KESESUAIAN DIAGNOSIS TUMOR PARU PRIMER BERDASARKAN CT SCAN TORAKS TANPA KONTRAS DENGAN HASIL PEMERIKSAAN PATOLOGI ANATOMI

YENNI OKTAVIA, dr. Yana Supriatna, Ph.D, Sp.Rad.; dr. Anita Ekowati, Sp.Rad (K)

2016 | Tesis-Spesialis | SP RADIOLOGI

Latar belakang. Tumor paru primer ganas atau kanker paru merupakan salah satu penyebab kematian terbesar selain kanker hati, lambung, kolorektal, payudara dan esofagus. Penggunaan CT scan toraks resolusi tinggi dapat secara akurat menggambarkan karakteristik morfologi suatu tumor sehingga deteksi dini kanker paru dapat segera dilakukan. Penelitian ini bertujuan untuk mencari kesesuaian diagnosis tumor paru primer (jinak/ganas) berdasarkan CT scan toraks tanpa kontras dengan hasil pemeriksaan Patologi Anatomi sebagai standar baku emas. Bahan dan cara. Metode penelitian ini menggunakan desain penelitian observasional analitik untuk uji kesesuaian diagnostik dengan membandingkan interpretasi CT scan toraks tanpa kontras dan menilai karakteristik morfologi tumor paru primer dengan hasil Patologi Anatomi. Pengambilan sampel secara retrospektif yang dilakukan di Instalasi Radiologi RSUP Dr. Sardjito. Subyek penelitian ini adalah citra CT scan toraks yang tersimpan pada computer work station dan di interpretasi oleh dokter spesialis radiologi. Hasil. Terdapat kesesuaian yang baik antara interpretasi Radiologi terhadap hasil pemeriksaan Patologi Anatomi dengan sensitivitas 87.5%, spesifisitas 87.5% dan akurasi 87.5% dari 24 sampel tumor ganas dan 24 sampel tumor jinak yang digunakan. Dari 7 komponen karakteristik morfologi tumor paru yang dinilai didapatkan: sensitivitas ukuran tumor 3cm 88%, spesifisitas 58%, akurasi 73% dan tepi irreguler-spiculated sensitivitas 92%, spesifisitas 67%, akurasi 79% dan terdapat kesesuaian terhadap hasil pemeriksaan PA. Karakteristik bentuk complex/lobulated sensitivitas 46%, spesifisitas 63%, akurasi 54%. Densitas mixed-GGO sensitifitas 38%, spesifisitas 46%, akurasi 42%. Temuan kalsifikasi sensitivitas 8%, spesifisitas 88%, akurasi 48%, temuan kavitas sensitivitas 4%, spesifisitas 83% dan akurasi 44%. Air brochograms sensitivitas 63%, spesifisitas 8%, akurasi 35%. Terdapat kesesuaian terhadap karakteristik morfologi bentuk complex/lobulated dan densitas mixed-GGO terhadap hasil PA. Tidak terdapat kesesuaian terhadap temuan kalsifikasi, kavitas maupun air bronchograms. Kesimpulan. Terdapat kesesuaian diagnosis tumor paru primer berdasarkan CT scan toraks tanpa kontras dengan hasil pemeriksaan PA, kesesuaian karakteristik morfologi ukuran tumor cm dan tepi irreguler-spiculated dengan nilai akurasi cukup tinggi serta kesesuaian pada karakteristik bentuk complex/lobulated dan densitas mixed-GGO dengan akurasi tidak cukup tinggi namun tidak terdapat kesesuaian pada temuan kalsifikasi, kavitas maupun air bronchograms.

Background. Primary malignant lung tumors or lung cancer is one of the biggest causes of death other than cancer of the liver, stomach, colorectal, breast and esophagus. The use of high-resolution thoracic CT-scan can accurately describe the morphological characteristics of a tumor, thus early detection of lung cancer can be done immediately. This study aimed to explore the diagnosis conformance of primary lung tumors (benign/malignant) based on non-contrsat thoracic CT-scan compared to the results of pathology as the gold standard. Material and methods. This research used analytic observational study design to test the conformance by comparing diagnostic interpretation of non-contrast thoracic CT scan and evaluating the morphological characteristics of primary lung tumors from the pathology results. Sampling was conducted retrospectively in the Department of Radiology, RSUP Dr. Sardjito. The subjects of this research are the thoracic CT scan images stored on a workstation computer and had been interpreted by a radiology specialist. Results. There were good agreement between the radiological interpretation and the results of the pathology with a sensitivity of 87.5%, specificity of 87.5% and accuracy of 87.5% from 24 malignant tumors samples and 24 benign tumor samples used. Of the seven morphological components of lung tumors assessed, the results were: the sensitivity of tumor size 3 cm was 88%, specificity 58%, accuracy 73% and the the sensitivity of irregular-spiculated edge was 92%, specificity 67%, accuracy 79% and there was conformance of the results with pathology result. Complex/lobulated shape characteristics had sensitivity of 46%, specificity 63%, accuracy 54%. Mixed-GGO density had sensitivity of 38%, specificity 46%, accuracy 42%. The findings of calcifications had sensitivity of 8%, specificity 88%, accuracy 48%, sensitivity of the cavity finding was 4%, specificity 83% and accuracy of 44%. Air bronchograms had sensitivity of 63%, specificity of 8%, 35% accuracy. There were conformity to the morphological characteristics of complex/lobulated shapes and mixed-GGO density with the results of pathology. There were no conformity to the findings of calcifications, cavities and air bronchograms. Conclusion. There was conformance of primary lung tumor diagnosed by non-contrast thoracic CT scan with the results of pathology. The conformance of the morphological characteristics of tumor size 3 cm and irregular spiculated edge had high enough accuracy value. The conformance of complex/lobulated shapes and mixed-GGO density characteristics did not have high enough of accuracy. There was no conformity on the findings of calcifications, cavities and air bronchograms.

Kata Kunci : non-contrast thoracic CT scan, primary lung tumors, tumor morphology