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"ABSTRAKTujuan. Penelitian ini membandingkan pemeriksaan sitologi urin dengan pemeriksaan sistoskopi konvensional untuk mendeteksi metastasis kanker serviks ke vesika urinaria.Metode. Penelitian dilakukan dengan uji diagnostik potong-lintang dengan subjek penelitian pasien kanker serviks stadium ≥IIB di RSUPN Dr. Ciptomangunkusumo dari Juli 2015 hingga Januari 2016. Nilai diagnostik pemeriksaan sitologi urin dihitung dengan luaran: sensitivitas, spesifisitas, nilai prediksi positif, nilai prediksi negatif, dan akurasi. Uji kesesuaian pemeriksaan sitologi urin dibandingkan baku emas pemeriksaan sistoskopi konvensional.Hasil. Dalam jangka waktu Juli 2015 hingga Januari 2016 didapatkan 111 kasus pasien dengan diagnosis kanker serviks stadium ≥IIB yang memiliki potensi mengalami metastasis ke vesika urinaria. Sebanyak 106 subjek diikutsertakan dalam analisis statistik. Pemeriksaan sitologi urin memiliki sensitivitas 20%, spesifisitas 89%, nilai duga positif 8,33%, nilai duga negatif 95,74%, dan akurasi 95,28%.Kesimpulan. Penelitian ini menyimpulkan bahwa pemeriksaan sitologi urin mempunyai akurasi 95,28% sehingga dapat digunakan sebagai metode penapisan untuk mendeteksi kanker serviks yang belum metastasis ke vesika urinaria dan sebagai alternatif protokol. Apabila hasil pemeriksaan sitologi urin negatif maka tidak perlu dilakukan pemeriksaan sistoskopi, tetapi apabila hasil pemeriksaan sitologi urin positif maka perlu dilakukan pemeriksaan sistoskopi.Kata kunci: kanker serviks, metastasis vesika urinaria, sitologi urin, sistoskopi, nilai diagnostik

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ABSTRACTObjective. The aim of this study is to compare the diagnostic value of urine cytology and conventional cystoscopy to diagnose bladder metastasis in cervical cancer.Methods. It is a cross sectional study with cervical cancer patients stage ≥IIB at Dr. Ciptomangunkusumo Hospital from July 2015 to January 2016 as the research subjects. The diagnostic value of urine cytology and conventional cystoscopy were calculated as sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. The gold standard was conventional cystoscopy.Result. From July 2015 to January 2016, there were 111 subjects with cervical cancer that have possibility infiltrated the bladder, and there were 106 subjects that included to statistical analysis. The urine cytology has sensitivity 20%, specificity 89%, positive predictive value 8.33%, negative predictive value 95.74%, and accuracy 95.28%.Conclusion: The urine cytology has accuracy 95.28 %, so it can be used as screening method and alternative diagnostic method to detect if there is no bladder metastasis in cervical cancer. If the result of urine cytology is negative, then there is no need to perform cystoscopy, but if the result of urine cytology is positive, then the cystoscopy should be performed.Keyword: cervical cancer, bladder metastasis, urine cytology, cystoscopy, diagnostic value"

"Tujuan : Membandingkan hasil sitologi urin spontan dengan bilasan bulibuli dalam diagnosis dan follow-up kanker buli-buli. Metode : Sebanyak 39 pasien dengan riwayat kanker buli-buli atau yang dicurigai kanker buli-buli berdasarkan adanya painless gross hematuria atau temuan lesi/tumor pada sistoskopi atau imaging, masing-masing dilakukan pemeriksaan sitologi urin spontan dan bilasan buli-buli. Spesimen urin spontan diambil dalam 24 jam sebelum tindakan. Sedangkan untuk bilasan buli-buli pada saat sistoskopi. Hasil : Dari 39 pasien 30 diantaranya terbukti kanker buli-buli pada pemeriksaan histopatologi dimana 27-nya merupakan pasien baru dan 3 sisanya rekurens. Sensitivitas keseluruhan sitologi urin spontan dan bilasan buli-buli adalah masing-masing 30% dan 53% (p=0,067). Sensitivitas menurut grade untuk urin spontan berturut-turut grade 1,11 dan III adalah 0, 14,3%; dan 42,9%. Sedangkan bilasan buli-buli 66,7%; 71,4% dan 42,9%. Sensitivitas menurut stage untuk urin spontan 12,5% dan 37,5% untuk masing-masing tumor superfisial dan muscle invasive. Hal yang sama pada bilasan buli-buli adalah 75,0% dan 43,8%. Tidak ditemukan perbedaan yang bermakna secara statistik baik menurut grade maupun stage pada kedua metode tersebut. Kesimpulan : Pada penelitian ini tidak didapatkan perbedaan bermakna terhadap hasil sitologi urin spontan dan bilasan buli-buli, namun demikian sensitivitas bilasan buli-buli lebih tinggi dibanding urin spontan.

