THE ACCURACY OF CYTOPATHOLOGICAL EXAMINATION IN DIAGNOSING THYROID NODULES AT DEPARTMENT OF ANATOMICAL PATHOLOGY SARDJITO GENERAL HOSPITAL YOGYAKARTA 2012-2014

KHAERANI ARISTA DEWI, dr.Ery Kus Dwianingsih,Ph.D;dr.Hanggoro Tri Rinonce,Ph.D.,Sp.PA.

2016 | Skripsi | S1 PENDIDIKAN DOKTER

Latar Belakang : Kanker tiroid adalah penyakit ganas yang biasa ditemukan dalam sistem endokrin. Kanker tiroid menempati peringkat 9 dari 10 kanker yang paling banyak terjadi di Indonesia. Belum ditemukan tanda klinis spesifik untuk mendiagnosis keganasan nodul tiroid dan membutuhkan tes yang multimodal. Pasien dengan nodul tiroid biasanya menjalani pemeriksaan Aspirasi Jarum Halus Sitologi (AJHS) , juga dikenal dengan pemeriksaan sitopatologi untuk mengetahui keganasan suatu nodul. Keakuratan pemeriksaan sitopatologi di Indonesia untuk menegakkan diagnosis kanker tiroid masih diragukan. Masih terdapat kemungkinan kesalahan diagnosis pada pemeriksaan sitopatologi. Tujuan : Tujuan dari penelitian ini adalah untuk mengetahui keakuratan pemeriksaan sitopatologi terhadap pemeriksaan histopatologi (sebagai baku emas). Metode : Penelitian ini merupakan studi analitik non-eksperimental menggunakan metode retrospektif cross sectional. Subjek penelitian adalah pasien yang melakukan dua pemeriksaan histopatologi dan sitopatologi nodul tiroid dari tahun 2012-2014 di Departemen PaTologi Anatomi RS Sardjito, Yogyakarta. Data diambil dari rekam medis yang menunjukkan hasil pemeriksaan histopatologi dan sitopatologi yang telah dianalisis oleh patologis dari RS Sardjito tahun 2012-2014. Hasil penelitian akan ditabulasikan menggunakan tabel 2x2 dan akan dikalkulasikan. Hasil : Dalam studi ini, ditemukan sensitivitas 90.0%, spesifisitas 56.5%, nilai prediksi positif 47.4%, nilai prediksi negatif 92.9%, false positive rate 43.5%, false negative rate 10.0%, dan keakuratan 66.67%. Kesimpulan : Hasil dari studi masih sensitif, spesifik, dan akurat sebagai tes diagnostik inisial untuk evaluasi pasien dengan nodul tiroid. Audit klinik sebaiknya dilakukan untuk meningkatkan kualitas dalam pemeriksaan sitopatologi di RS Sardjito.

Background : Thyroid cancer is a common malignant disease found in endocrine system, approximately 1% from all malignancy. In Indonesia thyroid cancer ranks 9 from 10 malignancies. There is no specific clinical feature to diagnose thyroid nodule malignancy and needs multimodality test. Patients with thyroid nodule usually undergo Fine Needle Aspiration Cytology (FNAC), also called cytopathological examination to examine the malignancy of the nodule. The accuracy of the cytopathological examination in Indonesia for diagnosis of thyroid cancer still varies between institutions. Objectives : The objectives of this study were to analyze the accuracy of cytopathological examination compared with histopathological examination as a gold standard diagnosis for thyroid cancer. It was also to evaluate the Sardjito Hospital technique of thyroid cytopathological examination or fine-needle aspiration cytology (FNAC). Methods : This was a non-experimental analytical study using retrospective cross sectional method. The subjects were patients that were examined for histopathological and cytopathological examination of thyroid nodule from the year 2012 to 2014 at the Department of Anatomic Pathology Sardjito General Hospital, Yogyakarta. The data were obtained from the medical record in Sardjito General Hospital in 2012-2014. The FNAC results were compared with histopathologic analysis after thyroidectomy. Data were analyzed and tabulated using a 2x2 table. RESULTS : In this study, the sensitivity of FNAC was 90.0%, specificity of FNAC was 56.5%, positive predictive value was 47.4%, negative predictive value was 92.9%,false positive rate was 43.5%, false negative rate was 10.0%, and accuracy was 66.67% to diagnose malignancy in thyroid nodules. CONCLUSION : FNAC is a sensitive, specific, and accurate initial diagnostic test for evaluation of patients with thyroid nodules. The clinical audit should be done to improve the quality of cytopathological examination in the Sardjito Hospital.

Kata Kunci : nodul tiroid, sitopatologi, akurasi, Thyroid nodule; Fine needle aspiration cytology; Sensitivity; Specificity;