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"ABSTRAKLatar belakang : Fine Needle Aspiration Cytology FNAC adalah teknik yang cepat, murah, dengan komplikasi yang minimal untuk mendiagnosis tumor tulang. FNAC memiliki kapasitas untuk membedakan lesi jinak dan ganas. Namun FNAC memiliki keterbatasan di sisi teknik dan cara interpretasi.Tujuan : mengevaluasi akurasi FNAC sebagai salah satu prosedur preoperasi diagnosis tumor tulang. Metode : Sampel diambil dari arsip rekam medis pasien curiga tumor tulang yang diperiksa dengan FNAC dan histopatologi di Departemen Patologi Anatomi FKUI/RSCM dari tahun 2011 sampai 2014. Uji diagnostik dilakukan untuk mengetahui sensitivitas, spesifisitas, PPV, NPV, dan akurasi dari FNAC. Hasil : Terdapat 78 pasien kasus curiga tumor tulang yang diperiksa dengan FNAC dan Histopatologi di Departemen Patologi Anatomi FKUI/RSCM pada tahun 2011 ndash; 2014. Empat puluh sembilan kasus dilaporkan tumor tulang ganas dengan 5 kasus diskrepansi subtipe ganas dan 20 kasus tumor tulang jinak dengan 1 kasus diskrepansi subtype jinak. Selain itu, terdapat 8 kasus negatif semu dan 1 kasus positif semu. Secara keseluruhan, hasil yang didapatkan adalah sensitivitas 86 , spesifisitas 95.2 , PPV 98 , NPV 71.4 , dan akurasi sebesar 88.5 .Kesimpulan : Penelitian ini menunjukkan bahwa FNAC memiliki kualitas yang baik untuk mendiagnosis tumor tulang, dibuktikan dengan tingginya angka sensitivitas dan spesifisitas 86 dan 95.2 .

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ABSTRACTBackground Fine Needle Aspiration Cytology FNAC is a rapid, inexpensive, minimum invasive technique with less complication in diagnosing bone neoplasm. FNAC is able to differentiate between neoplasm and non neoplasm cases. However, there are limitations of FNAC technique and interpretation.Aim to evaluate the accuracy of FNAC as one of diagnostic approach in preoperative or diagnosing bone neoplasm.Method Samples were obtained from archives of medical records data of patients who clinically suspected of bone neoplasm and undergo FNAC Histopathology in Anatomical Pathology Department FKUI RSCM from 2011 to 2014. The diagnostic test will be conducted in order to obtain the sensitivity, specificity, PPV, NPV, and accuracy of FNAC.Results There are 78 patients of bone neoplasm were undergo Fine Needle Aspiration Cytology and Histopathology examination from the archives Anatomical Pathology Department in 2011 to 2014. Forty nine cases were reported as malignant bone neoplasm with 5 discrepancy type and 20 cases were benign with 1 discrepancy type. Furthermore, there were 8 false negative cases, and 1 false positive case. The sensitivity, specificity, positive predictive value PPV , negative predictive value NPV , accuracy were 86 . 95.2 . 98 , 71.4 , and 88.5 respectively.Conclusions FNAC shows a good quality as one of diagnostic approach in bone neoplasm as can be seen in a high sensitivity and specificity 86 and 95.2 in this study. "