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Objectives : To compare the result of voided urinary cytology (VUC) with bladder wash cytology (BWC) in the diagnosis and follow-up of bladder tumors. Methods : Voided urine and bladder wash sample were obtained from 39 patients who having bladder cancer history or suspected bladder cancer based on painless gross hematuria or recent abnormal cystoscopy or suspicious intravenous urographic or ultrasonographic results. Voided urine specimen was collected in 24 hours before entering operating room. Bladder wash specimen was obtained during cystoscopy. Results : Bladder cancer was confirmed histologically in 30 patients, of which 27 had primary tumors and 3 had recurrent ones. The overall sensitivity of VUC and BWC were 30% and 53%, respectively (p=0.067). The sensitivity of VUC was 0 for grade I, 14.3% for grade II, 42.9% for grade III. The sensitivity of BWC was 66.7%> for grade I, 71.4%> for grade II and 42.9% for grade III. The sensitivity of VUC by tumor stage were 12.5%O and 37.5%> for superficial and muscle invasive, respectively. Those of BWC were 75.0% and 43.8%. There was no statistical significant difference for sensitivity between grades and stages of VUC and BWC. Conclusions : In this study, we did not find any significant difference, but the overall sensitivity of bladder wash cytology was superior than voided urine cytology."

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

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

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

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

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

"Metastasis merupakan proses penyebaran sel induk kanker dari satu jaringan ke jaringan lain. Kejadian tersebut merupakan salah satu tanda utama kanker. Kanker yang dihasilkan dari metastasis disebut dengan kanker metastasis. Pertumbuhan kanker metastasis dapat dimodelkan ke dalam persamaan matematika. Pada pemodelan ini diasumsikan tubuh manusia sudah memiliki sebuah kanker yang akan memicu pertumbuhan kanker metastasis dan banyak niche (ruang dimana sel induk kanker melakukan segala aktivitasnya seperti proliferasi dan diferensiasi) yang ada dalam tubuh manusia adalah konstan. Metode kinetik Monte Carlo dapat digunakan untuk mensimulasikan pertumbuhan kanker metastasis sehingga dapat diestimasi waktu pertumbuhan kanker metastasis tersebut.

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Metastases is the spread of the cancer stem cells from one tissue to another. The occurence of the process is one of the major signs of cancer. The cancer resulting from metastases of cancer is called metastases. The growth of metastases cancer can be modeled into mathematical equation. On this modeling, the human body is assumed to already have a cancer that will trigger the growth of metastases cancers and the number of niches (the space where the cancer stem cells do all their activities such as proliferation and differentiation) in the human body is a constant. Kinetic Monte Carlo method can be used to simulate the growth of metastases cancer so that the estimation time of the growth can be found."

