Peran Narrow Band-Imaging pada Karsinoma Nasofarings

AbstrakKarsinoma nasofarings (KNF) merupakan keganasan yang paling sering ditemukan pada bagian kepala dan leher yang memerlukan kajian jelas dalam penegakkan diagnosis agar penatalaksanaan yang diberikan sesuai dan akurat. Salah satu kendala yang ditemukan pada KNF adalah diagnosis dini dan rekurensi. Narrow Band-Imaging adalah salah satu teknik pemeriksaan noninvasive dan mudah dilakukan, menggunakan teknik optikal terkini dan filter sinar biru dengan panjang gelombang tertentu, yang mampu meningkatkan sensitivitas pemeriksaan nasoendoskopi dengan pengamatan perubahan struktur vaskularisasi akibat pertumbuhan tumor terutama untuk KNF dengan sifat pertumbuhan endofitik. Pola-pola perubahan vaskularisasi yang ditimbulkan oleh KNF dapat diamati dengan jelas melalui pemeriksaan ini dan diharapkan juga mampu memberikan kepastian waktu bagi klinisi dalam menentukan saat yang tepat untuk melakukan tindakan lanjut yang lebih invasif seperti biopsi sehingga diperoleh hasil yang lebih akurat di saat yang tepat.Kata kunci: Narrow Band-Imaging, Karsinoma Nasofarings, Endoskopi AbstractNasopharyngeal carcinoma (NPC) is the most common cancer in the otolaryngology, head and neck region, that needs an accurate examination for the management. An obstacle in management of NPC is the early diagnosis of the disease and recurrency. Narrow-band imaging, is a non-invasive diagnostic technique, which uses optical technique and special long wave blue filter, that will increase the sensitivity of the nasoendoscopy in the diagnosis of NPC by observing the changes in vascularisation, especially in exophitic growth. This creates on better opportunity of clinician to do more invasive diagnostic testing at earlier stage of the cancer.Keywords:Narrow Band-Imaging, Nasopharyngeal carcinoma, Endoscop

Validity of narrow-band imaging (NBI) nasoendoscopy on nasopharyngeal carcinoma post therapy biopsy

Nasopharyngeal carcinoma (NPC) is the most common malignancy found in the head and neck. It is a unique head and neck cancer due to its radiosensitivity. Therefore, radiotherapy becomes the main modality of therapy. Post-treatment evaluation of NPC is important to assess prognosis. Biopsy that is the gold standard for the evaluation can be performed with a narrow-band imaging (NBI) nasoendoscopy guide. This study aimed to determine the validity of NBI nasoendoscopic examination of NPC post-treatment biopsy. This study was a cross-sectional design for all post-treatment NPC patients who would undergo response assessment at the Department of Otorhinolaryngology, Head and Neck Surgery, Dr. Sardjito General Hospital, Yogyakarta. A total 40 patients during May-June 2018 period who underwent examination sequentially. Biopsy examination was carried out with NBI nasoendoscopy guidance and the results of biopsy were performed histopathological examination. Forty patients showed the results of NBI nasoendoscopic validity on NPC biopsy after treatment included sensitivity (85.7%), specificity (87.8%), positive predictive value (60%), negative predictive value (96.6 %), positive trend ratio (7.07), negative trend ratio (0.16), and accuracy (87.5%). Postoperative NBI nasoendoscopy features appear homogeneous (75%) and inhomogenous (25%). In conclusion, NBI nasoendoscopic validity on postoperative NPC biopsy is good

Metastasis Leher Tersembunyi pada Karsinoma Lidah T1-T2

AbstrakKarsinoma lidah memiliki kecenderungan yang tinggi untuk bermetastasis ke limfonodi leher, bahkan pada stadium awal (T1-T2). Tidak ada metode imaging atau pemeriksaan lain yang dapat mendeteksi metastasis leher tersembunyi. Ketebalan atau kedalaman invasi tumor adalah satu-satunya kriteria prediktor metastasis nodal pada karsinoma lidah dengan nilai cut offberkisar antara 3-9 mm. Diseksi Leher Selektif (DLE) level I-III "Diseksi Leher Supraomohioid" (DLSOH) telah direkomendasikan sebagai terapi utama karsinoma lidah stadium awal dengan klinis Node negatif (N0). Hanya pada sebagian kecil kasus yang mengalami metastasis ke level IV yang dikenal dengan “skip metastasis”,extended supraomohyoid neck dissectionlevelI-IV direkomendasikan oleh beberapa penulis. Diseksi leher bilateral harus dilakukan bila telah melibatkan struktur midline lidah.Kata kunci: karsinoma lidah, metastasis leher tersembunyi, diseksi leher supraomohioid AbstractCarcinoma of tongue has a high propensity for nodal metastasis in the neck, even in early stages (T1–T2). There is no method of imaging or other examination that will detect occult nodal metastasis. Tumor thickness or depth of invasion is the only size criterion predictor of nodal metastasis in carcinoma of tongue, the critical cut off values ranged from 3 to 9 mm. Selective dissection of levels I–III “supraomohyoid neck dissection” has been recommended as a primary treatment of neck disease in early carcinoma of tongue with clinically N0 neck. Most of the relatively small number of isolated metastasis to level IV are from primary tumours of the tongue, which are known as “skip metastasis”. Thus an extended supraomohyoid neck dissection of levels I–IV is recommended by some authors for elective treatment of the neck in carcinoma of tongue. Bilateral neck dissection should be performed in elective treatment of tumours involving midline structure.Keywords : carcinoma of tongue, occult nodal metastasis, supraomohyoid neck dissectio

