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"Maxillofacial trauma is one of the most devastating injuries faced by all plasticsurgeons. In the event of displacement and unstable fracture segments, which can leadto functional disruption, an open reduction and an internal fixation using miniplate andscrews are indicated. However, currently commonly used imported miniplate and screware very costly. The purpose of this study is therefore to evaluate the locallymade miniplate and screw in maxillofacial fracture management compared to theimported miniplate and screw. The study is a blind randomized clinical trial of patientswith mid-face fractures arriving at Cipto Mangunkusumo Hospital. Subjects are fracturelines that meet both inclusion and exclusion criteria and are then randomized to thestudy (locally made miniplate and screw) and control (BIOMET ® miniplate and screw)through a predetermined randomization list. Bone density is followed by non-contrasthead tomography immediately after surgery as a baseline and three months post-op.Subsequently, a radiologist consultant as a blinded evaluator will evaluate the bonedensity score and any screw loosening present local tissue reactions after fixation duringa visit to the outpatient clinic once a week for three weeks. The preliminary result of thefirst 9 samples suggested the locally-made miniplate and screw showed the same qualitycompare to the control. Bone density promoted by both implants was not significantdifference (P>0.05). There was no tissue reaction presentation around both implantplacement and nor the screw loosening appears at the three-month CT-Scan evaluation.Due to the COVID-19 pandemic, it is difficult to reach the number of samples asplanned, the clinical study was underpowered. Further clinical study is necessary toimprove the self-taping feature of the screw and reaching a more power study in orderto establish the non-inferiority of locally made miniplate and screw.

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Trauma maksilofasial adalah salah satu cedera paling parah yang dihadapi semua ahli

bedah plastik. Jika terjadi pergeseran dan segmen fraktur yang tidak stabil, yang

menyebabkan gangguan fungsi, maka diindikasikan untuk dilakukan tindakan reduksi

terbuka dan fiksasi internal menggunakan miniplate dan screw. Namun saat ini

miniplate dan screw impor yang biasa digunakan sangat mahal harganya. Oleh karena

itu, tujuan dan penelitian ini adalah untuk mengevaluasi miniplate dan screw buatan

lokal dalam manajemen fraktur maksilofasial yang dibandingkan dengan miniplate dan

screw impor. Desain penelitian adalah blind randomized clinical trial yang dilakukan

pada pasien dengan fraktur wajah bagian tengah yang datang ke Rumah Sakit Cipto

Mangunkusumo. Subjek penelitian ini adalah garis fraktur yang memenuhi kriteria

inklusi dan eksklusi dan kemudian akan dimasukkan kedalam grup intervensi (miniplate

dan screw buatan lokal) dan grup kontrol (BIOMET ® miniplate dan screw) secara acak

berdasarkan predetermined randomization list. Kepadatan tulang akan dievaluasi

menggunakan CT-Scan kepala non kontras segera setelah operasi sebagai baseline dan

dilakukan kembali tiga bulan pasca operasi. Selanjutnya dokter konsultan radiologi

yang bertindak sebagai blind evaluator akan mengevaluasi nilai kepadatan tulang dan

apakah ada tampilan screw yang longgar pada gambaran CT-Scan. Reaksi jaringan lokal

disekitar lokasi pemasangan implant juga akan dievaluasi setiap minggu selama tiga

minggu pada saat pasien menjalani perawatan melalui poliklinik bedah plastik. Hasil

studi pendahuluan terhadap 9 sampel awal menunjukkan bahwa miniplate dan screw

buatan lokal memiliki kualitas yang sama dengan miniplate dan screw impor. Tidak ada

perbedaan signifikan (P>0.05) pada kepadatan tulang yang dihasilkan oleh kedua

Miniplate dan screw. Tidak ada reaksi jaringan sekitar pemasangan implant yang terjadi

selama pengamatan dan juga tidak ada tampilan screw loosening pada CT-Scan tiga

bulan pasca operasi. Jumlah sampel yang sedikit akibat pandemik COVID-19

menyebabkan studi ini underpowered. Dibutuhkan studi lanjutan guna memperbaiki

fitur self-taping pada screw dalam rangka membuktikan bahwa Miniplate dan screw

buatan lokal tidak lebih inferior."