"ABSTRACTLatar belakang: Diagnosis pasti kanker paru ditegakkan dengan menemukan sel ganas pada pemeriksaan sitologi/ histopatologi pada spesimen yang didapat dari berbagai prosedur diagnostik.Tujuan: Untuk mengetahui jumlah sel ganas dari pemeriksaan sitologi yang didapat dari berbagai prosedur diagnostik TTNA terpandu CT scan, TTNA tidak terpandu, TTNA terpandu USG, BJH, sikatan bronkus, bilasan bronkus, TBNA, BAL, sitologi cairan pleura dan sitologi sputum .Metode: Penelitian potong lintang pada slide pasien kanker paru dari pemeriksaan sitologi yang ditegakkan dari berbagai prosedur diagnostik di Rumah Sakit Umum Pusat Persahabatan. Data diambil dari laborarorium Patologi Anatomi, Rekam Medis Rumah Sakit Umum Pusat Persahabatan dan data khusus Adenokarsinoma paru diambil dari laboratorium KalGen Jakarta Pusat pada periode 1 Juni 2015 sampai 31 Juli 2016. Slide pasien yang mengandung sel ganas akan dikoding oleh SpPA dan dihitung jumlahnya dibawah mikroskop dibawah supervisi Sp.PA.Hasil: Sampel penelitian 425 slide sitologi dengan karateristik pasien laki-laki 72,5 median usia 57 tahun, range usia 26-92 tahun dan pasien kanker paru perempuan 27,3 median usia 54 tahun, range usia 18-84 tahun . TTNA terpandu CT Scan merupakan prosedur diagnostik yang paling sering dapat menemukan sel ganas > 200 16,9 , diikuti BJH dengan jumlah sel > 200 11,8 , TTNA tidak terpandu dengan jumlah sel ganas > 200 7,3 . Jumlah sel ganas minimal yang memungkinkan untuk pemeriksaan molekuler lanjutan EGFR khususnya pada jenis adenokarsinoma paru adalah didapatkan 0,8 pemeriksaan EGFR pada jumlah sel ganas < 50 sel dan semakin tinggi jumlah sel ganas maka semakin memungkinkan untuk pemeriksaan molekuler lanjutan. Jumlah slide mempengaruhi jumlah sel ganas yang didapatkan nilai p=0,000 dan semakin banyak jumlah slide maka semakin banyak juga jumlah sel ganas yang didapatkan.Kesimpulan: Jumlah sel ganas pada slide sitologi kanker paru paling banyak ditemukan dengan pemeriksaan TTNA terpandu CT scan, dikuti BJH dan TTNA tidak terpandu. Jumah slide mempengaruhi jumlah sel ganas nilai bermakna, p= 0,000 .Kata kunci: Kanker paru, sel ganas, slide sitologi, prosedur diagnostik

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ABSTRACTBackground A definitive diagnosis of lung cancer by finding malignant cells on cytology histopathology examination of the specimen obtained from a variety of diagnostic procedures.Objective To determine the number of malignant cells of cytologic examination that are obtained from a variety of diagnostic procedures CT guided TTNA, unguided TTNA, ultrasound guided TTNA, FNAB, bronchial brushing, bronchial washing, TBNA, BAL, cytology examination of pleural fluid and sputum cytology .Methods A cross sectional study in lung cancer patients slides from cytological examination from a variety of diagnostic procedures in the Central General Hospital Persahabatan. Data are taken from Anatomical Pathology laborarorium, Medical Record of Central General Hospital Persahabatan and the specific data of lung adenocarcinoma taken from the laboratory KalGen in Central Jakarta from1 June, 2015 until July 31, 2016. Slides containing malignant cells of patients are to be coded by SpPA and numbered under a microscope under the supervision of Sp.PA.Results The research sample with characteristic cytologic slide of 425 male patients were 72.5 median age 57 years, range 26 92 years of age and female lung cancer patients were 27.3 median age 54 years, age range 18 84 year . CT guided TTNA was a diagnostic procedure that was most often able to find malignant cells 200 16.9 , followed by the BJH of cell counts 200 11.8 , unguided TTNA with the number of malignant cells 200 7.3 . Minimal number of malignant cells that were possible for advanced molecular examination EGFR , particularly on the type of lung adenocarcinoma was obtained 0.8 EGFR examination in the number of malignant cell "

