KESIMPULAN DAN SARAN
5.1. Kesimpulan
Berdasarkan penelitian ini disimpulkan bahwa LMP1 tertampil pada 82,4% kasus KNF yang bermetastasis pada KGB leher yang diperiksa di Laboratorium PA FKUSU. Terdapat perbedaan tampilan LMP1 pada jenis histopatologik keratinizing squamous cell carcinoma yang seluruhnya negatif dibanding nonkeratinizing carcinoma dengan tampilan LMP1 yang bervariasi. Pewarnaan imunositokimia LMP1 pada sediaan sitologi biopsi aspirasi KGB leher dapat dipergunakan untuk diagnosis metastasis KNF jenis nonkeratinizing carcinoma. Diperlukan penelitian lebih lanjut dengan sampel yang lebih besar dan secara multisenter untuk mengetahui hubungan LMP1 dengan lateralisasi KGB, ukuran (diameter) KGB dan jumlah KGB yang terlibat dalam metastasis KNF.
5.2. Saran
5.2.1. Saran Kepada Klinisi
Pada penelitian ini diketahui rincian gambaran klinik dan hasil pemeriksaan radiologik sangat penting untuk mengarahkan diagnosis metastasis KNF pada KGB leher, sehingga diharapkan klinisi memberikan keterangan lengkap tentang gambaran klinis penderita yang terdiri dari gejala/tanda hidung, gejala/tanda telinga, gejala/tanda intrakranial (saraf dan mata) dan hasil pemeriksaan radiologik (CT-scan atau MRI).
5.2.2. Saran Kepada Ahli Patologi
Status KGB yang diperiksa antara lain lokasi/level KGB, ukuran, jumlah dan lateralisasi (unilateral atau bilateral) sangat penting dalam membantu menentukan diagnosis dan stadium penderita KNF. Sangat penting mencantumkan hal-hal tersebut di atas dalam menentukan hasil pemeriksaan penderita.
5.2.3. Saran Kepada Peneliti Lain
Pemeriksaan adanya EBV dapat membantu menentukan terapi dan prognosis penderita KNF. Diharapkan dilakukan penelitian yang lebih lanjut dengan sampel yang lebih luas dan pemeriksaan yang lebih lengkap (dengan protein EBV lainnya seperti EBER, EBNA dan lain-lain) sehingga diperoleh hasil penelitian yang lebih bermakna.
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LOKASI DIAMETER (cm) 1 2 3 CT MRI I II III D (%) I S 1 2-C/108/12 ES L 54 LEVEL II-KI 0,5 √ √ 2 2 4 2 3-C/129/12 RS P 40 LEVEL II-KA 8 √ √ 2 2 4 3 4-C/185/12 A L 59 LEVEL II-KI 3 √ √ 2 1 3 4 5-C/211/12 R L 53 LEHER KA 5 √ √ 0 0 0 5 6-C/263/12 M P 45 LEHER KI 3 √ √ 2 1 3 6 7-C/287/12 K L 71 LEHER KA 1-2,5 √ √ 3 3 6 M 7 8-C/291/12 HH L 58 LEHER KI 2-3 √ √ 3 3 6 M 8 10-C/376/12 MS L 46 LEHER KA 10 √ (+) √ 1 1 2 9 11-C/388/12 AS L 59 LEHER KA 2 √ √ 2 3 5 10 12-C/390/12 NS L 63 LEHER KA 4 √ √ 2 2 4 11 13-C/400/12 HS L 50 LEHER KI 9 √ √ 2 3 5 12 14-C/466/12 JKG P 71 LEHER KA 2,5 √ √ 2 1 3 13 15-C/482/12 MP P 39 LEHER KI 2,5 √ √ 0 0 0 14 18-C/446/12 MAK L 65 LEHER KI 5 √ √ 2 3 5 15 19-C/101/11 RD P 60 LEVEL II-KI 1-2 √ √ 0 0 0 M 16 20-C/87/11 BT L 70 LEHER KA 1,5 √ √ 0 0 0 17 21-C/155/11 US L 60 LEHER KA 3 √ √ 2 1 3 18 22-C/158/11 MS P 75 LEHER KI 6 √ √ 2 1 3 19 23-C/14/13 RP P 89 LEVEL II-KA 3 √ √ 2 1 3 20 27-C/83/13 R P 63 LEVEL II-KI 3 √ √ 2 2 4 M 21 28-C/128/13 RS P 56 LEVEL II-KA 2 √ √ 2 2 4 22 30-C/135/13 A L 76 LEVEL II-KI 4 √ √ 0 0 0
data sampel penderita knf dengan metastasis ke kgb leher yang dipulas dengan lmp-1
KET