"Reduksi secara tertutup dan fiksasi internal menggunakan miniplate dan screw titanium masih merupakan modalitas terapi yang terbaik untuk fraktur tulang wajah yang displaced dengan gangguan fungsi dan deformitas secara penampilan. Namun, implan maksilofasial yang beredar di Indonesia masih sangat mahal. Untuk itu diperkenalkan miniplate dan screw buatan lokal (UniFIX®) yang lebih murah dan memiliki kualitas yang sama dengan miniplate dan screw yang diimpor. Dilakukan studi eksperimental cross over dengan menggunakan enam belas model tengkorak dari bahan polyurethane yang dipasang implan UniFIX® dan implan impor pada bagian rima orbita inferior oleh pengguna. Dilakukan pencatatan terhadap waktu untuk menyelesaikan pemasangan miniplate dan screw. Setiap pengguna diberikan kuesioner evaluasi terhadap kemudahan penggunaan miniplate dan screw dalam hal kenyamanan saat penggunaan, kecocokan screw dengan screwdriver, pembengkokan plate, dan self-tapping dari screw. Setelah itu, dilakukan penilaian oleh konsultan ahli kraniofasial terhadap stabilitas dan adaptabilitas dari miniplate dan screw yang telah dipasang. Hasil penelitian menunjukkan bahwa miniplate dan screw UniFIX® tidak inferior jika dibandingkan dengan miniplate dan screw impor dalam hal kemudahan penggunaan. Meskipun demikian, karakteristik self-tapping screw UniFIX® dapat ditingkatkan untuk mendapatkan kualitas yang lebih baik.

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Open reduction and internal fixation using miniplate and screw is still the best treatment of displaced facial fracture with functional impairment and cosmetic deformity. However, imported miniplate and screw currently widely used are highly costly. Therefore, a locally-made miniplate and screw (UniFIX®) which is cost-efficient and has the same quality with the imported brand is introduced. This study aims to evaluate the usability of UniFIX® miniplate and screw in comparison with the imported miniplate and screw. Cross over experimental study was conducted with sixteen polyurethane anatomical skull models. Both UniFIX® and imported miniplate and screw were placed on the infraorbital rims by users. Time to complete the placement was recorded. Each user received questionnaire to evaluate the usability of miniplate and screw in terms of operator s comfort, screw fit to screwdriver, plate bending, and self-tapping of the screw. Subsequently, two craniofacial consultants were given scoring sheet to evaluate the stability and the adaptability of each miniplate and screw. The results showed that the usability of UniFIX® miniplate and screw was not inferior compared to the imported brand. Nevertheless, the self-tapping feature of locally-made screw may be improved to produce better quality."

"Latar Belakang. Kesintasan 3 tahun pasien KNF stadium lokal lanjut di Indonesia lebih rendah dibandingkan luar negeri. Prediktor alternatif dari rasio hemoglobin-trombosit (RHT) lebih sederhana, murah, dan stabil nilainya dibanding rasio dari komponen sel leukosit, namun belum ada studi yang meneliti perannya dalam memrediksi mortalitas tiga tahun pasien KNF stadium ini. Tujuan. Mengetahui peran RHT sebelum terapi dalam memrediksi kesintasan tiga tahun pasien KNF stadium lokal lanjut.Metode. Studi kohort retrospektif yang meneliti 289 pasien KNF stadium lokal lanjut yang diterapi di Rumah Sakit Cipto Mangunkusumo (RSCM) dalam rentang waktu Januari 2012 - Oktober 2016. Nilai RHT optimal didapatkan menggunakan receiver operating curve (ROC). Subjek penelitian dibagi menjadi 2 kelompok, di bawah dan di atas titik potong. Kurva Kaplan-Meier digunakan untuk menilai kesintasan tiga tahun dan dilakukan uji regresi Cox sebagai uji multivariat terhadap variabel perancu (usia > 60 tahun, stadium, jenis kelamin, dan indeks massa tubuh) untuk mendapatkan nilai adjusted hazard ratio (HR). Hasil. Nilai titik potong RHT optimal adalah 0,362 (AUC 0,6228, interval kepercayaan (IK) 95% : 0,56-0,69, sensitivitas 61,27%, spesifisitas 60,34%). 48,44% pasien memiliki nilai RHT <0,362 dan memiliki mortalitas tiga tahun lebih besar dibandingkan kelompok lainnya (50%vs31,54%). RHT < 0,362 secara signifikan memrediksi kesintasan tiga tahun (p = 0,003; HR 1,75; IK 95% 1,2-2,55). Pada analisis multivariat, RHT < 0,362 sebelum terapi merupakan faktor independen dalam memrediksi kesintasan tiga tahun pada pasien KNF stadium lokal lanjut (adjusted HR 1,82; IK 95% 1,25-2,65). Simpulan. RHT < 0,362 sebelum terapi dapat memrediksi kesintasan tiga tahun pasien KNF stadium lokal lanjut.

