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All Journal Jurnal Plastik Rekonstruksi The New Ropanasuri Journal of Surgery Indonesian Journal of Cancer
Diani Kartini
Department Of Surgery, FM Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital
Biochemistry, Genetics & Molecular Biology Civil Engineering, Building, Construction & Architecture Health Professions Immunology & microbiology Medicine & Pharmacology Public Health Other

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Triple Diagnostic Accuracy on Early Stage Breast Cancer at dr. Cipto Mangunkusumo and Persahabatan General Hospital Kartini, Diani; Megatia, Ika; Darmiati, Sawitri; Rustamadji, Primariadewi; Budiningsih, Setyawati
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Breast cancer is the most common cancer in Indonesia with incidence rate 40.3 per 100.000 women and mortality rate 16.6 per 100.000women. On early stage, the decision for operative procedure (i.e. mastectomy) requires intraoperative frozen section to assess malignancy; which is mostly unavailable in secondary hospitals. The triple diagnostic (TD) test consists of physical examination, breast ultrasonography and fine needle aspiration biopsy is an accurate and simple preoperative diagnostic method that may solve the problem. The study aimed to find out conformance of the triple diagnostic to histopathology findings in those with breast lump where the malignancy was suspected. Method. A study of diagnostic accuracy conducted enrolling subjects with suspected malignant breast lump managed in dr Cipto Mangunkusumo General Hospital (RSCM) and Persahabatan Hospital (RSP) in period of February 2016 to August 2017 who met the criteria: those underwent preoperative triple diagnostic, intraoperative frozen section and histopathology examination. The conformance of TD and frozen section were compared to histopathology findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were the focuses of the study. Results. There were 33 subjects enrolled (prevalence of 4.3%), mean age of 49.6 years ± 10.9, were above 40 years (78.8%). Tumor size of 2–5 cm found in 63.6% subjects, and the most histopathology finding was invasive carcinoma (84.8%). Frozen section showed sensitivity of 96.8%, specificity of 100%, PPV of 100%, NPV of 66.7% and accuracy of 97.0%. TD showed sensitivity of 77.4%, specificity of 100%, PPV of 100%), NPV of 22.2% and accuracy of 78.8% (p = 0.016). Conclusion. Triple diagnostic reaches up to 78% accuracy on early stage breast cancer may be used secondary hospital in Indonesia whenever frozen section is unavailable.
Association between Obesity and Hormone Receptor Characteristics of Primary Breast Cancer at Cipto Mangunkusumo General Hospital, Jakarta, in 2017 Gunardi, Hardian; Kartini, Diani
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction. Obesity is an independent risk factor and prognostic factor of primary breast cancer. Abundant adipose tissue would lead to increment of blood estrogen level; thus, promoting proliferation of cancer cell, especially those with positive estrogen receptor (ER) and progesterone receptor (PR). No study reported the association between obesity and hormone receptor characteristics of primary breast cancer in Indonesia. Method. We collected cases of primary breast cancer which is diagnosed and undergone immunohistochemistry examination at Cipto Mangunkusumo General Hospital in 2017. The subjects divided into obese group and non-obese group. The ER and PR characteristics of both groups were compared Results. We collected 202 cases of primary breast cancer, with 89 cases (44%) in obese group and 113 cases (56%) in non-obese group. The mean body mass index (BMI) of the subjects was 24.45±4.3. Both groups were similar in terms of age, menopausal status, stage, histopathological