"Pemeriksaan toksikologi forensik terdiri dari pemeriksaan kualitatif dan kuantitatif. Pemeriksaan menggunakan metode Biochip Array Technology merupakan metode baru dengan teknologi nano digunakan untuk pemeriksaan toksikologi forensik. Tujuan penelitian ini untuk mengetahui nilai diagnostik pemeriksaan morfin dan benzodiazepin menggunakan metode tersebut. Penelitian ini menggunakan desain penelitian potong lintang (Cross sectional), dengan sampel penelitian adalah seorang laki-laki atau perempuan berusia diatas 18 tahun sejumlah 20 orang yang diambil dengan cara Consecutive sampling pada bulan September 2014 di Puskesmas Johar Baru, Jakarta Pusat. Dari sampel tersebut yang diperiksa dengan GC/MS, 4 sampel terdeteksi positif morfin, dan 3 sampel terdeteksi benzodiazepin. Pemeriksaan dengan metode Biochip Array Technology, 4 sampel positif morfin, dan 6 sampel terdeteksi positif benzodiazepin. Hasil analisa uji diagnostik menunjukkan bahwa pemeriksaan morfin menggunakan metode tersebut memiliki sensitivitas sebesar 100 %, spesifisitas 100 %, nilai duga positif 100 % dan nilai duga negatif 100 %. Hasil uji diagnostik pemeriksaan benzodiazepin menggunakan metode tersebut adalah sensitivitas 100 %, spesifisitas 82,35%, nilai duga positif 50 % dan nilai duga negatif 100 %. Dapat disimpulkan bahwa metode ini sangat baik digunakan untuk pemeriksaan morfin sedangkan untuk pemeriksaan benzodiazepine kurang baik.

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Forensic toxicology examination consists of a qualitative and quantitative examination. Biochip Array Technology is a new method with nanotechnology used for Forensic toxicology examination. The aim is to know the identificcation value of Biochip Array Technology diagnostic test to forensic toxicology examination of Morphine and benzodiazepine in urine. Cross Sectional diagnostic study was applied to those who are male or female aged over 18 years old, 20 samples were taken consecutively in Agustus 2014 from primary health centres of Johar Baru, Jakarta Pusat. From these samples using the GC/MS, 4 samples are positive morphine, 3 samples are positive benzodiazepine. From Biochip Array Technology Examination, 4 samples are positive morphine, 6 samples are positive benzodiazepine. Diagnostic test analysis in morphine examination showed that Biochip Array Technology revealed 100 % sensitivity, 100 % specificity, 100 % positive predictive value, and 100 % negative predictive value. Diagnostic test analysis in benzodiazepine examination showed that Biochip Array Technology revealed 100 % sensitivity, 82,35 % specificity, 50 % positive predictive value and 100 % negative predictive value. It can be concluded that this method is reliable in morphine examination but only if the sample is controlled, while for benzodiazepine examination, this method is not reliable."

"[Pemeriksaan toksikologi forensik terdiri dari pemeriksaan kualitatif dan kuantitatif. Pemeriksaan menggunakan metode Biochip Array Technology merupakan metode baru dengan teknologi nano digunakan untuk pemeriksaan toksikologi forensik. Tujuan penelitian ini untuk mengetahui nilai diagnostik pemeriksaan morfin dan benzodiazepin menggunakan metode tersebut. Penelitian ini menggunakan desain penelitian potong lintang (Cross sectional), dengan sampel penelitian adalah seorang laki-laki atau perempuan berusia diatas 18 tahun sejumlah 20 orang yang diambil dengan cara Consecutive sampling pada bulan September 2014 di Puskesmas Johar Baru, Jakarta Pusat. Dari sampel tersebut yang diperiksa dengan GC/MS, 4 sampel terdeteksi positif morfin, dan 3 sampel terdeteksi benzodiazepin. Pemeriksaan dengan metode Biochip Array Technology, 4 sampel positif morfin, dan 6 sampel terdeteksi positif benzodiazepin. Hasil analisa uji diagnostik menunjukkan bahwa pemeriksaan morfin menggunakan metode tersebut memiliki sensitivitas sebesar 100 %, spesifisitas 100 %, nilai duga positif 100 % dan nilai duga negatif 100 %. Hasil uji diagnostik pemeriksaan benzodiazepin menggunakan metode tersebut adalah sensitivitas 100 %, spesifisitas 82,35%, nilai duga positif 50 % dan nilai duga negatif 100 %. Dapat disimpulkan bahwa metode ini sangat baik digunakan untuk pemeriksaan morfin sedangkan untuk pemeriksaan benzodiazepine kurang baik., Forensic toxicology examination consists of a qualitative and quantitative examination. Biochip Array Technology is a new method with nanotechnology used for Forensic toxicology examination. The aim is to know the identificcation value of Biochip Array Technology diagnostic test to forensic toxicology examination of Morphine and benzodiazepine in urine. Cross Sectional diagnostic study was applied to those who are male or female aged over 18 years old, 20 samples were taken consecutively in Agustus 2014 from primary health centres of Johar Baru, Jakarta Pusat. From these samples using the GC/MS, 4 samples are positive morphine, 3 samples are positive benzodiazepine. From Biochip Array Technology Examination, 4 samples are positive morphine, 6 samples are positive benzodiazepine. Diagnostic test analysis in morphine examination showed that Biochip Array Technology revealed 100 % sensitivity, 100 % specificity, 100 % positive predictive value, and 100 % negative predictive value. Diagnostic test analysis in benzodiazepine examination showed that Biochip Array Technology revealed 100 % sensitivity, 82,35 % specificity, 50 % positive predictive value and 100 % negative predictive value. It can be concluded that this method is reliable in morphine examination but only if the sample is controlled, while for benzodiazepine examination, this method is not reliable.]"

