Akurasi Pewarnaan Histokimia Nucleolar Argyrophilic Organizing Regions (AgNORs) dan Ki-67 untuk Membedakan Lesi Jinak, Premalignan dan Malignan Jaringan Prostat

Abstract

Latar belakang: Identifikasi sel-sel basal dengan pewarnaan Hematoksilin dan Eosin (H&E) tidaklah mudah pada jaringan prostat. Sehingga bisa saja terjadi sel-sel basal mungkin tidak dikenali pada kelenjar-kelenjar jinak tanpa pewarnaan khusus. Metode: Penelitian uji diagnostic untuk menilai akurasi diagnostik AgNORs dan IHK Ki-67 dalam mendiagnosis lesi jinak, premalignan dan malignan jaringan prostat. Penelitian dilakukan di Laboratorium Departemen Patologi Anatomik Fakultas Kedokteran Universitas Sumatera Utara, jalan Universitas No. 1 Gedung Abdul Hakim Lt. 1 Kampus USU-Medan. Hasil: Analisis ROC mendapatkan nilai AUC 0,962. Nilai cut-off point lesi malignan pada pewarnaan AgNORs ≥12,5%, memberikan akurasi 90,9%; sensitivitas 94,7%; spesifisitas 82,4%; PPV 92,3%; NPV 87,5%; (LR+) 5,38 dan LLR (-) 0,06. Pewarnaan IHK Ki-67 nilai AUC 0,932. Nilai cut-off point lesi malignan ≥27,5% memberikan akurasi 92,7%; sensitivitas 97,4%; spesifisitas 82,4%; PPV 92,5%; NPV 93,3%; (LR+) 5,53 dan LLR (-) 0,03. Lesi premalignan, analisis ROC nilai AUC 0,741. Nilai cut-off point AgNORs ≥ 6,5% memberikan akurasi 66,7%; sensitivitas 82,4%; spesifisitas 58,1%; PPV 51,9%, NPV 85,7%; (LR+) 1,97 dan (LLR-) 0,27. Sementara pada IHK Ki-67 dengan nilai AUC 0,675. Nilai cut-off point lesi premalignan ≥ 4,5% memberikan akurasi 64,6%; sensitivitas 94,1%; spesifisitas 48,4%; PPV 50%; NPV 93,8%; (LR+) 1,82 dan (LLR-) 0,12. Kesimpulan: Dapat dipertimbangkan melakukan pewarnaan AgNORs bersamaan dengan pewarnaan rutin H&E untuk menilai lesi jinak, premalignan dan malignan jaringan prostat, dimana pelaksanaan pemeriksaan pewarnaan ini tidak memerlukan keahlian khusus, harga terjangkau, fasilitas tersedia dengan mudah, pemeriksaan lebih sederhana dan hasil pemeriksaan lebih cepat.

Background: Identification of basal cells on prostate with H&E staining is not easy to find. Therefore, basal cells might not be recognized in benign glands without special staining. Method: This diagnostic test study with analytic cross-sectional design was done to evaluate about the diagnostic of AgNORs and Ki-67 staining in diagnosing benign, premalignant and malignant prostate lesions. Results: For malignant lesions, cut-off point of AgNORs value was ≥12.5% with sensitivity of 94.7%; specificity 82.4%; PPV 92.3%; NPV 87.5%; LR (+)5.38 and LR (-) 0.06 and accuracy 90.9%. Meanwhile, cut-off point of Ki67 value was ≥27.5% with sensitivity of 97.4%; specificity 82.4%; PPV 92.5%; NPV 93.3%; LR (+) 5.53, LR (-) 0.03 and accuracy 92.7%. For premalignant lesions, cut-off point of AgNORs was ≥ 6.5% with sensitivity of 82.4%; specificity 58.1%; PPV 51.9%; NPV 85.7%; LR (+) 1.97, LR (-) 0.27 and accuracy 66.7%. Cut-off point of Ki67 value was ≥ 4.5% with sensitivity of 94.1%; specificity 48.4%; PPV 50%; NPV 93.8%; LR (+) 1.82, LR (-) 0.12 and accuracy 64.6%. Conclusion: This study showed that the AgNORs and Ki-67 staining can differentiate between benign and malignant, premalignant and malignant lesions of the prostate but can‟t be used to differentiate benign and premalignant lesions of the prostate. However, application of AgNORs combined with H&E routine staining can be considered in order to diagnose benign, premalignant and malignant prostate lesions.