Akurasi Computed Tomography dlaam Menentukan Limfadenopati Maligna Leher Berdasarkan NODE-RADS 1.0

WINILYA SEPTRIDA, Prof. Dr.Arif Faisal, Sp.Rad(K),DHSM ; dr. Anita Ekowati, SpRad(K)TR

2023 | Tesis-Spesialis | RADIOLOGI

Latar Belakang : Prevalensi kanker kepala leher semakin meningkat di dunia. Adanya keterlibatan limfonodi di regio kepala-leher, menjadi salah satu tanda penyebaran kanker melalui pembuluh limfe, yang menyebabkan perubahan ukuran dan konfigurasi, disebut limfadenopati. Seringkali penentuan limfadenopati oleh proses patologis pada Computed Tomography (CT) mengalami kendala, sehingga pada tahun 2020, Elsholtz et al memperkenalkan Node Reporting and Data System 1.0 (Node-RADS 1.0) untuk menyelaraskan sistem penilaian limfonodi. Tujuan : Penelitian ini bertujuan untuk menilai akurasi CT dalam menentukan limfadenopati maligna leher berdasarkan Node-RADS 1.0 Material dan Metode : Penelitian ini merupakan jenis penelitian observasional analitik.menggunakan data sekunder pada 40 subjek dengan klinis benjolan leher yang telah menjalani pemeriksaan CT kontras cervical di Instalasi Radiologi RSUP Dr.Sarjito Yogyakarta pada bulan Januari 2018-Desember 2019. Melalui citra CT kontras leher dilakukan penilaian limfadenopati terbesar, yang direkomendasikan untuk Biopsi Aspirasi Jarum Halus (BAJAH) oleh bagian patologi anatomi dipandu ultrasonografi (USG), dan hasil pemeriksaan tersebut dijadikan baku emas. Limfadenopati dinilai berdasarkan kriteria ukuran yaitu short axis >5mm (leher), dan kriteria konfigurasi berdasarkan tabel Node-RADS 1.0. Kemudian dilakukan analisis data dengan tes uji diagnostik tabel 2x2 Hasil : Pada 40 sampel penelitian, pada citra CT kontras cervical, diperoleh 28 sampel (70%) dengan gambaran mengarah limfadenopati maligna, sedangkan dari hasil patologi Anatomi (PA) yang diperoleh melalui BAJAH dipandu USG didapatkan 25 sampel (62,5%) membuktikan limfadenopati maligna. Sehingga, dari kedua pemeriksaan CT kontras leher dan PA didapatkan positif limfadenopati maligna dan benar adalah 20 sampe (50%) memiliki akurasi sebesar 67,5%, dengan sensitivitas 80,0%, spesifisitas 46,7%, PPV 71,4%, NPV 58,3%, LR(+) 1,5, dan LR (-) 0,42. Kesimpulan : Akurasi CT kontras cervical dalam menentukan limfadenopati maligna berdasar Node-RADS 1.0 sebesar 67,5%, sehingga CT tetap memiliki kekuatan sebagai alat diagnostic terutama dalam menentukan limfadenopati yang belum diketahui tumor primernya dan membantu klinisi untuk menilai prognosis pasien

Background : The prevalence of head and neck cancer is increasing worldwide. The involvement of lymph nodes in the head-neck region is a sign of the spread of cancer through the lymph vessels, which causes changes in size and configuration, called lymphadenopathy. Often the determination of lymphadenopathy by the pathological process of Computed Tomography(CT) ran into problems, so in 2020, Elsholtz et al. introduced Node Reporting and Data System 1.0 (Node-RADS 1.0) to align the lymph node scoring system. Objective : This study aims to assess the accuracy of CT in determining malignant lymphadenopathy of the neck based on Node-RADS 1.0. Materials and Methods : This study used an analytic observational methode using secondary data on 40 subjects with clinical neck lumps who had undergone cervical contrast enhance CT (CECT) examinations at Department of Radiology, Dr. Sardjito General Hospital Yogyakarta, from January 2018 to December 2019. Through neck CECT images, the largest lymphadenopathy was assessed, which was recommended for Fine Needle Aspiration Biopsy (FNAB) guided by ultrasonography (USG), and the result of examinations were used as the gold standard. Lymphadenopathy was assessed based on size criteria on a short axis >5mm (neck), and configuration criteria based on the Node-RADS 1.0 table. Then do the analysis data with 2x2 table diagnostic test. Result : There were 40 patients underwent cervical CECT examination. 28 (70%) were found with suspected malignant lymphadenopathy on neck CECT, while from the Histopathology results obtained through FNAB guided USG, there were 25 samples (62.5%) proved malignant lymphadenopathy. From both CECT examinations of the neck and histopathology were found true positive malignant lymphadenopathy were 20 samples (50%) had an accuracy of 67.5%, with a sensitivity of 80.0%, a specificity of 46.7%, a PPV of 71.4%, NPV 58.3%, LR(+) 1.5, and LR(-) 0.42. Conclusion : The accuracy of cervical CECT in determining malignant lymphadenopathy based on Node-RADS 1.0 is 67.5%; therefore, CT still has power as a diagnostic tool, especially in determining lymphadenopathy where the primary tumor is unknown, helping clinicians to assess patient prognosis.

Kata Kunci : Malignant lymphadenopathy, CT accuracy, Node-RADS 1.0