"Latar belakang: Infeksi saluran kemih ISK merupakan salah satu penyakit infeksi yang paling sering pada anak usia 2 bulan ndash; 2 tahun. Infeksi saluran kemih sulit dideteksi karena gejalanya yang tidak khas. Diagnosis pasti dengan biakan urin membutuhkan waktu yang lama, sedangkan pemeriksaan urinalisis sulit mendeteksi ISK karena pengosongan kandung kemih yang cepat. Pewarnaan Gram urin lebih mudah dilakukan, cepat, dan murah sehingga diajukan sebagai metode diagnosis alternatif. Tujuan: Mengetahui kesesuaian pemeriksaan pewarnaan Gram urin dibandingkan dengan biakan urin dalam mendiagnosis ISK pada anak usia 2 bulan - 2 tahun. Metode: Studi potong lintang, di RSCM Jakarta, bulan Mei hingga Desember 2016. Penelitian melibatkan 59 anak usia 2 bulan ndash; 2 tahun dengan klinis tersangka ISK. Urin diambil dengan teknik kateterisasi peruretra. Sampel urin diperiksakan pewarnaan Gram, biakan urin dan urinalisis. Biakan urin sebagai baku emas pemeriksaan, dinyatakan sebagai ISK apabila tumbuh kuman dengan koloni >50.000 cfu/mL. Pewarnaan Gram dinyatakan positif ISK apabila ditemukan satu jenis bakteri per lapang pandang besar. Hasil: Prevalens ISK pada penelitian ini sebesar 38,9. Sensitivitas pewarnaan Gram urin sebesar 47,8 IK 95 26,8-69,4, spesifisitas 97,2 IK 95 85,5-99,9, NDP 91,7 IK 95 60,3-98,8, NDN 74,5 IK 95 60,3-98,8, LR 17,2 IK 95 2,4-124,6, LR - 0,54 IK 95 0,36-0,8, akurasi 78. Simpulan: Terdapat kesesuaian antara pemeriksaan pewarnaan Gram urin dengan biakan urin dalam mendiagnosis ISK. Terapi antibiotik dapat segera diberikan apabila hasil pemeriksaan Gram urin positif menunjukkan hasil positif. Pemberian antibiotik dapat ditunda menunggu hasil biakan urin, apabila gejala klinis ISK tidak terlalu khas dan tidak ditemukan bakteri dari pewarnaan Gram urin.

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Background: Urinary tract infection UTI one of the most common disease in children age 2 months 2 years. Urinary tract infection in children is often difficult to diagnose because of the atypical symptoms. The definitive diagnosis with urine culture has its limitations because it takes a long time to get results, while it is difficult to detect UTI using urinalysis due to the rapid bladder emptying. Gram staining of urine is thought to be easier, faster, and cheaper, therefore it is proposed as an alternative method for early diagnosis of UTI.

Objective: To compare the diagnostic accuracy of urine Gram staining with urine culture to diagnose UTI in children aged 2 months to 2 years.

