanyak 58 dari 86 penderita kanker payudara stadium IIIB danIV di Rumah Sakit Kanker Dharmais dilakukan pemeriksaan ekspresi PAI-1 melaluipemeriksaan immunohistokimia dari jaringan kanker payudara dengan menggunakanantibody PAI-1 Santa Cruz Biotechnology, inc. PAI-1 C-9 : sc-5297 a mousemonoclonal antibody raised against amino acids 24-158 of PAI-1 of human origin pengenceran 1 : 50. Kemudian dilanjutkan analisa survival untuk mendapatkan dataprognosis PAI-1 dan dinilai pula faktor klinikopatologi yang berpengaruh terhadapekspresi PAI-1. Hasil : Dengan cut off sebesar 90 didapatkan sensitivitas pemeriksaan ekspresi PAI-1sebesar 84,7 dan spesifisitas 60. Dari hasil analisa statistik, ternyata terdapathubungan yang bermakna antara ekspresi PAI-1 dan survival rate dengan HR 4,08 IK95 1,75 - 9,50 dengan nilai p=0,001. Selanjutnya melalui analisis survival denganKaplan-Meier menunjukkan ada perbedaan survival rate yang bermakna antara kelompok ekspresi PAI-1 yang tinggi dengan PAI-1 yang rendah pada kankerpayudara stadium lanjut log rank p=0,001 , dimana kelompok PAI-1 yang tinggimemiliki lama hidup 1408 hari, sedangkan PAI-1 yang rendah memiliki lama hidup540 hari jadi terdapat selisih 868 hari. Ekspresi PAI-1 tidak berhubungan denganfaktor-faktor kliniko-patologi, kecuali grade didapatkan RR 1,5 IK95 1,2-1,8. Kesimpulan : Pasien kanker payudara stadium lanjut dengan ekspresi PAI-1 yangtinggi memiliki survival yang lebih baik dibanding dengan PAI yang rendah. EkspresiPAI-1 pada kanker payudara stadium lanjut tidak berhubungan dengan faktor klinikopatologikecualigrade.

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Background: Breast canceissue for women around the world. Although there has been much progrr is aness in terms of screening, early detection and management, progression of the disease continues, breast cancer is still the leading cause of death from cancer in all women and is the most common cancer diagnosed in women in 140 of 184 countries around the world including developing countries such as Indonesia where 87 are at an advanced stage stage IIIA, IIIB, IV. The existence of the patients who come for treatment at an advanced stage causes many problems in morbidity, mortality, and decrease quality of life, resulting in low survival rate. To predict the progression and development of the cancer we need specific biomarkers as prognostic and predictive markers. PAI 1 Plasminogen activator inhibitor 1 as part of plasminogen activator system has been known to be a strong independent prognostic factor for disease free and overall survival. Increased levels and the expression of PAI 1 in the previous clinical studies often indicate a poor prognosis. But in vivo studies indicate that PAI 1 has a dual role. On one side the PAI 1 plays a role in suppressing the development of cancer by blocking angiogenesis, but on the other hand it can also promote the development of cancer by increasing angiogenesis and blocks apoptosis. Does PAI 1 suppress the development of cancer or promote the development of cancer, is the question of this study. The writer will study the role of PAI 1 in predicting the likelihood of survival rate associated with clinicopathologic factors in advanced breast cancer.

Research method: This study assess the prognostic survival rate with hystorical cohort analytic methods in breast cancer patients with stage IIIB and IV. A total of 58 from 86 patients with breast cancer stage IIIB and IV at Dharmais Cancer Hospital was tested for expression of PAI 1 through immunohistochemistry assay of breast cancer tissue using antibody PAI 1 Santa Cruz Biotechnology, Inc., PAI 1 C 9 sc5297 a mouse monoclonal antibody raised against amino acids 24 158 of PAI 1 of human origin dilution 1 50. Survival analysis was done to obtain the prognostic data of PAI 1 and rated the clinicopathologic factors that influence the expression of PAI1.

Result: With a cut off of 90, expression of PAI 1 test has 84.7 sensitivity and 60 specificity. Statistical analysis shows a significant correlation between the expression of PAI 1 and survival rate with HR 4.08 95 CI 1.75 to 9.50 , with p 0.001. Furthermore, survival analysis by Kaplan Meier showed significant differences in survival rate between the group of high expression of PAI 1 and low expression PAI 1 in advanced breast cancer log rank p 0.001 , where the group with high PAI 1 has 1408 days of survival life, while the group with low PAI 1 has 540 days of survival life, with difference of 868 days. Also the expression of PAI 1 shows not significant correlation with clinicopatologycal factors except grade RR 1,5 IK95 1,2 1,8.

Conclusion: Advanced breast cancer patients with the expression of high PAI 1 hadbetter survival compared with low PAI 1. The expression of PAI 1 in Advancedbreast cancer was not associated with clinicopathologycal factors excepted grade."