morphology and grade. No significant association was found between obesity and ER or PR. We analyzed correlation between BMI and the percentage of expressed hormone receptor, but no correlation was found. This finding did not conform with other Western studies. Difference in characteristics of the subjects and other hormonal factors might contribute to the outcome. Conclusion. There is no association between obesity and hormone receptor characteristics of primary breast cancer at Cipto Mangunkusumo General Hospital in 2017. Keywords: obesity, hormone receptor, estrogen, progesterone, primary breast cancer
The Role of Melatonin in Improving Hypoxia in Malignant Tumor: A Mini-Review Kartini, Diani; Taher, Akmal; Panigoro, Sonar S.; Setiabudy, Rianto; Jusman, Sri W; Haryana, Sofia M; Abdullah, Murdani; Rustamadji, Primariadewi
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Circulating Tumor Cell and Regulator T-Lymphocyte in Core Biopsy for Breast Cancer Panigoro, Sonar Soni; Kartini, Diani; Wulandari, Dewi; Supono, Arif
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Introduction: Breast cancer is the most common malignancy found in Indonesia. Core biopsy is one of the modalities used in breast cancer diagnosis with sensitivity of 91-99% and specificity of 96-100%. The procedure causes damage to tumor tissue thus causing tumor cells to enter circulation (CTC) and therefore acute inflammation and infiltration of inflammatory cells. In the final phase of infiltration, the number of Tregs cells will increase, as well as secretion of TGFβ and IL-10, creation of immunosuppresion microenvironment, COX2 stimulation by TGFβ then conversion of CD4+ T cells into FoxP3+ (Tregs), therefore the number of Tregs cells will increase. SOX-4 is activated by TGFβ, and then EMT proccess occurs, tumor cells enter circulation and CTC number will increase. Considering the side effect of core biopsy which is entrance of tumor cells to circulation causing the procedure to be in debate/contradicting opinions. Based on this premise, this study aims to investigate whether there is a change and relationship in Tregs count and CTC count before and after core biopsy procedure. Methods: This study includes 32 blood sample from patients with Stage III and IV breast cancer who went to surgical oncology outpatient clinic in Dr. Cipto Mangunkusumo National Central General Hospital (RSCM) and Gatot Subroto Army Hospital (RSPAD) before and 2 weeks after core biopsy during August to December 2016. Blood is sent to Clinical Pathology Laboratory of RSCM-FKUI to be measured its Tregs count (CD4, CD25, FoxP3 biomarker) and CTC count (CK19 biomarker) using flow cytometry. Statistical analysis was performed using Wilcoxon to determine the difference in CTC/Tregs count before and after core biopsy. Spearman correlation test was performed to determine the relationship between Tregs count and CTC count. Results: Results showed decrease in number of CTC after core biopsy with P value of 0.569 (p > 0.05). There was a decline in Tregs count after core biopsy with p value of 0.049. Small rho value (r=0.165, r=0.235, r=0.046) and p value greater than 0.05 signifies that there is no association between Tregs count to CTC count before or after procedure. Conclusion: Core biopsy do not cause increase in CTC or Tregs, however it cannot be concluded that the procedure is safe, despite the significant finding is only in the decline of Tregs count but not for CTC count. There is no association between Tregs count to CTC count before or after core biopsy.
Consequential Surgeries Limit Recurrence of Skin Malignancies in Xeroderma Pigmentosum: A Case Report Kurnia, Ahmad; Kartini, Diani; Herwirastri, Novinda; Adyasa, Zoya M
The New Ropanasuri Journal of Surgery
Publisher : UI Scholars Hub