Methods: A cross sectional study was conducted at Cipto Mangunkusumo Hospital from May to December 2016. The study involved 59 children aged 2 months 2 years drawn through consecutive sampling method with clinically suspected UTI. Urine sample was taken with per urethra catheterization techniques. Urine samples were examined by Gram staining, urine culture and urinalysis. Urine culture as a gold standard examination is expressed as UTI when colonies of bacterias grow 50,000 cfu mL. Gram stain tested positive for UTI if one type of bacteria is found per high power field.

Results: The prevalence of UTI in this study is 38.9. The sensitivity of urine Gram staining is 47.8 95 CI 26.8 to 69.4, specificity of 97.2 95 CI 85.5 to 99.9, NDP 91.7 CI 95 from 60.3 to 98.8, NDN 74.5 95 CI 60.3 to 98.8, LR 17.2 95 CI 2.4 to 124.6, LR 0.54 95 CI 0.36 to 0.8, and accuracy of 78.

Conclusion There is a correlation between the urine Gram staining with urine culture in diagnosing UTI in children aged 2 months 2 years. Antibiotics may be administered immediately when urine Gram staining shows positive result. Antibiotics for UTI may be delayed until the results of urine culture, if clinical symptoms of UTI is not very distinctive and urine Gram staining shows negative result."

"Karsinoma kandung kemih merupakan keganasan nomor empat terbanyak. Dampak beban ekonomi karsinoma kandung kemih cukup nyata, sehingga diperlukan deteksi dini keganasan kandung kemih untuk menurunkan beban ekonomi. Sistoskopi merupakan pemeriksaan baku emas untuk identifikasi karsinoma kandung kemih, tetapi pemeriksaan tersebut invasif dan menyebabkan ketidaknyamanan bagi pasien. Sitologi urin tidak invasif, tetapi hasilnya tidak bisa didapatkan dengan cepat dan terdapat ketergantungan interpretasi pemeriksa.Tujuan penelitian ini adalah untuk membandingkan nilai diagnosis dua penanda tumor, yaitu ELISA NMP-22, ELISA UBC urin, serta kombinasi keduanya pada pasien karsinoma kandung kemih. Penelitian uji diagnostik ini terdiri dari 25 orang pasien dengan indikasi sistoskopi dan trans ureteral resection bladder tumor (TUR-BT)/biopsi tumor. Pasien yang memenuhi kriteria masukan dan tolakan dilakukan pengambilan urin pasien kemudian dilakukan pemeriksaan ELISA NMP-22 dan ELISA UBC urin. Hasil pemeriksaan ELISA NMP-22 dan ELISA UBC urin akan dibandingkan dengan pemeriksaan sistoskopi disertai dengan hasil histopatologi.Permeriksaaan ELISA NMP-22 urin dengan cut-off 10 U/ml mempunyai sensitivitas 62,3% dan spesifisitas 83,3%, nilai prediksi positif 81,8% dan nilai prediksi negatif71,4%,likelihood ratio positif3,73 dan likelihood ratio negatif0,45. Jika kasus sistitis dieksklusi maka didapatkan sensitivitas adalah 69,2%, spesifisitas 75%, nilai prediksi positif 81,8%, nilai prediksi negatif 60%, likelihood ratio positif 2,76 , likelihood ratio negatif0,42. Pemeriksaan ELISA UBC dengan cut-off 12 ug/Lmempunyai sensitivitas 38,5% dan spesifisitas 91,7%, nilai prediksi positif 83,3% dan nilai prediksi negatif57,9%,likelihood ratio positif4,63 dan likelihood ratio negatif0,67. Jika kasus sistitis dieksklusi maka didapatkan sensitivitas adalah 38,5%, spesifisitas 87,5%, nilai prediksi positif 83,3%, nilai prediksi negatif 46,7%, likelihood ratio positif 3,08 , likelihood ratio negatif0,70. Kombinasi pemeriksaan ELISA NMP-22 dengan UBC urin mempunyai sensitivitas 76,9% dan spesifisitas 75%, nilai prediksi positif 76,9% dan nilai prediksi negatif75%,likelihood ratio positif3,08 dan likelihood ratio negatif0,31. Jika kasus sistitis dieksklusi maka didapatkan nilai sensitivitas adalah 78,5%, spesifisitas 71,4 %, nilai prediksi positif 84,6 %, nilai prediksi negatif 62,5%, likelihood ratio positif2,74 , likelihood ratio negatif0,30. Kami menyimpulkan kombinasi pemeriksaan ELISA NMP-22 dengan ELISA UBC urin lebih baik karena mempunyai sensitivitas paling tinggi sehingga adanya tumor di kandung kemih baik primer maupun rekuren tidak akan luput dari diagnosis, meskipun harus dipastikan lagi dengan pemeriksaan sistoskopi.

