Spikula sebagai prediktor keganasan Nodul Paru Soliter pada pemeriksaan CT-Scan Thorax

ASTARINI, Dyah, dr. Henry Kusumo H., SpRad(K)

2007 | Tesis | PPDS I Radiologi

Latar Belakang Masalah : Nodul paru soliter (NPS) merupakan tantangan diagnostik dalam membedakan lesi paru ganas dan jinak. Karakteristik nodul berupa spikula, ukuran, tepi, lokasi, dan kalsifikasi intranoduler dianggap sebagai prediktor keganasan paru pada pemeriksaan CT-scan thorax. Spikula diperkirakan sebagai strand infiltratif ke parenchym paru pada lesi ganas dan sebagai strand fibrotik pada lesi jinak. Tujuan Penelitian : Untuk mengetahui peranan spikula sebagai prediktor keganasan suatu nodul paru soliter pada pemeriksaan CT-scan thorax. Bahan dan Cara : Suatu retrospective observational analytic study dengan subyek penelitian adalah penderita yang telah dilakukan foto CT-scan thorax di Instalasi Radiologi RSUP Dr. Sardjito Yogyakarta, antara kurun waktu bulan Oktober 2003 sampai Oktober 2006, didapatkan gambaran nodul paru soliter dan telah diperiksa secara histopatologis. Data yang terkumpul dicatat dan dianalisis dengan menggunakan Chi-Square test dan Logistic Regression test. Hasil : Didapatkan 152 penderita (102 laki-laki dan 50 perempuan, antara umur 18-81 tahun, umur rata-rata 58 tahun) dengan nodul paru soliter (151 ganas dan 51 tidak ganas). Analisis dengan menggunakan univariate Chi-Square (x2) pada 95% CI, terdapat perbedaan bermakna antara nodul ganas dan nodul jinak berdasarkan lokasi nodul (p = 0,023), tepi nodul (p = 0,000), spikula (p = 0,035) dan kalsifikasi intranoduler (p = 0,000). Ukuran nodul (diameter) tidak terdapat perbedaan yang bermakna antara nodul ganas dan nodul jinak karena memiliki nilai p > 0,05 (p = 0,330). Analisis dengan menggunakan multivariat Logistic Regression, spikula mempunyai nilai p = 0,001 pada 95% CI (2,010 – 13,257) dengan estimasi OR = 5,163; tepi nodul mempunyai nilai p = 0,012 pada 95% CI (1,329 – 10,506) dengan estimasi OR = 3,736; and lokasi nodul mempunyai nilai p = 0,040 pada 95% CI (1,041 - 5,445) dengan estimasi OR = 2,381. Kalsifikasi intranoduler pada penelitian ini dianggap sebagai faktor protektif karena mempunyai nilai p > 0,05 (p = 0,994) pada 95% CI (0,245 - 4,034) dengan estimasi OR < 1 (OR = 0,995). Kesimpulan : Karakteristik nodul berupa spikulasi, lokasi nodul, tepi nodul terdapat perbedaan yang berbeda bermakna antara nodul yang ganas dan nodul jinak. Spikula paling berperan sebagai prediktor keganasan suatu nodul paru soliter pada pemeriksaan CT-scan thorax.

Background : Solitary pulmonary nodules were a diagnostic defiance to differentiated malignant and benign pulmonary lesions. Characteristics of lung nodules included spiculation, size, margins, location and intranodular calcification were considered as the predictor factors in pulmonair malignancy at CT thorax examinations. The spiculation estimated as the infiltrative strand into the surrounding lung parenchyma in malignant lesions and it estimated as the fibrotic strand in benign lesions. Purpose : To determine the role of spiculation as the predictor of malignancy in solitary pulmonary nodules at CT thorax examinations. Subjects and Methods : An retrospective observational analytic study was conducted with subjects were patients who respectively underwent an CT thorax examinations at Radiology Units of Dr. Sardjito Central General Hospital, Yogyakarta, in a period of October 2003 to October 2006, yielded pattern of solitary pulmonary nodules and histopatological findings. All the examination result were noticed and analyzed by Chi-Square test and Logistic Regression test. Result : We evaluated 152 patients (102 men and 50 women; age range, 18-81 years; average age, 58 years) of solitary pulmonary nodules (151 malignant and 51 benign). Analyzed by univariate Chi-Square (x2) in 95% CI, yielded difference significantly between malignant and benign nodules, based on location of nodules (p = 0,023), margins of nodules (p = 0,000), spiculation (p = 0,035) and intranodular calcification (p = 0,000). Size (diameter) nodules yielded not difference significantly between malignant and benign nodules because they had p value > 0,05 (p = 0,330). Analyzed by multivariate Logistic Regression, spiculation of nodules had p = 0,001 in 95% CI (2,010 – 13,257) with estimated OR = 5,163; margins of nodules had p = 0,012 in 95% CI (1,329 – 10,506) with estimated OR = 3,736; and location of nodules had p = 0,040 in 95% CI (1,041 - 5,445) with estimated OR = 2,381. Intranodular calsification in the research were considered protective factor because they had p value > 0,05 (p = 0,994) in 95% CI (0,245 - 4,034) with estimated OR value < 1 (OR = 0,995). Conclusion : Characteristics of lung nodules included spiculation, location and margins of nodules yielded difference significantly between malignant and benign nodules. The spiculation is a most important role as a predictor of malignancy in solitary pulmonary nodules at CT thorax examinations.

Kata Kunci : CT Scan Thorax,Nodul Paru Soliter,Spikula