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Xeroderma Pigmentosum (XP) is a rare inherited skin malignancy with no causative treatment options. Reporting a 23-year-old woman with xeroderma pigmentosum who underwent several surgical tumor removals followed by further five procedures to apply tissue expander, facial resurfacing using full-thickness skin grafts with a donor from abdominal. The next series was tumor resection in the chin, forehead, nasal reconstruction, tumor removal on bilateral third digits, and defect closure. No recurrence after nine years of postoperative monitoring with an aesthetically acceptable result.
Impact of Artificial Intelligence on Mammography Interpretation by Breast Radiologists, Non-Breast Radiologists, and Senior Residents Darmiati, Sawitri; Afifi, Rahmi; Billy, Christy Amanda; Panigoro, Sonar Soni; Kartini, Diani; Prihartono, Joedo
Indonesian Journal of Cancer Vol 17, No 4 (2023): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v17i4.1100

Abstract

Background: Artificial intelligence (AI) is recognized to have tremendous potential to revolutionize breast cancer management through mammography. However, the extent of its impact on radiologists with different levels of experience remains largely unexplored. Therefore, this study aimed to comprehensively show how AI could assist radiologists of varying expertise including breast and non-breast radiologists, as well as senior residents, in performing mammogram interpretation.Methods: This retrospective study analyzed eligible mammograms from Cipto Mangunkusumo Hospital between January 2017 and March 2021. Mammographic readings were conducted independently by two breast radiologists, two from other subspecialties, and three senior residents, all blinded to clinical information. AI standalone performance, as well as radiologists with and without AI assistance, was measured. Results: The results showed that a total of 886 eligible mammograms were analyzed. AI standalone performance, assessed using ROC curve analysis, yielded an AUC of 0.946 (95% CI, 0.925–0.967) with sensitivity and specificity of 90.1% and 93.6%, respectively. AI assistance significantly improved the sensitivity and specificity of all radiologists, regardless of experience level, with a median increase of 19.4% (IQR, 10.4–33.5%) and 12.1% (IQR, 5.2–16.2%), respectively. Moreover, there was a trend toward a higher increase with AI assistance in dense compared to fatty breasts.Conclusions: AI proved to be a highly effective diagnostic supplement for radiologists across varying experience levels, specifically in non-breast radiologists, offering the potential to add even greater value in cases of dense breast tissue. The results were derived from a national referral tertiary hospital that generally received many breast cancer cases referred from other hospitals for further treatment. Therefore, further studies incorporating different levels of hospitals were needed.
Free Flap Evaluation Following Reconstruction of Locally Advanced Squamous Cell Carcinoma of The Tongue Atmodiwirjo, Parintosa; Kartini, Diani; Arina, Maryam Nur; Sapphira, Elrica; Ramadan, Mohamad Rachadian; Triatmoko, Sara Ester
Jurnal Plastik Rekonstruksi Vol. 10 No. 2 (2023): Jurnal Plastik Rekonstruksi
Publisher : Lingkar Studi Bedah Plastik Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14228/jprjournal.v10i2.361

Abstract

Background: Neoadjuvant chemotherapy (NAC) is a crucial component in the management of tongue-based locally advanced squamous cell carcinoma (LASCC) due to its ability to decrease tumor mass and facilitate free tissue transplantation. The utilization of adjuvant radiation and chemotherapy has been observed to decelerate the progression of post-operative tumor growth. Probability of free flap failure is elevated. Post-operative complications and the long-term functional outcomes of speaking, salivation, and swallowing determine the quality of free flaps. Methods: A retrospective review of tongue LASCC patients who underwent NAC followed by glossectomy and free tissue transfer from 2015 to 2018. Tongue functional outcomes of speaking, swallowing, and salivation were assessed using FACE-Q scale in 3 times follow-up period. Result: This study included 7 patients who underwent tongue reconstruction. Treatment modalities were based on tumor presentation, with 4 patients (57.1%) receiving Taxane, 5-Fluorouracil, and Paclitaxel/Doclitaxel (TPF), and 3 patients (42.1%) receiving Paclitaxel and 5-Fluorouracil (PF). Tongue reconstruction utilized the radial forearm free flap in 5 patients (71.4%) and the anterolateral thigh free flap in 2 patients (28.6%). Intraoperatively, NAC had no impact on the integrity of small and reliable donor vessels. Three patients died from tumor metastases after the second follow-up assessment, while one patient was lost to follow-up. The study found no significant association between chemotherapy dosage and free flap vitality (P = 0.629). FACE-Q assessments revealed moderate to low scores in speaking, eating, and drinking outcomes. Conclusion: Tongue reconstruction after NAC in LASCC patients remains a challenging procedure for surgeons. While the consideration of surgical difficulties due to damage of the donor vessels demands a more structured pre-operative plan. No correlation between the exposure of NAC or AR to free flap complication as well as functional outcome.
Co-Authors Adyasa, Zoya M Afifi, Rahmi Akmal Taher Arina, Maryam Nur Atmodiwirjo, Parintosa Billy, Christy Amanda Darmiati, Sawitri Dewi Wulandari Gunardi, Hardian Gunawan Wibisana Haryana, Sofia M Herwirastri, Novinda Joedo Prihartono Jusman, Sri W Kurnia, Ahmad Megatia, Ika Mohamad Rachadian Ramadan Murdani Abdullah Primariadewi Rustamadji Rianto Setiabudy Sapphira, Elrica Setyawati Budiningsih Sonar S. Panigoro Sonar Soni Panigoro Supono, Arif Triatmoko, Sara Ester