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Bladder cancer is the forth most common cancer. Bladder cancer posseses a significant economic burden so that early detection of baldder cancer may decrease the economic burden. Cystoscopy is the reference standard for identification of bladder carcinoma, but it is invasive andcauses significant discomfortto the patient. Urinary cytology is noninvasive but time consuming and hampered by inter-observer variations. The aim of this study is to compare the diagnostic value of the urine NMP-22 ELISA test, UBC-ELISA test and combination of both tests on suspect bladder carcinoma patients.This diagnostic study included25 patients who were indicated for cystoscopy and trans uretheral resection bladder tumor / tumor biopsy. From patients who met requirements for the inclusion and exclusion criteria, the urine voided sample was taken and used for NMP-22 ELISA test and UBC ELISA test. The results of NMP-22 ELISA test and UBC ELISA test were evaluated against the cystoscopy and histological findings as the reference standard.The result of diagnostic study of NMP-22 ELISA test with cut-off 10 U/mlshowed that it had a sensitivity of 62,3% and a specificity of 83,3%, a positive predictive value of 81,8% and a negative predicitive value of 71,4%, a positive likelihood ratio of 3,73 and a negative likelihood ratio of 0,45. If the cystitis case was excluded, it had a sensitivity of 69,2%, and a specificity of 75%, a positive predictive value of 81,8%, and a negative predicitive value of 60%, a positive likelihood ratio of 2,76 , and a negative likelihood ratio of0,42. Diagnostic value of UBC ELISA test with cut-off 12 ug/L had a sensitivity of 38,5% and a specificity of 91,7%, a positive predictive value of 83,3% and a negative predicitive value of 57,9%, a positive likelihood ratio of 4,63 and a negative llikelihood ratio of 0,67. If the cystitis case was excluded, it had a sensitivity of 38,5%, and a specificity of 87,5%, a positive predictive value of 83,3%, and a negative predicitive value of 46,7%, a positive likelihood ratio of 3,08 , and a negative likelihood ratio of0,70.Diagnostic value of combined NMP-22 ELISA test with UBC ELISA test had a sensitivity of 76,9% and a specificity of 75%, a positive predictive value of 76,9% and a negative predicitive value of 75%, a positive likelihood ratio of 3,08 and a negative llikelihood ratio of0,31. If the cystitis case was excluded, it had a sensitivity of 78,5%, and a specificity of 71,4%, a positive predictive value of 84,6%, and a negative predicitive value of 62,5%, a positive likelihood ratio of 2,74 , and a negative likelihood ratio of0,30.The conclusion was that the combined NMP-22 ELISA test with UBC test had the highest sensitivity, thus itwould not miss any primary or recurrent tumour in the bladder, although this neededto be confirmed by cystoscopy."