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Background. The 3-year survival of locally advanced nasopharyngeal cancer (NPC) patients in Indonesia is lower than in foreign countries. Alternative predictors from the hemoglobin-platelet ratio (HPR) as single variable are easier, cheaper, and stable in value than the ratio of leukocyte cell components, but there are no study conducted to know its potential in predicting three-year survival in locally advanced nasopharyngeal cancer.

Objective. To determine the role of pre-treatment hemoglobin to platelet ratio in predicting three-year survival of locally advanced nasopharyngeal cancer patients.

Method. Retrospective cohort study that examined 289 locally advanced NPC patients who underwent therapy at the National Government General Hospital-Cipto Mangunkusumo from January 2012 to October 2016. HPR cut-off was determined using ROC, and then subjects were divided into two groups according to its HPR value. The Kaplan-Meier curve was used to determine the three-year survival of the patients and cox regression test used as multivariate analysis with confounding variables in order to get adjusted hazard ratio (HR).

Results. The optimal cut-off for HPR was 0,362 (AUC 0,6228, 95% CI: 0,56-0,69, sensitivity 61,27%, specificity 60,34%). Patients with HPR < 0,362 occurred in 48, 44% and had higher three-year mortality (50% vs. 31, 54%). HPR <0.362 significantly predicted the three years of survival (p = 0,003; HR 1, 75; CI 95% 1, 2-2, 55). In multivariate analysis, it was concluded that pre-treatment HPR < 0,362 was an independent factor in predicting three-year survival in locally advanced NPC patients (adjusted HR 1, 82; CI 95% 1, 25-2, 65).

Conclusion. Pre-treatment HPR < 0, 362 could predict the three-year survival of locally advanced nasopharyngeal cancer patients."

"Latar belakang Kanker payudara merupakan salah satu kanker paling banyak dialami oleh perempuan di dunia. Data yang didapatkan di RSUPN Cipto Mangunkusumo Jakarta menunjukkan bahwa sebagian besar pasien datang pada stadium lanjut lokal. Penanganan kanker payudara pada tahap lanjut lokal meliputi pemberian kemoterapi neoadjuvan, mastektomi, serta rekonstruksi. Waktu pelaksanaan rekonstruksi payudara pascamastektomi terbaik masih mejadi perdebatan pada klinisi. Studi ini bertujuan untuk membandingkan luaran antara rekonstruksi payudara secara immediate dan delayed pada pasien kanker payudara lanjut lokal yang dilakukan mastektomi dan pemberian kemoterapi neoadjuvan.Metode Penelitian ini merupakan sebuah studi tinjauan sistematik dengan pencarian literatur dari basis data elektronik Cochrane, Pubmed, dan ScienceDirect, tanpa membatasi waktu dan bahasa. Telaah kritis dilakukan dengan menggunakan panduan Critical Appraisal Skills Programme (CASP). Luaran yang dinilai dalam penelitian ini adalah mortalitas, rekurensi, komplikasi, dan kualitas hidup.Hasil Ditemukan sebanyak empat artikel tentang perbandingan antara luaran rekonstruksi immediate dan delayed pada rekonstruksi kanker payudara stadium lanjut lokal pascakemoterapi neoadjuvan yang kemudian disaring hingga diperoleh dua artikel yang dinilai layak dikaji. Dari hasil kajian ini diketahui bahwa tidak terdapat perbedaan mortalitas dan rekurensi antar kelompok, didapatkan tingkat komplikasi yang lebih tinggi pada kelompok dengan rekonstruksi immediate, serta tidak didapatkan data mengenai kualitas hidup pada kedua kelompok.Kesimpulan Didapatkan tingkat komplikasi yang lebih tinggi secara signifikan pada rekonstruksi payudara secara immediate, namun tidak didapatkan perbedaan luaran pada parameter lainnya antar kelompok

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Background Breast cancer is one of the most common cancers among women in the world. Data from Cipto Mangunkusumo National General Hospital showed that most of the patients were in locally-advanced stage. The treatment of locally advanced breast cancer includes administration of neoadjuvant chemotherapy, mastectomy, and reconstruction. The ideal timing of post-mastectomy breast reconstruction is still a matter of debate for clinicians. This study aimed to compare the outcome between immediate and delayed breast reconstruction in locally advanced breast cancer after mastectomy and neoadjuvant chemotherapy.

