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Level of Retinol Deposit and Cervical Cancer Utami, Tofan W; Ibrahim, Fera; Purwoto, Gatot; Tiffani, Wely L; Aziz, Muhammad F; Andrijono, Andrijono
Indonesian Journal of Obstetrics and Gynecology Volume. 5, No. 1, January 2017
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To analyze level of retinol deposit sufficiency in the natural history of cervical cancer. Methods: Serum retinol level was measured by ELISA from peripheral blood of subjects with normal cervix, cleared and persistent high risk human papilloma virus (HR-HPV) subclinical infection, and cervical cancer who fulfilled the inclusion and exclusion criteria. The study was held in Dr. Cipto Mangunkusumo and Fatmawati Hospital, Jakarta, within 2 years (August 2013- 2015). Blood was taken twice, consisting of post-8-hour fasting blood and 2 hours after 6000 IU retinyl palmitate oral administration. Results: Of 47 total samples, sufficient level of retinol deposit in normal cervix, cleared and persistent HR-HPV subclinical infection, and cervical cancer group was 85.0% (reference), 75.0% (OR 1.89), 33.3% (OR 11.33), and 75% (OR 1.89); respectively. Statistically, there was no significant difference from sufficiency level of retinol deposit between normal cervix and clearance HR-HPV subclinical infection (p=0.628), normal cervix and persistent HR-HPV subclinical infection (p=0.078), normal cervix and cervical cancer (p=0.433), cervical cancer and clearance HR-HPV subclinical infection (p=1.000), cervical cancer and persistent HR-HPV subclinical infection (p=0.430), persistent and clearance HR-HPV subclinical infection group (p=0.740). Conclusion: This study proves that normal cervix group has the highest level of retinol deposit sufficiency; however, it cannot be stated that cervical cancer group has less sufficiency level. Persistent HR-HPV subclinical infection group has the lowest level of retinol deposit (OR 11.33). There is no association between sufficient level of retinol deposit and clearance of HR-HPV. [Indones J Obstet Gynecol 2017; 5-1: 46-54] Keywords: cervical cancer, HR-HPV clearance, retinol deposit

Human Papillomavirus Genotypes and its Prevalence in Normal Population Utami, Tofan W
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 4, October 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: Over 200 types of human papillomavirus (HPV) have been recognized on the basis of DNA sequence. Multiple infection is more prone to be persistent than single infection. The purpose of this study is to assess the variation of HPV types and their prevalence among negative VIA as normal population in Indonesian women. Method: We processed cervical swabs from 1,214 patients with negative VIA. HPV DNA and its genotypes were detected using PCR based INNO-Lipa HPV DNA test. We also classified whether each infection is single or multiple. Result: From 1,214 women with negative VIA, 39 (3.21%) samples were positive for HPV DNA. Among them, we detected 19 types of HPV, consisting of 13 types of high-risk HPV, 5 types of low-risk HPV, and 1 type of unknown HPV (type X). The most prevalent type was HPV type 52 (18.31%), followed by type 39 and X with the same proportion (9.86%), and HPV type 16, 18, and 74 (each 8.45%). Of the total 39 HPV-positive samples, 17 (43.6%) showed multiple-type infection and 22 (56.4%) showed single-type infection. The majority of single infection involves high-risk-HPV. The remaining were type 6, 44, 18, 51 and 66, with each single-type infection showing a prevalence of 4.54%. Conclusion: Our study shows that single HPV infection among the negative VIA population are dominated by high-risk type HPV (types 52, 39, 16, and 18). Single infection was more often encountered than multiple infection. [Indones J Obstet Gynecol 2014; 4: 211-215] Keywords: HPV DNA, HPV genotypes, multiple infection, negative VIA, single infection