"Latar Belakang: Osteosarkoma merupakan keganasan tulang primer dengan beragamsubtipe dan memerlukan pendekatan multidisiplin dalam diagnosis dan tatalaksananya.Hingga saat ini belum ada alat diagnostik yang terbukti dapat mendekaticlinicopathological conference (CPC) sebagai standar baku emas. Keterbatasan fasilitas,biaya, dan antrian pemeriksaan yang panjang sering kali menunda diagnosisosteosarkoma. Penelitian ini bertujuan untuk membuat model sistem skoring berdasarkantemuan klinis, laboratorium, radiografi konvensional, dan histopatologis untukmendiagnosis osteosarkoma secara cepat dan tepat.Metode: Penelitian ini dilakukan dalam dua tahap. Tahap pertama bertujuan untukmemformulasikan sistem skoring untuk mendiagnosis osteosarkoma menggunakan datasekunder secara retrospektif di RS. Dr. Cipto Mangunkusumo tahun 2016 hingga 2020.Studi ini melibatkan semua pasien dengan suspek keganasan tulang primer dandidiagnosis akhir berdasarkan CPC. Uji analisis dilakukan secara univariat, bivariat, danmultivariat menggunakan regresi logistik backward stepwise dilanjutkan dengan ujikalibrasi dan diskriminasi menggunakan uji Hosmer-Lemeshow dan kurva receivingoperator characteristic (ROC), serta menentukan titik potong pada model. Tahap keduaditujukan untuk mengevaluasi model sistem skoring yang diformulasi pada tahap pertamasecara prospektif menggunakan data primer sejak September 2022 hingga Desember2022 di poliklinik Orthopaedi dan Traumatologi RS. Dr. Cipto Mangunkusumo.Hasil: Penelitian tahap pertama melibatkan 120 subjek dan menghasilkan dua modelsistem skoring, yaitu dengan mempertimbangkan riwayat pijat (model 1) dan tanpamempertimbangkan riwayat pijat (model 2). Dari hasil analisis multivariat, didapatkansembilan variabel yang dimasukan dalam model sistem skoring yaitu usia, indeks massatubuh (IMT), onset, riwayat pijat, lokasi tumor, kadar alkaline phosphatase (ALP), laktatdehidrogenase (LDH), letak lesi berdasarkan radiografi konvensional, serta gambaranhistopatologis berdasarkan fine needle aspiration biopsy (FNAB). Uji kalibrasi model 1dan 2 menunjukan kalibrasi yang baik (p=0,498 dan p=0,917). Uji diskriminasi padamodel sistem skoring menunjukan nilai area under the curve (AUC) 0,818 dengan nilaip<0,001 pada model 1 dan 2. Titik potong pada model 1 dan 2 berturut-turut adalah 19dan 11 poin. Penelitian tahap kedua melibatkan 34 subjek dan menunjukan sensitivitas,spesifisitas, dan akurasi model 1 dan 2 berturut turut sebesar 81,25% dan 87,5%, 100%dan 100%, dan 91,1% dan 94,1%.Kesimpulan: Didapatkan dua model sistem skoring yang mampu mendiagnosisosteosarkoma dengan cepat dan tepat dibandingkan dengan CPC. Lokasi tumor di lututdan gambaran sel pleiomorfik dengan atau tanpa matriks osteoid ganas merupakan faktoryang paling berpengaruh terhadap diagnosis osteosarkoma.

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Introduction : Osteosarcoma, being one of the most prevalent among the primary bone

malignancies, consists of multiple subtypes and requires a multidisciplinary approach for

proper diagnosis and treatment. Lately, there have not been a diagnostic tool that is able

to rival the accuracy of clinicopathological conference (CPC) as a gold standard in

determining the diagnosis and treatment of osteosarcoma. Limitations in budgeting, as

well as the time taken for each patient to undergo supporting examinations often leads to

a delayed diagnosis. This research aims to create a scoring system that is based on clinical

symptoms, laboratory results, conventional radiology, as well as histopathological results

to establish a quick and accurate diagnosis for osteosarcoma.

Method: This research was conducted in two stages; the first stage aims to formulate the

scoring system for diagnosing osteosarcoma by using a retrospective, secondary data

obtained from Dr. Cipto Mangunkusumo Hospital from 2016 up to 2020. This study

involved all patients with suspected bone malignancies that was eventually diagnosed

with osteosarcoma by means of CPC. The analysis was done with univariate, bivariate,

and multivariate analysis using backward stepwise logistic regression method followed

by calibration and discrimination test using Hosmer-Lemeshow test and receiving

operator characteristic (ROC) curve analysis, and determined the cut-off point in the

scoring system model. The second stage was aimed to prospectively evaluate the

previously formulated scoring system model in the first stage using primary data from

September 2022 to December 2022 at Orthopaedic and Traumatology outpatient clinic

Dr. Cipto Mangunkusumo Hospital.

Result: The first stage of the study involved 120 subjects and resulted two models of

scoring system, namely by considering massage history (model 1) and without

considering massage history (model 2). From multivariate analysis, nine variables were

included in the scoring system model, including age, body mass index (BMI), onset,

massage history, tumor location, alkaline phosphatase (ALP) levels, lactate

dehydrogenase (LDH), location of the lesion based on conventional radiography, and

histopathological finding based on fine needle aspiration biopsy (FNAB). Calibration

tests for models 1 and 2 showed good calibration (p=0.498 and p=0.917). The

discrimination test on the scoring system model showed an area under the curve (AUC)

value of 0.818 with a p-value <0.001 in both models 1 and 2. The cut-off points in model

1 and 2 were 19 and 11, respectively. The second stage of the study involved 34 subjects

with the sensitivity, specificity, and accuracy of models 1 and 2 showing 81.25% and

87.5%, 100% and 100%, and 91.1% and 94.1%, respectively.

