Uji sensitivitas dan spesifisitas aspirasi jarum halus dalam penegakan diagnosis nodus tiroid

ARYONO, Ahmad, Prof. DR. dr. Teguh Aryandono, SpB, K-Onk

2009 | Tesis | S2 Ilmu Bedah

Latar belakang dan tujuan penelitian Berdasarkan guideline of the American Association of Clinical Endocrinologist, aspirasi jarum halus ( AJH ) dipercaya sebagai metode efektif untuk membedakan antara yang jinak dan ganas pada nodus tiroid. Di RSUP DR. Sardjito pada 5 tahun terakhir ( 2004 2008 ) didapatkan 12 kasus negatif palsu dari 14 kasus keganasan tiroid. Angka negatif palsu yang tinggi menjadikan pertanyaan apakah ada peran dari AJH tiroid dalam penegakan diagnosis nodus tiroid. Penelitian ini bertujuan untuk mengetahui sensitivitas dan spesifisitas AJH terhadap pemeriksaan histopatologi. Bahan dan cara kerja Penelitian ini merupakan penelitian retrospektif dengan rancang bangun uji diagnostik. Hasil AJH pada pasien dengan nodus tiroid yang dilakukan tiroidektomi dibandingkan dengan histopatologi temuan operasi. Kemudian dilakukan uji sensitivitas dan spesifisitas. Telah dilakukan AJH tiroid pada 120 pasien sejak Januari 2004 sampai Desember 2008. Pemeriksaan dilakukan pada 23 laki – laki dan 97 wanita dengan usia terbanyak berkisar 41 - 50 tahun. Hasil AJH, didapatkan ganas empat kasus, jinak 74 kasus, neoplasma folikuler 42 kasus. Histopatologi temuan operasi, didapatkan hasil ganas 23 kasus, jinak 97 kasus. AJH di RSUP DR. Sardjito mempunyai nilai sensitivitas 14,29% , spesifisitas 96,86%, nilai duga positif 50%, nilai duga negatif 83,78%, rasio kemungkinan positif 4,55, rasio kemungkinan negatif 0,884, prevalensi 18,92% dan akurasi 86,49%. Simpulan AJH tiroid di RSUP DR. Sardjito mempunyai nilai sensitivitas yang rendah dan nilai spesifisitas yang tinggi, sehingga AJH tiroid kurang mempunyai peranan yang penting dalam penegakan diagnosis nodus tiroid.

Background and objective Based on guideline of the American Association of Clinical Endocrinologist, fine needle aspiration (FNA) was believed as effective method to differentiate between benign and malignant thyroid nodus. At DR. Sardjito Hospital,during 2004 – 2008 there were 12 cases of false negative from 14 cases of the thyroid malignancy. The high false negative value was made question about the rule of FNA in determining thyroid nodus diagnosis. The purpose of experiment was to find out sensitivity and specificity of FNA in determining thyroid nodus diagnosis at DR. Sardjito Hospital. Methods This experiment was a retrospective experiment with diagnostic test. The result of FNA was compare with the result of histopathology from operation result. Then the sensitivity and specificity was done. Result FNA was done to 120 patient since January 2004 until December 2008. It consist 23 of men and 97 women, mostly 41 – 50 years old. The results of FNA were four of malignancy, 74 of benign, and 42 of follicular neoplasm. The results of histopathology were 23 of malignancy and 97 of benign. The FNA at DR. Sardjito Hospital has 14,29% of sensitivity, 96,86% of specificity, 50% of PPV, 83,78% of NPV, 4,55 of LR +, 0,884 of LR-, 18,92% of prevalence, and 86,49% of accuracy. Conclusion The thyroid FNA at DR. Sardjito Hospital has low value of sensitivity and high value of specificity. The thyroid FNA has less rule in determining thyroid nodus diagnosis.

Kata Kunci : Nodus tiroid, Aspirasi jarum halus, Sensitivitas, Spesifisitas, Thyroid nodus, fine needle aspiration, sensitivity, specificity