Visual Inspection of Acetic Acid (VIA) as a Promising Standard for Cervical Cancer Screening Utami, Tofan W
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 4, October 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To evaluate the "false negative" of VIA in our study population compared to HPV DNA test as the reference test or gold standard. Method: We processed the cervical swab from 1,279 patients with negative VIA and detected the HPV DNA by using INNO-Lipa HPV DNA test. Result: From 1,279 women with negative VIA, 65 samples were excluded because of incomplete data and duplicate examination. From the remaining 1,214 women with negative VIA, 39 samples were confirmed to be positive for HPV DNA by both PCR and hybridization, leading to a "false negative" result of 3.21%. Conclusion: This study shows VIA as a very effective method for cervical cancer screening. VIA gives an excellent result, particularly for ectocervix, with minimal cost. Therefore, it is very suitable to be used as cervical cancer screening in developing countries like Indonesia. [Indones J Obstet Gynecol 2014; 4: 216-219] Keywords: cervical cancer, HPV DNA, negative VIA, screening, VIA

Accuracy of Intraoperative Frozen Section in Diagnosing Malignancy of Ovarian Neoplasm Utami, Tofan W; Iskandar, Jasmine; Tanamas, Gregorius; Jamtani, Mona; Nuranna, Laila; Nuryanto, Kartiwa H
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 3, July 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To evaluate the accuracy of frozen section for ovarian neoplasm in our hospital. Method: A retrospective evaluation was conducted on medical records of patients with ovarian neoplasms who underwent a frozen section laparotomy between the years 2008 and 2013 at Dr. Cipto Mangunkusumo Hospital. Records with incomplete data on frozen section or paraffin block report were excluded. Criteria for frozen section laparotomy in our facility was based on a malignancy score of equal to or more than 6. Frozen section reports were compared to paraffin block report based on benign, borderline, or malignant cases. Result: From 139 patients with ovarian neoplasm, only 91 patients fulfilled the inclusion and exclusion criteria. Frozen section examination revealed benign cases was 15.4%, borderline cases was 15.4%, and malignant cases was 69.2%. Based on histopathological type, clear cell cystoadenocarcinoma was the most commonly observed histotype (19.8%). The sensitivity of frozen section for benign, borderline, and malignancy cases respectively was 81.8%, 76.9%, 91.0%. The specificity of frozen section for benign, borderline, and malignancy case respectively was 93.8%, 94.8%, 91.6%. Conclusion: We found that the accuracy of intraoperative frozen section in our facility is adequate to diagnose ovarian neoplasm and can be used to assist in determining the extent of surgical management. [Indones J Obstet Gynecol 2015; 3: 161-164] Keywords: frozen section, ovarian neoplasm, paraffin block, sensitivity, specitificity

Prevalence of High-Risk Human Papillomavirus (HPV) among Negative Visual Inspection of Acetic Acid (VIA) Utami, Tofan W
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 3, July 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: Persistence of high-risk HPV infection is known to be the major cause of cervical cancer. It is important to differentiate the genotype of HPV infection, whether it is high, intermediate or low risk. The aim of this study was to assess the prevalence of high-risk HPV types among Indonesian women with negative VIA. Method: We analyzed cervical swabs from 1,214 patients with negative VIA. By using INNO-Lipa HPV DNA test, we detected the HPV DNA and its genotype. Result: From the 1,214 women with negative VIA, 48 (3.95%) samples were confirmed to have positive HPV DNA by using PCR and electrophoresis. However, hybridization test were not able to detect HPV genotypes in 9 samples. These 9 samples were tested again with PCR and electrophoresis and resulted in negative HPV DNA. Among the remaining 39 samples (3.21%), we detected 19 types of HPV, consisting of 13 types of high-risk HPV, 5 types of low-risk HPV, and 1 type of unknown HPV (type X). Conclusion: Among patients with negative VIA, 3.21% was found to be positive for HPV DNA. From this percentage, the prevalence of high-risk HPV is higher than the low-risk and unknown HPV. Therefore we cannot ignore results of negative VIA, particularly in highrisk group, because there is a slight possibility that presence of HPV can be identified, especially the high risk ones which have a tendency to be persistent. We support the importance of HPV DNA test as cervical cancer screening method. [Indones J Obstet Gynecol 2014; 3: 153-156] Keywords: cervical cancer, high-risk HPV, negative VIA

