HUBUNGAN FITUR ULTRASONOGRAFI TIROID DENGAN HISTOPATOLOGI PADA KANKER TIROID PAPILER DAN NON- PAPILER

HARYO CHANDRA K, Prof. dr. Arif Faisal, Sp.Rad (K),DHSM.; dr. Hesti Gunarti, Sp.Rad (K)

2017 | Tesis-Spesialis | SP RADIOLOGI

Latar Belakang : Ultrasonografi (USG) sebagai modalitas yang akurat, non-invasif dan murah dalam mendeteksi kanker tiroid. Kanker tiroid terbagi menjadi tipe papiler, folikular, Hurtle sel, anaplastik dan medular. Kanker tiroid papiler paling sering, yaitu sekitar 75% dari seluruh jumlah kanker tiroid. Penelitian ini bertujuan untuk mengetahui hubungan fitur ultrasonografi tiroid berupa komposisi, margin, ekogenitas, kalsifikasi, bentuk, halo sign, dan vaskularisasi dengan histopatologi kanker tiroid papiler dan non-papiler serta membedakan fitur USG diantara keduanya. Bahan dan Cara : Penelitian dilakukan secara retrospektif di Instalasi Radiologi RSUP Dr.Sardjito Yogyakarta. Subjek penelitian adalah pasien dengan lesi tiroid yang telah menjalani pemeriksaan ultrasonografi tiroid dan pemeriksaan histopatologi di RSUP Dr. Sardjito Yogyakarta pada bulan Januari 2015-Desember 2016. Besar sampel penelitian berjumlah 41 sampel. Interpretasi fitur ultrasonografi dievaluasi oleh seorang dokter spesialis radiologi yang bertugas di Instalasi Radiologi RSUP Dr.Sardjito Yogyakarta. Kemudian dilakukan uji fisher exact test, jika nilai p<0,25 maka dilanjutkan uji multivariat regresi logistik dan bernilai signifikan jika nilai p<0,05. Kedua uji dihitung menggunakan Software SPSS 20. Hasil : Fitur USG dominan kanker tiroid papiler adalah komposisi padat (64,5%), margin ireguler (51,6%), hipoekoik (51,6%), tanpa kalsifikasi (74,2%), wider-than-tall (77,4%), tanpa halo sign (71,0%) dan vaskularisasi intralesi (45,2%). Sedangkan kanker tiroid non-papiler adalah komposisi padat (70%), margin ireguler (70%), isoekoik (60%), tanpa kalsifikasi (100%), wider-than-tall (60%) dan vaskularisasi perilesi (60%). Akan tetapi tidak terdapat hubungan antara fitur USG tersebut dengan kejadian kanker tiroid papiler dan non-papiler, nilai p>0,05. Margin ireguler (OR=2,188; CI 95%=0,476 - 10,051), wider-than-tall (OR=2,286; CI 95%=0,500 - 10,448) dan tanpa halo sign (OR=2,444; CI 95%=0,566 - 10,549) memiliki kecenderungan kepada kanker tiroid papiler daripada non-papiler karena memiliki nilai OR>1. Kesimpulan: Tidak terdapat hubungan signifikan antara komposisi, margin, ekogenitas, kalsifikasi, bentuk, halo sign, dan vaskularisasi dengan histopatologi kanker tiroid papiler dan non-papiler walaupun fitur margin ireguler, wider-than-tall dan tanpa halo sign memiliki kecenderung kepada kanker tiroid papiler.

Background: Ultrasound is an accurate, non-invasive and relatively affordable modality on detecting thyroid carcinoma. Thyroid carcinoma is divided into papillary, follicular, Hurtle cell, anaplastic and medullary type. Papillary thyroid carcinoma is the most common type, which about 75% of all cases of thyroid carcinoma. This study is aimed to understand the correlation between thyroid ultrasound which consists of composition, margins, echogenicity, calcification, shapes, halo-sign and vascularization with histopathologic findings of papillary and non-papillary thyroid carcinoma and also differentiate ultrasound features on both cases. Materials and Methods: The study is held retrospectively in Radiology Department of Sardjito Hospital, Yogyakarta. The subjects are patients with thyroid lesions that had thyroid ultrasound and histopathologic examination in Sardjito Hospital throughout January 2015 until December 2016. Sample size of the study was 41. Ultrasound features interpretation were evaluated by a radiologist from Radiology department in Sardjito Hospital. Afterwards fisher exact test was done, and if the value of p<0,25, multivariate logistic regression test will be done afterwards and considered significant if the value of p<0,05. Both test was done using SPSS 20 Software. Result: Ultrasound features that was dominant papillary thyroid carcinoma are solid composition (64,5%), irregular margin (51,6%), hypoechoic (51,6%), without calcification (74,2%), wider-than-tall (77,4%), without halo-sign (71,0%) and presence of vascularization within the lesion (45,2%). In non-papillary thyroid carcinoma are solid composition (70%), irreguler margin (70%), isoechoic (60%), without calcification (100%), wider-than-tall (60%) and presence of vascularization around the lesion (60%). However, there was no correlation between the ultrasound features with the incidence of papillary and non-papillary thyroid carcinoma, value of p>0,05. Irregular margin (OR=2,188; CI 95%=0,476 - 10,051), wider-than-tall (OR=2,286; CI 95%=0,500 - 10,448) and the absence of halo-sign (OR=2,444; CI 95%=0,566 - 10,549) had the liability to papillary thyroid carcinoma than non-papillary thyroid carcinoma due to the value of OR>1. Conclusion: There is no significant correlation between composition, margins, echogenicity, calcification, shapes, halo-sign and vascularization with histopathologic findings of papillary and non-papillary thyroid carcinoma although the ultrasound features of irregular margins, wider-than-tall and the absence of halo-sign had the liability to papillary thyroid carcinoma.

Kata Kunci : Kanker tiroid papiler, Ultrasonografi, Histopatologi, Papillary thyroid carcinoma, ultrasonography, histopathology