Method This systematic review utilized Cochrane, Pubmed, and ScienceDirect as the databases. There was no limitation on the timing of publication, nor the language. The critical analysis was conducted using the Critical Appraisal Skills Program (CASP) guide. The outcomes assessed in this study were mortality, recurrences, complications, and quality of life.

Result There were four articles comparing immediate and delayed reconstruction outcomes in locally advanced breast cancer, after mastectomy and neoadjuvant chemotherapy. The articles were further screened to obtain two articles deemed suitable for this study. This study showed that there was no difference in mortality and recurrence between groups. However, there was a significant higher complication rate in the immediate reconstruction group. There was no data regarding the quality of life in the two groups.

Conclusion There was significantly higher rate of complications with immediate breast reconstruction, but there was no difference in outcome in other parameters between groups"

"Latar Belakang: NAC neoadjuvant chemotherapy secara umum telah digunakan di LABC locally advanced breast cancer untuk mengurangi ukuran tumor dan membuat tumor tersebut bisa untuk dioperasi. Meskipun ukuran tumor telah berkurang, masih diperdebatkan batas pembedahan pasca NAC untuk LABC dengan karsinoma mastitis, ulkus payudara, dan fitur agresif lainnya bebas dari tumor karena kemoterapi tidak bisa membunuh 100 dari sel-sel tumor. Metode: Desain penelitian adalah studi potong lintang. Sampel diambil dari semua pasien dengan LABC yang datang ke klinik onkologi rawat jalan dari RS Cipto Mangunkusumo dan ditato untuk batas pembedahan berdasarkan ukuran tumor sebelum NAC. Penelitian ini dilakukan untuk menentukan batas pembedahan yang benar di LABC setelah NAC. Hasil: Dari total 85 pasien, 42 pasien termasuk dalam studi dan 30 pasien masih menjalani pemberian NAC. Umur pasien berkisar antara 27-70 tahun dengan frekuensi tertinggi adalah 40-50 tahun 47,6 . Frekuensi kasus tersering adalah pasien dengan stadium IIIB 92,9 , grade 2 66,7 , histopalogi karsinoma duktal invasif 92,8 hasil IHK imunohistokimia over-ekspresi HER2 42,8 , volume tumor sebelum NAC > 100cc 85,8 dan volume tumor setelah NAC 50-100cc 57,2 . Regimen kemoterapi yang banyak digunakan CAF 76,1 dengan respon parsial 95,2. Kesimpulan: Batas sayatan kulit berdasarkan ukuran tumor pasca NAC dapat menjadi acuan untuk operasi, namun pada dasar sayatan operasi masih perlu dilakukan frozen section untuk memastikan bebas tumor atau tidak. Seorang ahli bedah juga harus lebih berhati-hati dalam menentukan batas sayatan operasi pada kasus mastitis karsinomatosis, ulkus payudara yang besar dan tumor yang terletak di medial payudara dimana pada kondisi ini batas sayatan operasi dapat beresiko tidak bebas tumor.

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Introduction: There is limited evidence regarding the effectivness of neoadjuvant chemotherapy NAC to improve surgical margins for locally advanced breast cancer LABC patients. In this study, NAC was used to reduce tumor size to improve operability and reduce surgical margins, with confirmation of tumor free areas provided by post operative histopathology. The reduction of surgical margins has the potential to reduce the need for extensive surgery and the risk of complications in LABC patients.

Method: The study participants were patients diagnosed with LABC in Ciptomangunkusumo Hospital Jakarta and Awal Bros Bekasi Hospital Bekasi between 2014 and 2015. Patients underwent NAC, and those with partial or complete response were sent for surgery. Tumor excision was done according to the pre NAC surgical margin, which was marked by tattoo. Histopathology then checked for tumor cells in the surgical margins based on breast tumor size of pre and post NAC. Data was analyzed with SPSS version 20 with numerous statistical tests. Cross tabulation analyses were done to examine the characteristics of the study participants. McNemar test was used to determine and compare the pre and post NAC surgical margins.