Prevalence of High-Risk Human Papillomavirus (HPV) among Negative Visual Inspection of Acetic Acid (VIA) Utami, Tofan W
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 3, July 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: Persistence of high-risk HPV infection is known to be the major cause of cervical cancer. It is important to differentiate the genotype of HPV infection, whether it is high, intermediate or low risk. The aim of this study was to assess the prevalence of high-risk HPV types among Indonesian women with negative VIA. Method: We analyzed cervical swabs from 1,214 patients with negative VIA. By using INNO-Lipa HPV DNA test, we detected the HPV DNA and its genotype. Result: From the 1,214 women with negative VIA, 48 (3.95%) samples were confirmed to have positive HPV DNA by using PCR and electrophoresis. However, hybridization test were not able to detect HPV genotypes in 9 samples. These 9 samples were tested again with PCR and electrophoresis and resulted in negative HPV DNA. Among the remaining 39 samples (3.21%), we detected 19 types of HPV, consisting of 13 types of high-risk HPV, 5 types of low-risk HPV, and 1 type of unknown HPV (type X). Conclusion: Among patients with negative VIA, 3.21% was found to be positive for HPV DNA. From this percentage, the prevalence of high-risk HPV is higher than the low-risk and unknown HPV. Therefore we cannot ignore results of negative VIA, particularly in highrisk group, because there is a slight possibility that presence of HPV can be identified, especially the high risk ones which have a tendency to be persistent. We support the importance of HPV DNA test as cervical cancer screening method. [Indones J Obstet Gynecol 2014; 3: 153-156] Keywords: cervical cancer, high-risk HPV, negative VIA

Human Papillomavirus Genotypes and its Prevalence in Normal Population Utami, Tofan W
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 4, October 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: Over 200 types of human papillomavirus (HPV) have been recognized on the basis of DNA sequence. Multiple infection is more prone to be persistent than single infection. The purpose of this study is to assess the variation of HPV types and their prevalence among negative VIA as normal population in Indonesian women. Method: We processed cervical swabs from 1,214 patients with negative VIA. HPV DNA and its genotypes were detected using PCR based INNO-Lipa HPV DNA test. We also classified whether each infection is single or multiple. Result: From 1,214 women with negative VIA, 39 (3.21%) samples were positive for HPV DNA. Among them, we detected 19 types of HPV, consisting of 13 types of high-risk HPV, 5 types of low-risk HPV, and 1 type of unknown HPV (type X). The most prevalent type was HPV type 52 (18.31%), followed by type 39 and X with the same proportion (9.86%), and HPV type 16, 18, and 74 (each 8.45%). Of the total 39 HPV-positive samples, 17 (43.6%) showed multiple-type infection and 22 (56.4%) showed single-type infection. The majority of single infection involves high-risk-HPV. The remaining were type 6, 44, 18, 51 and 66, with each single-type infection showing a prevalence of 4.54%. Conclusion: Our study shows that single HPV infection among the negative VIA population are dominated by high-risk type HPV (types 52, 39, 16, and 18). Single infection was more often encountered than multiple infection. [Indones J Obstet Gynecol 2014; 4: 211-215] Keywords: HPV DNA, HPV genotypes, multiple infection, negative VIA, single infection

Visual Inspection of Acetic Acid (VIA) as a Promising Standard for Cervical Cancer Screening Utami, Tofan W
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 4, October 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To evaluate the "false negative" of VIA in our study population compared to HPV DNA test as the reference test or gold standard. Method: We processed the cervical swab from 1,279 patients with negative VIA and detected the HPV DNA by using INNO-Lipa HPV DNA test. Result: From 1,279 women with negative VIA, 65 samples were excluded because of incomplete data and duplicate examination. From the remaining 1,214 women with negative VIA, 39 samples were confirmed to be positive for HPV DNA by both PCR and hybridization, leading to a "false negative" result of 3.21%. Conclusion: This study shows VIA as a very effective method for cervical cancer screening. VIA gives an excellent result, particularly for ectocervix, with minimal cost. Therefore, it is very suitable to be used as cervical cancer screening in developing countries like Indonesia. [Indones J Obstet Gynecol 2014; 4: 216-219] Keywords: cervical cancer, HPV DNA, negative VIA, screening, VIA

