NILAI DIAGNOSTIK ULTRASONOGRAFI DOPPLER DALAM MENENTUKAN KEGANASAN TUMOR OVARIUM DIBANDINGKAN HASIL HISTOPATOLOGI

Kanker ovarium merupakan keganasan organ viseral dan paling mematikan serta dianggap silent killer. Kanker ini umumnya baru menimbulkan keluhan bila telah menyebar ke rongga peritoneum atau organ visera lainnya. Pada tingkat ini penyakit telah mencapai stadium lanjut sehingga tindakan pembedahan dan terapi adjuvan seringkali tidak menolong. Kurangnya gejala awal maupun sensitifitas skrining serta teknik deteksi dini merupakan alasan keterlambatan dalam diagnosis. Pengenalan dini kanker ovarium stadium awal berdasarkan pemeriksaan fisik saja tidak cukup sehingga perlu dilengkapi pemeriksaan radiologi seperti Ultrasonografi (USG), Computted Tomography Scan, Magnetic Resonance Imaging (MRI). USG Doppler adalah teknik pencitraan yang sering digunakan, noninvasif, biaya relatif murah, dan  ditoleransi dengan baik. Penggunaan USG Doppler dimungkinkan untuk menilai vaskularisasi tumor dan nilai resistive index. Penelitian ini bertujuan mengetahui nilai diagnostik USG Doppler dalam menentukan keganasan tumor ovarium dibandingkan hasil histopatologi. Penelitian ini dilaksanakan di Bagian Radiologi RS. Dr. Wahidin Sudirohusodo dan RS. Universitas Hasanuddin, Makassar dimulai pada bulan Juni-Agustus 2018. Desain penelitian menggunakan uji diagnostik. Sebanyak 55 sampel dengan klinis tumor ovarium umur 14-67 tahun dilakukan pemeriksaan USG Doppler untuk menilai distribusi vaskuler, jumlah vaskuler, dan nilai resistive index, dilanjutkan sistem kategori untuk menentukan sifat tumor jinak atau ganas. Ganas, jika terdapat ≥ 2 kriteria Doppler ganas, dan jinak jika terdapat < 2 kriteria Doppler ganas. Hasil diagnosis USG Doppler dibandingkan dengan hasil histopatologi. Data dianalisis secara statistik berdasarkan uji diagnostik. Hasil penelitian menunjukkan USG Doppler memiliki nilai diagnostik yang cukup tinggi dalam menilai keganasan tumor ovarium dengan sensitivitas 94,7%, spesifisitas 70,6%, nilai prediksi posistif 87,8%, nilai prediksi negatif 85,7% dan akurasi 87,2%.       Ovarian cancer is a visceral organ malignancy that is lethal and is considered as “silent killer”. This cancer typically cause complaint if it has spread to peritoneum cavity or other visceral organ where the disease reached late stage, thus, surgical or adjuvant therapy is not beneficial anymore. The lack of early manifestation, screening sensitivity and difficulty in early detection technique are reasons for delay diagnosis. Early detection of ovarian cancer based on physical examination is not sufficient, and should be completed with imaging studies such as USG, CT scan, MRI and nuclear medicine. Doppler US is a technique that is non-invasive, relatively cheap and well-tolerated. This examination may assessed tumor vascularization and resistive index. This study aimed to investigate the diagnostic values of Doppler Ultrasound in determining the malignancy of ovarian tumor compared with result of histopathology. This study was conducted in Radiology Department of Dr.Wahidin Sudirohusodo Hospital and Hasanuddin University Hospital, Makassar from June through August 2018. Design of the study was diagnostic test. Doppler Ultrasound examination was carried on 55 samples with clinical sign of ovarian tumor aged between 14-67 years to evaluate the vascular distribution, number of vascular, and values of resistive index; followed by categorical system to determine the characteristics of benign or malignant ovarian tumor. The lesion is considered malignant if two or more Doppler malignant criteria were found, and benign if less than two criteria were found. The result of Doppler was compared to the result of histopathology. Data were analyzed statistically based on diagnostic test. This study result showed that Doppler Ultrasound had diagnostic value which was high enough to evaluate tumor malignancy with sensitivity of 94.7%, specificity of 70.6%, positive predictive value of 87.8%, negative predictive value of 85.7%, and the accuracy of 87.2%.