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Dema Zurtika
Peran morfologis lesi berdasarkan ultrasonografi payudara dalam membedakan kanker payudara subtipe luminal A dan luminal B di RSUPN dr Cipto Mangunkusumo = The role of morphological lesion of breast ultrasound in differentiating luminal A and luminal B Subtype Breast Cancer at RSUPN dr Cipto Mangunkusumo
"Latar Belakang: Kanker payudara adalah salah satu keganasan yang paling sering dan penyebab utama kematian terkait kanker pada perempuan. Ultrasonografi (USG) merupakan modalitas radiologis yang paling banyak dipakai dan banyak tersedia untuk menilai kelainan payudara. Pemeriksaan imunohistokimia bertujuan untuk mengetahui karakteristik molekular kanker payudara di antaranya adalah subtipe luminal A dan luminal B. Hasil imunohistokimia menjadi dasar dalam pemberian terapi dan prognosis pasien kanker payudara, namun pemeriksaan tersebut belum tersedia secara luas. Data temuan morfologis lesi berdasarkan USG payudara dalam membedakan kanker payudara subtipe luminal A dan luminal B masih terbatas dan memberikan hasil yang bervariasi. Penelitian ini bertujuan untuk mengetahui temuan morfologis lesi berdasarkan USG payudara yang dapat membedakan kanker payudara subtipe luminal A dan luminal B.
Metode: Studi retrospektif ini melibatkan subyek dengan kanker payudara yang belum mendapat terapi serta memiliki data USG dan data imunohistokima subtipe luminal A dan luminal B. Dilakukan analisis menggunakan uji Chi Square antara temuan morfologis USG (echogenic rim, batas spikulasi, posterior shadowing, dan indeks Adler) dengan imunohistokimia subtipe luminal A dan luminal B.
Hasil: Diperoleh 188 subyek dengan usia rerata subyek 49,4 tahun, nilai median ukuran lesi 6 cm, dan sebesar 68% subyek adalah stadium lokal lanjut. Proporsi kelompok luminal B 62% sedangkan luminal A 38%. Terdapat perbedaan bermakna antara stadium kanker payudara dengan kelompok subtipe luminal (p = 0,014). Ditemukan perbedaan yang bermakna antara morfologis lesi echogenic rim dengan kelompok luminal, dengan nilai p = 0,03 dan OR 1,94 (95% CI 1,06 – 3,55). Pada analisis subyek usia ≥ 50 tahun ditemukan perbedaan proporsi yang signifikan pada ukuran tumor (p = 0,043), stadium (p = 0,001), echogenic rim (p = 0,05), dan penebalan kutis subkutis (p = 0,007).
Simpulan: Proporsi temuan echogenic rim berdasarkan USG payudara di kelompok kanker payudara subtipe luminal A secara bermakna lebih tinggi dibandingkan subtipe luminal B. Adanya lesi dengan echogenic rim maka kemungkinan untuk diagnosis kanker payudara subtipe luminal A adalah 1,94 kali dibandingkan lesi tanpa echogenic rim.
Background: Breast cancer is one of the most common malignancies and the leading cause of cancer-related death in women. Ultrasonography (USG) is the most widely used radiology modality for assessing breast abnormalities. Immunohistochemistry examination allow to determine the molecular characteristics of breast cancer, includes luminal A and luminal B subtypes. The results are used as the treatment guidance and prognosis, but these tests are not widely available. The study of morphologic lesions based of breast ultrasound to differentiate luminal A and luminal B subtypes of breast cancer are still limited and give varied results. The aim of this study is to determine the morphologic lesions on breast ultrasound that can be used to differentiate luminal A and luminal B subtype.
Method: A retrospective study was conducted by reviewing imaging of subjects with untreated breast cancer who had undergone ultrasound examination and immunohistochemistry examination of luminal A and luminal B subtypes. Chi Squared test was performed to evaluate the relationship between morphological findings of ultrasound (echogenic rim, spiculation, posterior shadowing, and Adler's index) and luminal A and luminal B subtypes breast cancer.
Result: Total subject was 188 with the mean age of the subjects was 49,4 years, the median value of the lesion size was 6 cm, and 68% of the subjects were locally advanced stage. Luminal B group was 62% of the subject while luminal A was 38%. There was a significant difference between the stage of breast cancer and the luminal subtype group (p = 0,014). A significant difference also was found between the echogenic rim lesions and the luminal group, with p value = 0,03 and OR 1,94 (95% CI 1,06 – 3,55). In the subgroup analysis (aged ≥ 50 years), also noted that there were significant differences in the proportion of tumor size (p = 0,043), stage (p = 0,001), echogenic rim (p = 0,05), and skin thickening (p = 0,007).