Accuracy of Intraoperative Frozen Section in Diagnosing Malignancy of Ovarian Neoplasm Utami, Tofan W; Iskandar, Jasmine; Tanamas, Gregorius; Jamtani, Mona; Nuranna, Laila; Nuryanto, Kartiwa H
Indonesian Journal of Obstetrics and Gynecology Volume. 3, No. 3, July 2015
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To evaluate the accuracy of frozen section for ovarian neoplasm in our hospital. Method: A retrospective evaluation was conducted on medical records of patients with ovarian neoplasms who underwent a frozen section laparotomy between the years 2008 and 2013 at Dr. Cipto Mangunkusumo Hospital. Records with incomplete data on frozen section or paraffin block report were excluded. Criteria for frozen section laparotomy in our facility was based on a malignancy score of equal to or more than 6. Frozen section reports were compared to paraffin block report based on benign, borderline, or malignant cases. Result: From 139 patients with ovarian neoplasm, only 91 patients fulfilled the inclusion and exclusion criteria. Frozen section examination revealed benign cases was 15.4%, borderline cases was 15.4%, and malignant cases was 69.2%. Based on histopathological type, clear cell cystoadenocarcinoma was the most commonly observed histotype (19.8%). The sensitivity of frozen section for benign, borderline, and malignancy cases respectively was 81.8%, 76.9%, 91.0%. The specificity of frozen section for benign, borderline, and malignancy case respectively was 93.8%, 94.8%, 91.6%. Conclusion: We found that the accuracy of intraoperative frozen section in our facility is adequate to diagnose ovarian neoplasm and can be used to assist in determining the extent of surgical management. [Indones J Obstet Gynecol 2015; 3: 161-164] Keywords: frozen section, ovarian neoplasm, paraffin block, sensitivity, specitificity

Risk of Malignancy Index is not accurate as a Triage Tool for Ovarian Cancer Tanamas, Gregorius; Iskandar, Jasmine; Utami, Tofan W; Anggraeni, Tricia D; Nuryanto, Kartiwa H
Indonesian Journal of Obstetrics and Gynecology Volume. 2, No. 1, January 2014
Publisher : Indonesian Socety of Obstetrics and Gynecology

Objective: To evaluate Risk of Malignancy Index (RMI) as a triage tool for ovarian cancer in Dr. Cipto Mangunkusumo Hospital. Method: This is a retrospective study conducted from January 2008-December 2012 in patients diagnosed with ovarian mass. Patients admitted for surgery due to ovarian masses were included to this study. RMI 3 score was calculated based on ultrasonography examination in Dr. Cipto Mangunkusumo Hospital, CA-125 test and menopausal status. Patients without final pathological report and incomplete data were excluded from study. Data were analysed using SPSS 20 to evaluate RMI result and final pathlogical report in benign and malignant case. Result: From 882 patients identified with ovarian masses from cancer registry, only 99 patients aged 17-70 y.o were included in this study. Most of the patients were nully-parity (28.3%), non-menopausal women (60.6%), normal body mass index (40.4%), and with stage IIIC ovarian cancer (33.3%). Ultrasonography examination showed that most of patients had solid mass and ascites (19.2%). Meanwhile, CA-125 showed that patients with <35 U/ml were 10.1% and ≥ 35 U/ml were 89.9%. Patients with RMI scores <200 (benign cases) were 19 cases (19.2%) and ≥ 200 (malignant cases) were 80 cases (80.8%). Meanwhile, patients with benign final pathological report were 23 cases (23.2%) and malignant cases were 76 cases (76.8%). There was no statistical difference in RMI between benign and malignant cases based on final pathological report. Conclusion: Our study showed that RMI was not accurate as triage tool for ovarian cancer in our hospital. Further investigation and more patients are needed to confirm this study. Keywords: CA-125, menopausal status, ovarian cancer, risk of malignancy index (RMI), ultrasonography.

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