Results: Out of 42 patients, 38 were observed to have tumor free surgical margins in both pre and post NAC. Of the remaining four patients, three patients had tumor cells in both surgical margins, and one patient had a tumor free pre NAC but positive tumor cells post NAC. McNemar analysis suggests no significant difference p 1,000 in the two surgical margins evaluated. Based on Wilson score analysis, agreement of negative result of surgical margin in pre NAC compare to post NAC is 97.3 CI 86,18 99.52 . Mean while, agreement of positive tumor cell in pre NAC to post NAC surgical margin is 100 CI 90.36 100.

Conclusion: Surgical margins in the skin based on the post NAC tumor size can be used as a guide for surgery, but not in the tumor base. If the surgical margin of tumor base is ambiguos, frozen section can be performed to confirm tumor free in the tumor base. This will reduce the risk of residual tumor cells in surgical margins. "

"Penelitian tentang 'Analisis Kelembagaan Dalam Upaya Pembangunan Kesejahteraan Masyarakat' ini dimaksudkan untuk mempelajari peran lembaga lokal dalam upaya mewujudkan ketahanan ekonomi masyarakat sebagai bagian dari pembangunan kesejahteraan masyarakat. Penelitian ini menggunakan metode kualitatif yang menghasilkan data yang deskriptif dan diperoleh melalui wawancara yang mendalam dengan para informan. Koperasi Jasa Keuangan (KJK) PEMK merupakan organisasi lokal yang dibentuk oleh masyarakat dan berada ditengah-tengah komunitas masyarakat kelurahan, namun belum menjadi sebuah lembaga lokal karena harus menempuh proses pelembagaan didalamnya. Kesimpulan yang diperoleh dari penelitian ini adalah faktor-faktor yang melatarbelakangi terjadinya perubahan organisasi pelaksana program pemberdayaan masyarakat adalah aspek yuridis, aspek filosofis dan aspek lembaga.

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Research on "Institutional Analysis of Public Welfare In Development Effort" is intended to study the role of local institutions in an effort to realize the economic resilience of the community as part of the development of public welfare.

This study used qualitative methods to generate descriptive data obtained through in-depth interviews with informants.

Cooperative Financial Services (KJK) PEMK is a local organization formed by the community and in the midst of village communities, but has not become a local institution because they have to take the process of institutionalization in it.

Conclusions obtained from this study are the factors underlying the change in community empowerment programs implementing organizations are juridical aspects, philosophical aspects and aspects of the institution."

"[ABSTRAK Latar belakang : Kanker payudara lanjut lokal (KPLL) adalah kanker payudara stadium III.Modalitas terapi KPLL adalah pembedahan, kemoterapi, radioterapi, hormonal terapi dan terapi target. Respon kemoterapi neoadjuvan terdiri dari respon klinis dan respon patologi. Penilaian respon kemoterapi neoadjuvan penting untuk memprediksi angka ketahanan hidup dan dapat menjadi pedoman kemoterapi selanjutnya. Penilaian respon patologi selama ini bersifat kuantitatif dan sering tidak selaras dengan respon klinis. Perubahan jumlah selularitas dapat terlihat, tetapi kualitas sel tumor tersebut tidak dapat diketahui dengan pulasan Haematoxylin-eosin (HE) pada fase awal fragmentasi DNA, sehingga penilaian respon patologi perlu dilakukan secara kuantitatif dan kualitatif yaitu menilai selularitas sel tumor dan persentase apoptosis. Bahan dan cara : Dilakukan penelitian retrospektif analitik secara potong lintang pada kanker payudara lanjut lokal tahun 2010-2014 di Departemen Patologi Anatomi FKUI/RSCM dan divisi bedah onkologi RSCM. Sampel biopsi dan reseksi dibandingkan untuk mengevaluasi penurunan selularitas, kemudian diklasifikasikan ke derajat Miller- Payne (MP). Sampel reseksi dipulas dengan TUNEL dan dihitung persentase apoptosis. Penurunan selularitas antara biopsi dan mastektomi dengan TUNEL merupakan Modifikasi MP. Hasil : Perubahan respon patologi dengan Modifikasi MP menimbulkan peningkatan derajat pada 24 kasus. Tidak terdapat hubungan antara respon klinis dengan persentase apoptotis (p=0,108), respon klinis dengan MP (p=1,000) dan Modifikasi MP (p=0,655). Tidak didapatkan hubungan dan adanya korelasi yang lemah antara penyusutan massa tumor secara klinis dengan jumlah sel tumor yang mati dengan MP (p=0,177; r =0,212) dan Modifikasi MP (p=0,609; r = 0,081). Terdapat perbedaan signifikan antara jumlah sel mati yang dinilai dengan MP dan Modifikasi MP (p =0,000). Kesimpulan : Persentase apoptosis tidak berhubungan dengan respon klinis. Modifikasi MP meningkatkan nilai derajat respon patologik, tetapi penilaian Modifikasi MP tetap tidak menunjukkan korelasi dengan respon klinik.ABSTRACT Background: Locally advanced breast cancer (LABC) is a stage III breast cancer. The management of LABC includes surgery, chemotherapy, radiotherapy, hormonal and targeted therapy. Responses to neoadjuvant (before surgery) chemotherapy consist of clinical and pathological responses. Evaluating chemotherapy response is essential to predict survival rate and it may become guidelines for the next chemotherapy in the future. Until now, the evaluation of pathological response only involves quantitative assessment and the clinical responses are often inconsistent with the pathological responses. Morphological changes of apoptotic cells can still be seen. However, the quality of the tumor cells is vague when the cells are stained with Hematoxylin-eosin (HE) during the first stage of DNA fragmentation. The evaluation of pathological responses; therefore, need to be performed by quantitative and qualitative methods, i.e. by evaluating the cellularity of tumor cells and the percentage of apoptosis.