Conclusion: This study has proposed two models of scoring systems that can be used

for a more rapid and accurate diagnosis of osteosarcoma when compared to CPC; the

location of the tumor mass in the knee joint and the appearance of pleomorphic cells, with

or without the appearance of malignant osteoids, both being significant factors in

diagnosing osteosarcoma"

"[ABSTRAKPendahuluan: GCT tulang merupakan lesi jinak tetapi secara lokal dapat bersifat agresif pada daerah epifisis. Angka rekurensi yang tinggi, dilaporkan mencapai 75%. Tumor dapat bermetastasis ke paru (2-9%) dan tercatat 0-37% angka mortalitas akibat metastasis. Beberapa penelitian menghasilkan variasi berbeda penanganan tumor ini terhadap luaran onkologi dan fungsional serta angka kematian paska pembedahan. Penelitian ini bertujuan melaporkan pengalaman dalam penatalaksanaan pembedahan tumor ini dan untuk melihat adanya hubungan antara tatalaksana pembedahan dengan dampak klinis.Metode: Penelitian ini merupakan kohort retrospektif, sebanyak 99 pasien GCT tulang menjalani tindakan kuretase ataupun wide resection di Rumah Sakit Cipto Mangunkusumo pada 1995 - 2014. Luaran onkologi berdasarkan angka rekurensi lokal, metastasis tumor serta mortalitas dan luaran fungsional berdasarkan sistem penilaian Musculoskeletal Tumor Society (MSTS).Hasil: Lokasi tumor terutama di distal femur (25,2%). Rekurensi lokal terjadi pada 4 pasien, terutama di distal femur (50%). Rekurensi lokal terjadi seimbang pada wide resection dan kuretase dan secara statistik tidak bermakna (p 0.578, uji eksak Fischer). Tidak dijumpai kejadian rekurensi lokal pada seluruh pasien yang mengalami metastasis. Metastasis terjadi pada kelompok wide resection. Kematian terjadi pada 4 pasien yang mengalami metastasis. Sebagian besar pasien (51,1%) menunjukkan luaran fungsional kategori sangat baik (skor MSTS di atas 75%). Analisis kesintasan bebas rekurensi lokal secara statistik tidak bermakna (p 0.564). Analisis multivariat (regresi Cox) hanya faktor metastasis yang berpengaruh pada mortalitas (p. 0.001)Kesimpulan: Terdapat hubungan yang bermakna antara stadium tumor dengan metastasis dan jenis tindakan operasi. Tidak terdapat perbedaan bermakna antara kejadian rekurensi lokal dan metastasis serta luaran fungsional dengan jenis tindakan operasi.

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ABSTRACTIntroduction: Giant cell tumor of bone is benign lesion with ability to be locally aggressive in epiphysis. Its recurrence rate was reported as high as 75%. Tumor can metastasize to lungs (2-9%) and up to 37% mortality rate due to metastasis. Several studies have reported different rates of local recurrence, lung metastasis, mortality rate, and functional outcome. This study aims to report our experience and analyze the correlation between surgery and clinical findings.Methods: In this retrospective cohort, 99 patients GCT of bone undergone curettage or wide resection in Cipto Mangunkusumo Hospital during 1995-2014. Oncological outcome were analyzed according to local recurrence rate, metastasis, and mortality rate, while functional outcome were measured according to Musculoskeletal Tumor Society Score (MSTS).Results: Tumor location were predominantly in distal femur (25.2%). Local recurrence were observed in 4 patient and mainly in distal femur (50%). Local recurrence were evenly balanced between surgical curettage and wide resection (50% each) and thus not statistically significant (Exact Fischer, p=0.578). Metastasis were observed in patients who undergone wide resection, however, no significant correlation were found between metastasis incidence and types of surgical intervention (Exact Fischer, p=0.318). Four have died related to metastasis. No local recurrence were observed in patients suffering from metastasis. In more than half of patients (51.5%), the functional status were very good (MSTS >75. Recurrence-free survival analysis not significant statistically (p 0.564).Multivariate analysis (Cox regression) showed that only metastasis was found to be significantly correlated to mortality (p. 0.001).Conclusion: Tumor stage was correlated to metastasis, and type of surgical intervention. No significant correlation were found between local recurrence, metastasis, and functional outcome to types of surgical intervention., Introduction: Giant cell tumor of bone is benign lesion with ability to be locally aggressive in epiphysis. Its recurrence rate was reported as high as 75%. Tumor can metastasize to lungs (2-9%) and up to 37% mortality rate due to metastasis. Several studies have reported different rates of local recurrence, lung metastasis, mortality rate, and functional outcome. This study aims to report our experience and analyze the correlation between surgery and clinical findings.Methods: In this retrospective cohort, 99 patients GCT of bone undergone curettage or wide resection in Cipto Mangunkusumo Hospital during 1995-2014. Oncological outcome were analyzed according to local recurrence rate, metastasis, and mortality rate, while functional outcome were measured according to Musculoskeletal Tumor Society Score (MSTS).Results: Tumor location were predominantly in distal femur (25.2%). Local recurrence were observed in 4 patient and mainly in distal femur (50%). Local recurrence were evenly balanced between surgical curettage and wide resection (50% each) and thus not statistically significant (Exact Fischer, p=0.578). Metastasis were observed in patients who undergone wide resection, however, no significant correlation were found between metastasis incidence and types of surgical intervention (Exact Fischer, p=0.318). Four have died related to metastasis. No local recurrence were observed in patients suffering from metastasis. In more than half of patients (51.5%), the functional status were very good (MSTS >75. Recurrence-free survival analysis not significant statistically (p 0.564).Multivariate analysis (Cox regression) showed that only metastasis was found to be significantly correlated to mortality (p. 0.001).Conclusion: Tumor stage was correlated to metastasis, and type of surgical intervention. No significant correlation were found between local recurrence, metastasis, and functional outcome to types of surgical intervention.]"

