TINGKAT AKURASI BIOPSI ASPIRASI JARUM HALUS (BAJH) DALAM MENEGAKKAN DIAGNOSIS KEGANASAN LIMFADENOPATI DI RSUP DR.SARDJITO YOGYAKARTA TAHUN 2012-2014

CLAUDIA PRISKA, dr.Indrawati,Sp.PA; dr.Ery Kus Dwianingsih,Ph.D

2016 | Skripsi | S1 PENDIDIKAN DOKTER

LATAR BELAKANG: Limfadenopati adalah perbesaran limfonodi lebih dari 1 cm. Etiologi limfadenopati meliputi infeksi, keganasan, dan penyakit autoimun. Bila dicurigai keganasan, dibutuhkan pemeriksaan penunjang untuk menegakkan diagnosis. Biopsi patologi anatomi masih menjadi baku emas. Namun, tidak semua layanan kesehatan mampu melakukan prosedur ini karena keterbatasan sarana dan tenaga medis. Metode ini juga tergolong invasif dan mahal. Metode lain yang terus dikembangkan adalah biopsi aspirasi jarum halus (BAJH). BAJH merupakan uji diagnostik yang sederhana, murah, cepat, dan aman, serta memiliki akurasi tinggi dalam mendiagnosis keganasan. Namun, penelitian tentang nilai diagnostik BAJH pada limfadenopati belum banyak dilakukan. Oleh karena itu, melalui penelitian ini, penulis berusaha menyajikan data terbaru mengenai akurasi prosedur BAJH sebagai alat diagnosis keganasan limfadenopati. TUJUAN PENELITIAN: Penelitian ini bertujuan untuk mengetahui nilai diagnostik BAJH dalam mendiagnosis keganasan limfadenopati di RSUP Dr.Sardjito Yogyakarta dalam kurun waktu 2012-2014. METODE: Penelitian ini merupakan jenis uji diagnostik retrospektif dengan pendekatan cross sectional analitik. Data rekam medis pasien limfadenopati yang memiliki hasil pemeriksaan BAJH dan dikonfirmasi dengan biopsi PA dikumpulkan untuk selanjutnya dilakukan tabulasi dan koding, serta analisis dengan program SPSS dan tabel 2x2. HASIL: Dari 57 kasus yang diperoleh, 37 kasus (64,9%) merupakan limfadenopati maligna yaitu 21 kasus tumor metastasis, 13 kasus limfoma non-Hodkin, dan 3 kasus limfoma Hodkin. Dalam menegakkan diagnosis keganasan limfadenopati, didapatkan sensitivitas 78,39%; sensitivitas 65%; dan akurasi 73,68%. Dalam menegakkan diagnosis tumor metastasis, didapatkan sensitivitas 90,48%; spesifisitas 90,63%; dan akurasi 90,57%. Dalam menegakkan diagnosis limfoma non-Hodkin, didapatkan sensitivitas 58,33%; spesifisitas 95,12%; dan akurasi 86,79%. Dalam menegakkan diagnosis limfoma Hodkin, didapatkan sensitivitas 33,33%; spesifisitas 98%; dan akurasi 94,34%. BAJH memiliki akurasi 81,82% pada limfadenopati generalisata, 70% pada limfadenopati kepalaleher, dan 40% pada limfadenopati inguinal. KESIMPULAN: BAJH memiliki nilai diagnostik sedang-rendah (61-79%) dalam menegakkan keganasan limfadenopati. BAJH memiliki nilai diagnostik tinggi dalam menegakkan diagnosis tumor metastasis (>90%). Sementara itu, BAJH memiliki keterbatasan dalam mendiagnosis limfoma Hodkin dan non-Hodkin dimana sensitivitas keduanya kurang dari 60%. Berdasarkan lokasi limfadenopati, BAJH memiliki akurasi tertinggi pada limfadenopati generalisata dan terendah pada limfadenopati inguinal.

BACKGROUND: Lymphadenopaty is an enlargement of lymph node more than 1 cm. It may be caused by infection, cancer, o autoimmune disease. Supporting examination is needed for diagnosing malignant lymphadenopathy. In this case, excisional biopsy is the gold standard. However, this procedure could not be performed in all health facilities because of limitation of human sources or equipments. Besides, it is also an invasive and expensive procedure. Other supporting examinations are developed continuously to overcome this problem. One of them is fine needle aspiration biopsy (FNAB). It is a simple, cheap, fast, and safe diagnostic tool. It also has a high accuracy in diagnosing malignancies. Nevertheless, there is only few studies about the diagnostic value of FNAB in lymphadenopathy, especially in Indonesia. Hence, this study is expected to provide the diagnostic value of FNAB in diagnosing malignant lymphadenopathy. PURPOSE: To provide the diagnostic value of FNAB in diagnosing malignant lymphadenopathy in RSUP Dr.Sardjito Yogyakarta from January 2012 until December 2014. METHOD: This study is a retrospective diagnostic study with cross-sectional analitic approach. The medical records from patients with lymphadenopathy who have undergone both FNAB and excisional biopsy are collected. Furthermore, coding, tabulation, and analysis are done by using SPSS program and table 2x2 to find the sensitivity, specificity, and accuracy. RESULTS: From 57 collected cases, 37 of them (64,9%) are malignant lymphadenopathy which are 21 cases of metastatic tumor, 13 cases of non-Hodkin lymphoma, and 3 cases of Hodkin lymphoma. The overall diagnostic sensitivity, specificity, and accuracy of FNAB in lymphadenopathy are 78,39%, 65%, and 73,68% respectively. In diagnosing metastatic tumor, FNAB has sensitivity of 90,48%; specificity of 90,63%; and accuracy of 90,57%. The sensitivity, specificity, and accuracy of FNAB in diagnosing non-Hodgkin lymphoma are 58,33%; 95,12%; and 86,79% respectively. In diagnosing Hodgkin lymphoma, FNAB has sensitivity of 33,33%; specificity of 98%; and accuracy of 94,34%. The accuracy of FNAB in diagnosing malignancies in generalized lymphadenopathy, head-neck lymphadenopathy, and inguinal lymphadenopathy are 81,82%;70%;and 40% respectively. CONCLUSION: FNAB has low-moderate diagnostic value in diagnosing malignant lymphadenopathy. High diagnostic value of FNAB (>90%) is found in diagnosing metastatic tumor. Meanwhile, FNAB has limitedness in diagnosing Non-Hodgkin lymphoma and Hodgkin lymphoma, with sensitivity for both less than 60%. Based on location of lymphadenopathy, FNAB has the highest accuracy in generalized lymphadenopathy and the lowest in inguinal lymphadenopathy.

Kata Kunci : limfonodi,keganasan limfadenopati,BAJH,akurasi