The role of thyroid stimulating hormone level as a predictive factor for advance stage thyroid carcinoma

Thyroid stimulating hormone (TSH) is a cancer growth stimulus factor that have effect on the progression of thyroid carcinoma, common neck head malignancy. This hormonelevel has diagnostic value and can assist in the diagnosis, staging and management of the thyroid carcinoma.This study aimed to investigatethe role of TSH level as a predictor of advance stage thyroid carcinoma. This was case-control study involvingthyroid enlargement subjects who underwent thyroidectomy at Dr. Sardjito General Hospital, Yogyakartafrom 2015 to 2017. Cancer staging examination using AJCC 2102and TSH levels examination were conducted before underwent thyroidectomy.The inclusion criteria for case group were advanced stage(stage III and IV), while for control group wereearly-stage of thyroid carcinoma (stage I and II). The exclusion criteria for both case and control groups were 1) suffering from thyroid hormone disorders requiring therapy before thyroidectomy, 2) receiving thyroid suppression therapy prior to thyroidectomy. Sixty-six post thyroidectomy patients were involved in this study. The patients were divided into case and control groups consisted of 33 patients in each group. Based on receiver operating characteristic curve, the cut of point 1.27 mIU/L for TSH was obtained with sensitivity of 72.7% and specificity of 78.8%. There was statistically significant difference TSH levelsbetween early stage thyroid carcinoma and late stage thyroid carcinoma(p = 0.001;OR: 9.9;95% CI: 3.19-30.15).It can be concluded that TSHlevels ≥ 1.27mIU/L as predictor of advance stage thyroid carcinoma

Tracheal Stenosis After Endotracheal Intubation and Percutaneous Dilatational Tracheostomy

Introduction Tracheal stenosis is an abnormal narrowing of the tracheal lumen which affects adequate airflow and caused by an inflammatory complication such as endotracheal intubation and percutaneous dilatational tracheostomy (PDT). Incidence of tracheal stenosis following endotracheal intubation and PDT was 8-44%. Case Report A 24 year old female presented with dyspnea and hoarseness after traffic accident. She was intubated for 2 weeks then followed by PDT for 3 weeks. The laryngoscopy examination after PDT extubation showed tracheal stenosis at the second-third tracheal ring with left vocal fold granuloma. Cervical computed tomography demonstrated a mass at vocal cord and narrowing of tracheal caliber at the first thoracic vertebra disk, above the stoma of PDT.The granuloma was excised and tracheal stenosis was removed by tracheal resectionand end-to-end anastomosis.  Discussion Tracheal stenosis is one of important sequelae after endotracheal intubationand PDT. Tracheal resection and primary anastomosis may be considered as an option for surgical management of tracheal stenosis

Sinonasal or nasopharyngeal undifferentiated Carcinoma?: diagnostic pitfall and the role of Epstein-Barrvirus (EBV) and human papillomavirus(HPV) examination

Undifferentiated carcinoma of the head and neck is frequently observed in nasopharynx, however it may also occur in oropharynx, salivary gland and sinonasal. Overlapping lesions in those regionscreate difficulty in determining the origin of the tumor. Thus, it causes diagnostic pitfall not only for pathologists, but also for clinicians. A 40 yearold man, presented with nasal obstruction, epistaxis, diplopia, and headache for a yearand showed nasal cavitysinistra and nasopharynx masses on CT-scan. Lymph node enlargement was not detected. First biopsywas performed and histopathologically diagnosed as nasopharyngeal undifferentiated carcinoma(NPC), extended into nasal cavity. Chemo-radiation protocol for NPC was conducted, and showing uncomplete response. Second biopsy was done, and reviewed with the first biopsy result. Thetumourwas arranged insolid, syncytial and trabecular pattern, with vesicular nuclei, prominent nucleoli, and lack of lymphoplasmacytic infiltrat. Immunohistochemistry (IHC) analysis of p16, EBNA1 and LMP1 were negative. PCR analysis of HPV-18 was positive, while EBV detection showed negative result. General association of EBV with NPC suggests that the presence of latent EBV infection can serve as a positive marker for NPC. Therefore, in this case, the EBV negativity and strong HPV association led to diagnosis of SNUC. The distinction of sinonasal undifferentiated carcinoma (SNUC) or from NPC was important for appropriate management and therapy