"Latar belakang: Giant Cell Tumor of Bone (GCT tulang) adalah tumor tulang primer yang bersifat jinak-agresif dan dapat bermetastasis. Rentang usia pasien GCT tulang adalah antara 13 sampai 69 tahun. Tumor ini sering ditemukan di bagian distal femur, distal radius, dan proximal tibia. Berdasarkan tipe tulang, GCT tulang sering ditemukan pada ujung tulang panjang. Namun, GCT tulang juga dapat ditemukan pada tipe tulang lainya. Pada beberapa keganasan tulang, seperti osteosarcoma, terdapat korelasi antara usia dengan lokasi tumor. Namun, untuk GCT tulang korelasi ini masih belum diketahui. Penelitian ini bertujuan untuk melihat adanya korelasi usia dengan lokasi pada GCT tulangMetode: Peneliti mengambil data rekam medis pasien GCT tulang di RSUPN dr.Cipto Mangunkusumo dari tahun 2016 sampai 2020. Kemudian, data usia dengan lokasi (topografi dan tipe tulang) dianalisis menggunakan tabel baris kolom.Hasil: Pada kelompok usia 10-39 tahun ditemukan 52 kasus pada tulang apendikular dan 1 kasus pada tulang axial. Pada kelompok usia 40-69 tahun ditemukan 29 kasus pada tuang apendikular dan 4 kasus pada tulang axial. Korelasi antara usia dan lokasi topografis tidak bermakna (p>0.05). Pada kelompok usia 10-39 tahun ditemukan 49 kasus pada tipe tulang panjang dan 4 kasus pada tipe tulang lainnya. Pada kelompok usia 40-69 tahun, ditemukan 27 kasus pada tulang panjang dan 6 kasus pada tipe tulang lainnya. Korelasi antara usia dengan lokasi tipe tulang tidak bermakna (p>0.05).Kesimpulan: Tidak ada hubungan bermakna antara usia dengan lokasi tumor (topografi dan tipe tulang) pada kasus GCT tulang

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Introduction: Giant cell tumor of bone (GCTB) is a primary bone tumor with benign- aggressive behavior and capacity to metastasize. The age range for GCTB is 13 to 69 years old. GCTB is commonly in distal femur, distal radius, and proximal tibia. Based on bone type, GCTB is frequently found on meta epiphyseal site of long bone. Although, some GCTB can be found on other bone type such as flat bone, short bone, and irregular bone. In some bone neoplasms, like osteosarcoma, there is a correlation between age and tumor site. Unfortunately for GCTB, this correlation is still unknown. This study aims to determine the correlation between age and tumor site of GCTB

Method: Medical record of patients with the diagnosis of GCTB in RSUPN dr.Cipto Mangukusumo from 2016 to 2020 is included in this study. Age at diagnosis and tumor site (topographically and bone type) of patient are analyzed using cross tabulation. Result: For age group 10-39 years old, there are 52 cases of GCTB in appendicular skeleton and one case in axial skeleton. For age group 40-69 years old there are 29 cases of GCTB in appendicular skeleton and 4 cases in axial skeleton. The correlation between age and tumor topographic site is statistically not significant (p > 0.05). For the bone type, there are 49 cases of GCTB in long bone and 4 cases in other bone type for age group 10- 39 years old. For age group 40-69 years old, there are 27 cases of GCTB in long bone and 6 cases in other bone type. The correlation between age and bone type is statistically not significant (p> 0.05)

Conclusion: There are no significant correlation between age and tumor site (topographically and bone type) in GCTB"