KLINIS (TRIAS) RADIOLOGIS HISTOPATOLOGI (WHO TYPE) LMP1
NO NO REG NAMA
(INISIAL) L/P
UMUR (THN)
LOKASI DIAMETER (CM) 1 2 3 CT MRI I II III D (%) I S
23 31-C/137/13 THH L 48 LEVEL II-KI 4 √ √ 2 3 5
24 32-C/169/13 MS L 51 LEVEL II-KI 3 √ √ 2 3 5
25 33-C/197/13 AS P 47 LEVEL II-KI 3,5 √ √ 0 0 0
26 34-C/366/13 HB L 74 LEHER KI-KA 3 √ √ 2 2 4 B
27 36-C/446/13 DBS L 43 LEVEL II-III KI-KA 2-7 √ (+) √ 2 2 4 M+B
28 37-A/5673/13 RS L 41 LEVEL II KI-KA 2 √ (+) √ 2 2 4 STD III M+B
29 39-C/424/13 JM L 61 LEVEL II-KA 1,5 √ √ 2 2 4 30 40-C/182/11 MS L 54 LEVEL II-KI 6 √ √ 2 2 4 31 41-C/189/11 JG P 65 LEVEL II-KA 2,5 √ √ 2 1 3 32 42-C/415/11 LS L 58 LEVEL II-KA 1,5-2,5 √ √ 3 3 6 M 33 43-C/418/11 D P 42 LEVEL II-KI 2 √ √ 2 2 4 34 44-C/1310296 W P 40 LEHER II KA-KI 4 √ √ 3 3 6 B 21 13 28 6 23 11 3 2 26 KETERANGAN :
TRIAS I : KGB membesar, gejala hidung & telinga (+) CT : CT-SCAN
TRAS II : KGB membesar, gejala hidung & telinga, mata & saraf (+) MRI : Magnetic Resonance Imaging TRIAS III : Gejala intrakranial (saraf+mata), hidung & telinga (+)
KLASIFIKASI HISTOPATOLOGIK
LOKASI KGB : I : Keratinizing squamous cell carcinoma
LEVEL II : KGB leher lateral atas, setinggi angulus mandibula II : Nonkeratinizing carcinoma LEVEL III : KGB leher lateral tengah di bawah KGB level II III : Basaloid squamous cell carcinoma
KI : KIRI M : MULTIPEL
KA : KANAN B : BILATERAL
KNF : Karsinoma nasofaring STD III : stadium III
KGB : Kelenjar getah bening
J U M L A H
NO NO REG NAMA
(INISIAL) L/P UMUR
KLINIS (TRIAS) RADIOLOGIS HISTOPATOLOGIK (WHO TYPE)
KET
HASIL ANALISA SPSS
KLASIFIKASI * skor Crosstabulation Count skor Total 0 LOW EXPRESSION HIGH EXPRESSION KLASIFIKASI KERATINIZING 3 0 0 3 NONKERATINIZING 3 8 20 31 Total 6 8 20 34
LATERALISASI * SKORLMP1 Crosstabulation Count SKORLMP1 Total negatif positif LATERALISASI unilateral 6 24 30 bilateral 0 4 4 Total 6 28 34
UKURAN * SKORLMP1 Crosstabulation Count SKORLMP1 Total negatif positif UKURAN < 6CM 6 22 28 > 6CM 0 6 6 Total 6 28 34
KLASIFIKASI * SKORLMP1 Crosstabulation Count SKORLMP1 Total negatif positif KLASIFIKASI KERATINIZING 3 0 3 NONKERATINIZING 3 28 31 Total 6 28 34
Chi-Square Tests Value df Asymp. Sig. (2- sided) Exact Sig. (2- sided) Exact Sig. (1- sided) Pearson Chi-Square 15.355a 1 .000 Continuity Correctionb 9.769 1 .002 Likelihood Ratio 11.976 1 .001
Fisher's Exact Test .003 .003
Linear-by-Linear Association 14.903 1 .000 N of Valid Cases 34
a. 2 cells (50.0%) have expected count less than 5. The minimum expected count is .53. b. Computed only for a 2x2 table
JUMLAH * SKORLMP1 Crosstabulation Count SKORLMP1 Total negatif positif JUMLAH TUNGGAL 5 20 25 MULTIPEL 1 8 9 Total 6 28 34
A
B
C
D
Gambar 1. Sediaan Sitologi KGB dengan metastasis KNF dengan pewarnaan Hematoksilin & Eosin (A), dan Papanicolaou (B,C,D). A,B,C Jenis nonkeratizing carcinoma, D. Jenis keratinizing squamous cell carcinoma.
A
B
Gambar 2. Sediaan sitologi dengan pewarnaan imunositokimia LMP1. A. Tampilan negative pada keratinizing squamous cell carcinoma. B. Tampilan
A
BC
D
E
F
Gambar 3. Tampilan LMP1 pada sediaan sitologi KGB dengan variasi intensitas A. Negatif; B,C,D,E,F,G Positif