Diversity of Nonribosomal Peptide Synthetase Genes in the AnticancerProducing Actinomycetes Isolated from Marine Sediment in Indonesia

Marine actinomycetes is a group of bacteria that is highly potential in producing novel bioactive compound. It has unique characteristics and is different from other terrestrial ones. Extreme environmental condition is suspected to lead marine actinomycetes produce different types of bioactive compound found previously. The aim of this study was to explore the presence and diversity of NRPS genes in 14 anticancer-producing actinomycetes isolated from marine sediment in Indonesia. PCR amplification and restriction fragment analysis of NRPS genes with HaeIII from 14 marine actinomycetes were done to assess the diversity of NRPS genes. Genome mining of one species of marine actinomycetes (strain GMY01) also was employed towards this goal. The result showed that NRPS gene sequence diversity in 14 marine actinomycetes could be divided into 4 groups based on NRPS gene restriction patterns. Analysis of 16S rRNA gene sequences of representatives from each group showed that all isolates belong to genus of Streptomyces. Genome mining result showed that strain GMY01 harboring 10 different NRPS gene clusters that encode secondary metabolites, as pure NRPS or hybrid between NRPS and other compounds. These results indicated that marine actinomycetes having a high potential to be developed as source of anticancer drugs development

Effectiveness of a multicentre nasopharyngeal carcinoma awareness programme in Indonesia

Objective: To evaluate the effectiveness of a nasopharyngeal carcinoma (NPC) awareness programme on the short-term and long-term improvement of knowledge and referral of patients with NPC by primary healthcare centres (PHCCs) staff in Indonesia. Design: The NPC awareness programme consisted of 12 symposia including a Train-The-Trainer component, containing lectures about early symptoms and risk factors of NPC, practical examination and the referral system for NPC suspects. Before and after training participants completed a questionnaire. The Indonesian Doctors Association accredited all activities. Participants: 1 representative general practitioner (GP) from each PHCC attended an NPC awareness symposium. On the basis of the Train-The-Trainer principle, GPs received training material and were obligated to train their colleagues in the PHCC. Results: 703 GPs attended the symposia and trained 1349 staff members: 314 other GPs, 685 nurses and 350 midwives. After the training, respondents’ average score regarding the knowledge of NPC symptoms increased from 47 points (of the 100) to 74 points (p<0.001); this increase was similar between symposium and Train-The-Trainer component (p=0.88). At 1½ years after the training, this knowledge remained significantly increased at 59 points (p<0.001). Conclusions: The initial results of this NPC awareness programme indicate that the programme effectively increases NPC knowledge in the short and long term and therefore should be continued. Effects of the improved knowledge on the stage at diagnoses of the patients with NPC will still need to be scrutinised. This awareness programme can serve as a blueprint for other cancer types in Indonesia and for other developing countries

Primary treatment results of Nasopharyngeal Carcinoma (NPC) in Yogyakarta, Indonesia

INTRODUCTION Nasopharyngeal Carcinoma (NPC) is a major health problem in southern and eastern Asia. In Indonesia NPC is the most frequent cancer in the head and neck area. NPC is very sensitive to radiotherapy resulting in 3-year disease-free and overall survival of approximately 70% and 80%, respectively. Here we present routine treatment results in a prospective study on NPC in a top referral; university hospital in Indonesia. METHODS All NPC patients presenting from September 2008 till January 2011 at the ear, nose and throat (ENT) department of the Dr. Sardjito General Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia, were possible candidates. Patients were included if the biopsy was a histological proven NPC without distant metastasis and were assessed during counselling sessions prior to treatment, as being able to complete the entire treatment. RESULTS In total 78 patients were included for treatment analysis. The median time between diagnosis and start of radiotherapy is 120 days. Forty-eight (62%) patients eventually finished all fractions of radiotherapy. The median duration of the radiotherapy is 62 days for 66 Gy. Median overall survival is 21 months (95% CI 18–35) from day of diagnosis. CONCLUSION The results presented here reveal that currently the treatment of NPC at an Indonesian hospital is not sufficient and cannot be compared to the treatment results in literature. Main reasons for these poor treatment results are (1) a long waiting time prior to the start of radiotherapy, (2) the extended overall duration of radiotherapy and (3) the advanced stage of disease at presentation.Maarten A. Wildeman, Renske Fles, Camelia Herdini, Rai S. Indrasari, Andrew D. Vincent, Maesadji Tjokronagoro, Sharon Stoker, Johan Kurnianda, Baris Karakullukcu, Kartika W. Taroeno- Hariadi, Olga Hamming-Vrieze, Jaap M. Middeldorp, Bambang Hariwiyanto, Sofia M. Haryana, I. Bing Ta