"[ABSTRAKTujuan. Penelitian ini membahas perbandingan performa diagnostik antara pemeriksaan ultrasonografi dengan pemeriksaan klinis dalam mengukur ukuran lesi primer kanker serviks.Metode. Dilakukan uji diagnostik potong-lintang secara retrospektif terhadap pasien kanker serviks stadium IB di RSUPN Dr. Ciptomangunkusumo dari tahun 2009 hingga tahun 2014. Nilai diagnostik dari kedua pemeriksaan dihitung dengan luaran: sensitivitas, spesifisitas, nilai prediksi positif, nilai prediksi negatif, dan akurasi. Uji kesesuaian dari kedua pemeriksaan juga dihitung dengan ukuran makroskopik sebagai standar baku emas.Hasil. Dari periode tahun 2009 hingga tahun 2014, didapatkan 92 subjek yang memenuhi kriteria inklusi dengan komposisi yaitu 65 kasus (70%) kanker serviks stadium IB1 dan 27 kasus (30%) kanker serviks stadium IB2. Ultrasonografi didapatkan memiliki nilai diagnostik yaitu sensitivitas 92%, spesifisitas 96%, nilai prediksi positif 92%, nilai prediksi negatif 96%, dan akurasi 95%. Sementara itu, pemeriksaan klinis didapatkan memiliki nilai diagnostik yaitu sensitivitas 51%, spesifisitas 92%, nilai prediksi positif 73%, nilai prediksi negatif 82%, dan akurasi 80%. Dari perhitungan kesesuaian antara ukuran pemeriksaan ultrasonografi dan ukuran makroskopik, didapatkan perbedaan rata-rata 0,56 cm. Sementara itu, dari perhitungan kesesuaian antara ukuran pemeriksaan klinis dan ukuran makroskopik, didapatkan perbedaan rata-rata 0,97 cm.Kesimpulan. Penelitian ini menyimpulkan bahwa pemeriksaan ultrasonografi memiliki performa diagnostik yang lebih baik dibandingkan pemeriksaan klinis dalam mengukur ukuran lesi primer kanker serviks.

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ABSTRACTObjective. The purpose of this study is to compare the diagnostic value of ultrasound and clinical examination in measuring the size of primary tumor of cervical cancer.Methods. It is a retrospective cross sectional study for patients with cervical cancer stage IB in Cipto Mangunkusumo hospital from 2009 to 2014. Diagnostic value of both examinations were calculated with outcome: sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Resemblance test of both examinations were also calculated with macroscopic size as the gold standart.Result. From period 2009 until 2014, there were 92 subject which fulfilled the inclusion criteria, consisted of 65 cases (70%) cervical cancer stage IB1 and 27 cases (30%) cervical cancer stage IB2. Ultrasonografi was found to have diagnostic values as follow: sensitivity 92%, specificity 96%, positive predictive value 92%, negative predictive value 96%, and accuracy 95%. Meanwhile, clinical examination was found to have diagnostic values as follow: sensitivity 51%, specificity 92%, positive predictive value 73%, negative predictive value 82%, and accuracy 80%. From the calculation of resemblance between ultrasound and macroscopic size, there was an average difference approximately 0.56 cm. Meanwhile, from the calculation of resemblance between clinical examination and macroscopic size, there was an average difference approximately 0.97 cm.Conclusion. It can be concluded that the ultrasound has better diagnostic value compare to clinical examaination in examining the size of primary tumor of cervical cancer., Objective. The purpose of this study is to compare the diagnostic value of ultrasound and clinical examination in measuring the size of primary tumor of cervical cancer. Methods. It is a retrospective cross sectional study for patients with cervical cancerstage IB in Cipto Mangunkusumo hospital from 2009 to 2014. Diagnostic value of bothexaminations were calculated with outcome: sensitivity, specificity, positive predictive value,negative predictive value, and accuracy. Resemblance test of both examinations were alsocalculated with macroscopic size as the gold standart. Result. From period 2009 until 2014, there were 92 subject which fulfilled the inclusioncriteria, consisted of 65 cases (70%) cervical cancer stage IB1 and 27 cases (30%) cervicalcancer stage IB2. Ultrasonografi was found to have diagnostic values as follow: sensitivity92%, specificity 96%, positive predictive value 92%, negative predictive value 96%, andaccuracy 95%. Meanwhile, clinical examination was found to have diagnostic values as follow:sensitivity 51%, specificity 92%, positive predictive value 73%, negative predictive value 82%,and accuracy 80%. From the calculation of resemblance between ultrasound and macroscopicsize, there was an average difference approximately 0.56 cm. Meanwhile, from the calculationof resemblance between clinical examination and macroscopic size, there was an averagedifference approximately 0.97 cm. Conclusion. It can be concluded that the ultrasound has better diagnostic value compare to clinical examaination in examining the size of primary tumor of cervical cancer.]"