AKURASI SISTEM SKORING COMPUTED TOMOGRAPHY ABDOMEN UNTUK DIAGNOSIS ASITES MALIGNA

INDRIA FAJRIANITA, dr. Yana Supriatna, Ph.D, Sp.Rad (K).; dr. Anita Ekowati, Sp.Rad (K).

2017 | Tesis-Spesialis | SP RADIOLOGI

Latar belakang. CT scan abdomen dapat membedakan asites maligna atau benigna dengan menilai karakteristik dari asites. Dan sitologi cairan asites merupakan baku emas untuk menentukan asites maligna atau benigna. Tujuan penelitian. Mengetahui akurasi sistem skoring CT scan abdomen untuk diagnosis asites maligna. Bahan dan Cara. Penelitian ini adalah analitik observasional uji diagnostik dengan pengambilan 48 subyek secara retrospektif di Instalasi Radiologi RSUP Dr. Sardjito Yogyakarta. Subyek adalah pasien asites yang telah melakukan CT scan abdomen dan pemeriksaan sitologi cairan asites pada bulan Januari 2014- Desember 2016. Interpretasi CT scan abdomen dievaluasi oleh seorang dokter spesialis radiologi konsultan abdomen. Sistem skoring dihitung menggunakan analisa bivariat dan multivariat pada densitas asites eksudat, penebalan peritoneum parietal, nodul peritoneum, omental cake, tebal dinding kandung empedu < 3mm, tethered bowel sign, distribusi cairan di lesser sac. Kemudian dilakukan analisa ROC menentukan titik cutoff antara maligna dan benigna. Hasil. Didapatkan skor densitas asites eksudat 1, penebalan peritoneum parietal 5, nodul peritoneum 5, omental cake 3, tebal dinding kandung empedu <3mm 2, distribusi cairan di lesser sac 6. Dan titik cutoff >=11,5 berarti asites maligna. Dengan nilai akurasi 83,3%, sensitifitas 95,8%, spesifisitas 70,8%, NPP 76,6%, NPN 94,4% apabila dibandingkan dengan hasil sitologi cairan asites. Kesimpulan. Terdapat akurasi yang baik antara sistem skoring CT scan abdomen dengan hasil sitologi cairan asites untuk diagnosis asites maligna.

Background. Abdominal CT can be used to diagnose malignant or benign ascites by evaluating the characteristics. Ascitic fluid cytology is the gold standard to identify malignant or benign ascites. Objectives. The aim of this study is to evaluate the accuracy of abdominal CT scoring system to diagnose malignant ascites. Materials and Methods. This is an analytic observational diagnostic study with retrospective sampling of 48 sample at Departement of Radiology RSUP Dr. Sardjito Yogyakarta. The subjects were ascites patients underwent abdominal CT and had the ascitic fluid analyzed during January 2014 until December 2016. Abdominal CT interpretation were evaluated by an abdominal imaging radiologist. Scoring system was evaluated statistically using bivariate and multivariate on several characteristic: exudate ascites density, parietal peritoneum thickening, peritoneal nodules, omental caking, thickness of gallbladder wall <3mm, tethered bowel sign, and lesser sac fluid distribution. The result was analyzed using ROC to determined cut-off point between malignant and benign ascites. Results. Final scoring for each characteristics: exudat ascites density 1 point, parietal peritoneum thickening 5 points, peritoneal nodules 5 points, omental caking 3 points, thickness of gallbladder wall <3mm 2 points, and lesser sac fluid distribution 6 points. Cutoff value was >=11,5 points for malignant ascites. Accuracy of this scoring system was 83,3%, sensitivity 95,8%, spesifisity 70,8%, PPV 76,6%, and NPV 94,4% compared with ascitic fluid cytology study. Conclusion. There is good accuracy of abdominal CT scoring system compared with ascitic fluid analysis to diagnose malignant ascites.

Kata Kunci : Karakteristik asites, Maligna, CT scan, Sistem skoring, Ascites fluid characteristic, malignant, CT, scoring system