Materials and method: A cross-sectional analytical retrospective study was conducted on the issue of locally advanced breast cancer between 2010 and 2014 at the Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital and Division of Surgical Oncology, Cipto Mangunkusumo Hospital. Specimens of biopsy and resection were compared to evaluate reduction in cellularity, which were subsequently categorized into stages of Miller-Payne (MP) classification. The specimens of resection were stained with TUNEL and the percentage of apoptosis was calculated. Reduction in cellularity between biopsy and mastectomy specimens with TUNEL staining is a modified MP methods.

Results: The evaluation of pathological responses using the modified MP method has increased the value of MP grading in 24 cases. We found no association between clinical responses with percentage of apoptosis (p=0,108), MP pathological responses (p=1,000) and modified MP (p=0,655). There is no association and weak correlation between decreasing tumor mass with MP (p=0,177; r=0,212) and modified MP (p=0,609; r=0,081). There was a correlation between the dead cell evaluated by MP and by modified MP. (p=0.000)

Conclusion: Apoptosis percentage does not correlate with clinical responses. Modified MP increases the degree or grading of pathological responses, but it does not improve the correlation with clinical responses., Background: Locally advanced breast cancer (LABC) is a stage III breast cancer. The management of LABC includes surgery, chemotherapy, radiotherapy, hormonal and targeted therapy. Responses to neoadjuvant (before surgery) chemotherapy consist of clinical and pathological responses. Evaluating chemotherapy response is essential to predict survival rate and it may become guidelines for the next chemotherapy in the future. Until now, the evaluation of pathological response only involves quantitative assessment and the clinical responses are often inconsistent with the pathological responses. Morphological changes of apoptotic cells can still be seen. However, the quality of the tumor cells is vague when the cells are stained with Hematoxylin-eosin (HE) during the first stage of DNA fragmentation. The evaluation of pathological responses; therefore, need to be performed by quantitative and qualitative methods, i.e. by evaluating the cellularity of tumor cells and the percentage of apoptosis.

Materials and method: A cross-sectional analytical retrospective study was conducted on the issue of locally advanced breast cancer between 2010 and 2014 at the Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital and Division of Surgical Oncology, Cipto Mangunkusumo Hospital. Specimens of biopsy and resection were compared to evaluate reduction in cellularity, which were subsequently categorized into stages of Miller-Payne (MP) classification. The specimens of resection were stained with TUNEL and the percentage of apoptosis was calculated. Reduction in cellularity between biopsy and mastectomy specimens with TUNEL staining is a modified MP methods.

Results: The evaluation of pathological responses using the modified MP method has increased the value of MP grading in 24 cases. We found no association between clinical responses with percentage of apoptosis (p=0,108), MP pathological responses (p=1,000) and modified MP (p=0,655). There is no association and weak correlation between decreasing tumor mass with MP (p=0,177; r=0,212) and modified MP (p=0,609; r=0,081). There was a correlation between the dead cell evaluated by MP and by modified MP. (p=0.000)

Conclusion: Apoptosis percentage does not correlate with clinical responses. Modified MP increases the degree or grading of pathological responses, but it does not improve the correlation with clinical responses.]"