Conclusion: The proportion of echogenic rim findings in the luminal A subtype breast cancer group was significantly higher than the luminal B subtype. The presence of a lesion with an echogenic rim means the probability of a diagnosis of luminal A subtype breast cancer is 1,94 times compared to lesion without an echogenic rim."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tugas Akhir  Universitas Indonesia Library
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I Wayan Wisnu Brata
Ekspresi Parathyroid Hormone-Related Protein (PTHrP) Sebagai Prediktor Metastasis Tulang Pada Karsinoma Payudara Subtipe Luminal = Expression of Parathyroid Hormone-Related Protein (PTHrP) As a Predictor of Bone Metastasis in Luminal Subtype of Breast Cancer
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ABSTRAK
Nama : I Wayan Wisnu Latar belakang: Kanker payudara (KPD) merupakan kanker yang paling sering terjadi pada wanita di seluruh dunia. Pada tahun 2020, KPD merupakan kasus kanker baru terbanyak di Indonesia dengan 65,858 kasus dan kematian 22,430 kasus. Namun, 90% kematian tersebut disebabkan karena proses metastasis. KPD sering bermetastasis ke tulang (70-80%) dalam kurun waktu 18-20 bulan setelah ditegakkannya diagnosis. PTHrP (Parathyroid Hormone-related Protein) diduga berhubungan dengan KPD yang bermetastasis ke tulang dan menandakan perjalanan klinis KPD yang lebih agresif. PTHrP dapat muncul sebagai alat diagnostik prabedah penting dan memberi gambaran kesintasan pasien yang mengalami metastasis tulang. Tujuan: Studi ini bertujuan untuk melihat hubungan ekspresi PTHrP dengan kejadian metastasis tulang pada karsinoma payudara subtipe luminal (KPDL). Metode: Penelitian ini adalah penelitian analitik dengan desain studi case control. Sampel diambil dengan cara consecutive sampling. Kriteria inklusi adalah pasien KPDL yang dilakukan biopsi atau operasi dan menjalani terapi di bagian Bedah Onkologi RSUP Dr. Cipto Mangunkusumo dan terdapat blok paraffin yang layak diproses. Data klinikopatologis seperti usia, indeks massa tubuh, ukuran tumor, keterlibatan KGB, dan stadium kanker diperoleh dari rekam medis. Dilakukan pewarnaan imunohistokimia dengan reagen AB75150 pada jaringan tumor payudara yang tersimpan dan tingkat ekspresi PTHrP disajikan dalam bentuk h-score. Analisis statistik dilakukan menggunakan program SPSS 27.0. Hasil: Didapatkan 45 sampel dengan 18 sampel dengan metastasis ke tulang dan 27 sampel tidak dengan metastasis ke tulang. Dari analisis data, didapatkan hubungan yang signifikan antara ekspresi PTHrP dengan kejadian metastasis tulang pada sampel KPDL (p = <0,001) dengan OR 31,2 (IK95% 5,3 – 185). OS sampel dengan ekspresi PTHrP kuat adalah 20.5% dengan HR 7.3 (IK95% 2-26.6). Proporsi ekspresi PTHrP kuat pada metastasis tulang 83%. Proporsi ekspresi kuat PTHrP pada KPDL sebesar 48.9 %. Kesimpulan: Peningkatan ekspresi PTHrP memiliki hubungan yang signifikan dengan kejadian metastasis tulang pada pasien KPDL serta OS yang lebih rendah.
