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Latar Belakang: Perdarahan Uterus Abnormal PUA merupakan salah satu penyebab tersering wanita datang ke Poliklinik Ginekologi. Data WHO yang didapat tahun 2015 menyimpulkan kejadian PUA dapat berkisar hingga 27. Pada tahun 2016-2017 di RSCM Jakarta, PUA menjadi lima diagnosis terbanyak di poli Ginekologi. Tindakan penilaian adanya kelaianan struktural sebagai etiologi dari PUA menjadi hal yang penting untuk dilakukan dalam penegakkan diagnosa serta tatalaksana. Kuretase menjadi tehnik yang paling umum digunakan, walaupun dengan biaya yang tinggi, akurasi dalam ketepatan pengambilan jaringan biopsi, lama rawat, hingga komplikasi yang dapat ditimbulkan. Histeroskopi menjadi pilihan utama di negara maju dikarenakan memiliki tingkat ketepatan pengambilan jaringan biopsi yang baik, minimal biaya serta akurasi. Namun hingga saat ini, belum ada data yang dimiliki untuk penilaian akurasi histeroskopi dalam penilaian kelainan struktural di Indonesia Tujuan : Mendapatkan nilai diagnostik Office Hysteroscopy sensitivitas, spesifisitas, nilai duga positif, nilai duga negatif dan AUC dalam mendiagnosis kelainan struktural di kavum uteri pada pasien dengan Perdarahan Uterus Abnormal di RSCM. Metode : Studi diagnostik metode potong lintang dilakukan di Rumah Sakit Cipto Mangunkusumo sejak Juni 2014-Juli 2017. Kami mengumpulkan data berdasarkan data kunjungan poli Histeroskopi kemudian menginklusi berdasarkan kriteria PUA penelitian dengan dugaan kelainan struktural ketebalan endometrium Premenopause >8mm dan Menopause >5mm , kemudian menganalisa data temuan saat histeroskopi dan hasil Patologi Anatomi PA sesuai Standar Baku yang digunakan berdasarkan kriteria FIGO. Operator Histeroskopi telah dilakukan uji kesesuaian dengan nilai Kappa 92. Data selanjutnya dilakukan perhitungan sensitivitas, spesifisitas dan menilai AUC dari tindakan histeroskopi dibandingkan hasil PA Hasil : Kemampuan diagnostik OH dinilai sangat baik dalam evalusi kelainan di kavum uteri yakni sebesar 94. Akurasi OH dalam mendiagnosis kelainan polip sangat baik yakni dengan sensitivitas 87, spesifisitas 92, NDP 89, NDN 89, RKP 10,26, RKN 0,15, akurasi 89, dan AUC sebesar 89,1 CI 95 83,2-94,9. Kemampuan diagnostik OH dalam mendiagnosis hyperplasia juga memiliki kemampuan yang baik dengan sensitivitas 83, spesifisitas 95, NDP 89, NDN 92, RKP 17, RKN 0,18, akurasi 91, dan AUC seesar 87,9 CI 80,9 83,2-94,9. Dalam mendiagnosis leiomyoma, OH memiliki kemampuan yang sangat baik dengan sensitivitas 100 , spesifisitas 100, NDP 100, NDN 100, akurasi 100, dan AUC sebesar 100 CI 95 100-100. Kemampuan OH dalam mendiagnosis malignansi juga sangat baik dengan sensitivitas 94, spesifisitas 97, NDP 91, NDN 98, RKP 36,875, RKN 0,06, akurasi 97, dan AUC sebesar 100 CI 95 100-100. Kesimpulan: Kemampuan OH dalam mendiagnosis kelainan struktural di kavum uteri pada pasien PUA memiliki nilai akurasi 94. Terlebih pada pasien dengan kelainan lesi fokal, OH memiliki nilai AUC > 87.
......Abnormal Uterus Bleeding AUB is one of the most common causes of women coming to Gynecology Polyclinics. WHO data obtained in 2015 concluded the incidence of AUB can range up to 27. In 2016 2017 at RSCM Jakarta, AUB became the top five diagnoses in our outpatient clinic. Assessment of structural anomaly as the etiology of AUB becomes an important thing to do in diagnosis and management for the patient. Curettage is the most commonly used technique, albeit at a high cost, accuracy in precision of biopsy tissue taking, length of stay, until complications can be generated. Hysteroscopy is the main choice in developed countries because it has a good accuracy of biopsy tissue retrieval, minimal cost and accuracy. However, until now, there is no data available for the assessment of hysteroscopic accuracy in the assessment of structural abnormalities in Indonesia Objective Obtain an Office Hysteroscopy diagnostic value sensitivity, specificity, positive predictive value, negative predictive value and AUC in diagnosing structural abnormalities in the uterine cavity in patients with abnormal Uterus Bleeding at RSCM. Methods A cross sectional diagnostic study was conducted at Cipto Mangunkusumo Hospital from June 2014 July 2017. We collected data based on histeroscopy visit data then inclusive based on AUB study criteria with suspected structural abnormalities endometrium thickness of Premenopause 8mm and Menopause 5mm then analyzed the findings data during hysteroscopy and Anatomy Pathology PA as gold Standard based from FIGO Criteria. Hysteroscopic operator has been tested for conformity with 92 Kappa value. Further data were calculated for sensitivity, specificity and rate of AUC from hysteroscopic result compared to PA results Results OH diagnostic ability was assessed very well in the evalution of abnormalities in the uterine cavity by 94. The accuracy of OH in diagnosing polypic abnormality was excellent with 87 sensitivity, 92 specificity, 89 PPV, 89 NPV, 89 accuracy, and AUC of 89.1 CI 95 83.2 94.9. The diagnostic ability of OH in diagnosing hyperplasia also has good ability with 83 sensitivity, 95 specificity, 89 PPV, 92 NPV, 91 accuracy, and AUC of 87.9 CI 80, 9 83.2 94.9. In diagnosing leiomyoma, OH has excellent ability with 100 sensitivity, 100 specificity, 100 PPV, 100 NPV, 100 accuracy, and 100 AI 100 CI 95 CI 100 100. OH s ability to diagnose malignancy is also excellent with 94 sensitivity, 97 specificity, 91 PPV, 98 NPV, 97 accuracy and 100 CI 100 CI 95. Conclusions The ability of OH in diagnosing structural abnormalities in the uterine cavity in PUA patients has an accuracy of 94. Especially in patients with focal lesion abnormalities, OH has an AUC value of 87.
Depok: Fakultas Kedokteran Universitas Indonesia, 2017
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