Introduction: Breast cancer (BC) is the most common cancer in women throughout the world. In 2020, BC was the largest number of new cancer cases in Indonesia with 65,858 cases and 22,430 deaths. However, 90% of deaths are caused by the metastatic process. BC often metastasizes to the bones (70-80%) within 18-20 months after diagnosis. PTHrP (Parathyroid Hormone-related Protein) is thought to be associated with BC that metastasizes to the bone and indicates a more aggressive clinical course of breast cancer. PTHrP may emerge as an important presurgical diagnostic tool and provide insight into the survival of patients presenting with bone metastases. There has been no research that states a specific relationship between PTHrP and luminal subtype BC. Objective: This study aims to examine the relationship between PTHrP expression and the incidence of bone metastases in luminal subtype BC. Methods: This research is an analytical study with a case control study design. Samples were taken by consecutive sampling according to the inclusion and exclusion criteria. Inclusion criteria were patients with luminal subtype BC who underwent biopsy or surgery and underwent therapy in the Surgical Oncology department of Dr. RSUP. Cipto Mangunkusumo and there are paraffin blocks that are suitable for processing. Clinicopathological data such as age, body mass index, tumor size, lymph node involvement, and cancer stage were obtained from medical records. Immunohistochemical staining was carried out on stored breast tissue and the PTHrP expression level was presented in the form of an H-score. Statistical analysis was carried out using the SPSS 27.0 program. Results: There were 45 samples obtained with 18 samples with bone metastases and 27 samples without bone metastases. From data analysis, a significant relationship was found between PTHrP expression and the incidence of bone metastases in luminal subtype BC samples (p = <0.001) with OR 31.2 (95% CI 5.3 – 185). OS of samples with strong PTHrP expression was 20.5% with HR 7.3 (95% CI 2-26.6). The proportion of strong PTHrP expression in bone metastases was 83%. The proportion of strong expression of PTHrP in luminal subtype BC was 48.9%. Conclusion: Increased PTHrP expression has a significant association with the incidence of bone metastases in luminal subtype BC patients as well as lower OS."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024
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UI - Tugas Akhir  Universitas Indonesia Library
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Raka Pradhana Fajri
Hubungan Usia dan Indeks Massa Tubuh terhadap Subtipe Molekuler Kanker Payudara di RSCM = Relationship between Age and Body Mass Index on Breast Cancer Molecular Subtypes at RSCM
"Kanker payudara merupakan jenis kanker yang paling banyak ditemukan pada wanita dengan 2,3 juta kasus baru pada tahun 2020. Klasifikasi berdasarkan ekspresi reseptor hormon penting diketahui karena tiap subtipe dapat berbeda dalam karakteristik klinis, strategi pengobatan, dan prognosis. Penelitian hubungan faktor risiko usia dan IMT terhadap subtipe kanker payudara yang telah dilakukan masih menghasilkan kesimpulan yang bertentangan dan belum konklusif sehingga penelitian lebih lanjut perlu dilakukan. Penelitian ini dilakukan di RCSM pada April-Mei 2024 dengan mengakses rekam medis 180 pasien kanker payudara primer yang datang ke Poli Bedah RSCM pada tahun 2022 dan menjalani pemeriksaan patologi anatomi dan imunohistokimia. Diperoleh 180 subjek dengan 82,8% berusia >40 tahun dan 17,2% berusia ≤40 tahun. Ditemukan 51,1% subjek obesitas, 27,2% berat badan normal, 16,1% berat badan berlebih, dan hanya 5,6% berat badan kurang. Ditemukan subtipe luminal mencakup 72,8% kasus dan non-luminal 27,2% kasus. Subtipe dengan proporsi paling banyak ditemukan adalah tipe luminal B dengan 41,1%, diikuti tipe luminal A 31,7%, TNBC 17,2%, dan HER2-enriched 10%. Analisis chi-square antara usia dengan subtipe kanker payudara serta IMT dengan subtipe kanker payudara tidak menemukan hubungan yang bermakna. Tidak terdapat hubungan antara usia ataupun IMT terhadap subtipe molekuler kanker payudara yang signifikan di RSCM tahun 2022.
Breast cancer is the most common type of cancer found in women with 2.3 million new cases in 2020. Classification based on hormone receptor expression is important because each subtype can differ in clinical characteristics, treatment strategies and prognosis. Research on the relationship between risk factors of age and BMI on breast cancer subtypes that has been carried out still produces conflicting conclusions and is not yet conclusive, so further research needs to be carried out. This research was conducted at RCSM in April-May 2024 by accessing the medical records of 180 primary breast cancer patients who came to the RSCM Surgical Clinic in 2022 and underwent anatomical pathology and immunohistochemical examinations. There were 180 subjects with 82.8% aged >40 years and 17.2% aged ≤40 years. It was found that 51.1% of subjects were obese, 27.2% were normal weight, 16.1% were overweight, and only 5.6% were underweight. It was found that the luminal subtype covered 72.8% of cases and non-luminal 27.2% of cases. The subtype with the highest proportion found was luminal B type with 41.1%, followed by luminal A type 31.7%, TNBC 17.2%, and HER2-enriched 10%. Chi-square analysis between age and breast cancer subtype and BMI and breast cancer subtype did not find a significant relationship. There was no significant relationship between age or BMI and breast cancer molecular subtype in RSCM in 2022."
Depok: Fakultas Kedokteran Universitas Indonesia, 2024
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UI - Skripsi Membership  Universitas Indonesia Library