Validitas Multiplex Real Time Polymerase Chain Reaction untuk Diagnosis Limfadenitis Tuberkulosis pada Spesimen Blok Parafin

Abstract

Limfadenitis tuberkulosis merupakan tuberkulosis ekstraparu yang paling sering ditemukan. Saat ini baku emas diagnosis limfadenitis tuberkulosis berdasarkan histopatologi. Pemeriksaan histopatologi tidak memberikan informasi etiologi pasti penyebab limfadenitis, padahal limfadenitis dapat disebabkan Mycobacterium tuberculosis maupun Mycobacterium non-tuberculosis yang sangat berbeda regimen terapinya. Spesimen limfadenitis tuberkulosis dalam blok parafin yang disimpan sangat bermanfaat ketika dibutuhkan pemeriksaan lanjutan.  Pemeriksaan multiplex real time polymerase chain reaction  pada  blok parafin dapat mendeteksi Mycobacterium  tuberculosis atau Mycobacterium  non-tuberculosis. Pemilihan objek penelitian dilakukan berdasarkan randomisasi sederhana. Penelitian uji diagnostik dengan  rancangan potong lintang untuk mengetahui  validitas pemeriksaan multiplex  real time polymerase chain reaction  dalam  mendiagnosis limfadenitis tuberkulosis  sebagai konfirmasi pada blok parafin dilakukan periode Juni 2012˗˗Juni 2013 di Rumah Sakit Dr. Hasan Sadikin Bandung. Objek penelitian terdiri atas 40 blok parafin limfadenitis tuberkulosis dan 22 blok parafin kelompok kontrol. Pemeriksaan multiplex real time poymerase chain reaction menggunakan primer gen sikuens sisipan IS6110 dan gen Mycobacterium protein tuberkulosis MPB64 untuk mendeteksi deoxyribonucleic acid Mycobacterium tuberculosis dan gen 16S rRNA (ribosomal ribonucleic acid) untuk mendeteksi Mycobacterium non-tuberculosis. Hasil uji validitas sensitivitas 75%, spesifisitas 77%, nilai duga positif 86,6%, nilai duga negatif 63%, dan akurasi 75,8%. Pemeriksaan multiplex real time polymerase chain reaction dapat dianjurkan untuk konfirmasi diagnosis limfadenitis tuberkulosis pada blok parafin. Simpulan: multiplex real time polymerase chain reaction  memiliki validitas sedang untuk diagnosis limfadenitis tuberkulosis pada spesimen blok parafin.

Kata kunci: Deoxyribonucleic acid, limfadenitis tuberkulosis, multiplex real time polymerase chain reaction, Mycobacterium tuberculosis

Validity of Multiplex Real Time Polymerase Chain Reaction for Tuberculous Lymphadenitis Diagnosis on Formalin Fixed Paraffin Embedded

Tuberculous lymphadenitis is one of the most common form of extra pulmonary tuberculous. The diagnosis of tuberculous lymphadenitis based  on  histopathology as a gold standard. Histopathology examination could not inform the etiology of lymphadenitis whether Mycobacterium tuberculosis or Mycobacterium nontuberculosis  of which  the treatment regiment is very different. The archieved specimen like formalin fixed paraffin embedded  of tuberculous lymphadenitis is useful for futher investigation. The multiplex real time polymerase chain reaction  can detect  Mycobacterium tuberculosis or Mycobacterium nontuberculosis  from formalin fixed paraffin embedded. The object of the study use simple random. The study with cross sectional design  to determine validity multiplex real time polymerase chain reaction  on tuberculous lymphadenitis from formalin fixed paraffin embedded, was done June 2012˗˗June 2013 at Dr. Hasan Sadikin Hospital Bandung. Objects  consisted  of  40  formalin fixed paraffin embedded  tuberculous lymphadenitis and  22 control group. The multiplex real time polymerase chain reaction use insertion  sequence IS6110 and Mycobacterium protein tuberculosis MPB64 gen for detect deoxyribonucleic acid Mycobacterium tuberculosis and 16S rRNA (ribosomal ribonucleic acid) gen for Mycobacterium nontuberculosis. The validity test of the Mycobacterium tuberculosis multiplex real time polymerase chain reaction with histopathology as a gold standards gave a sensitivity 75%, specificity 77%, positive predictive value 86.6%, negative predictive value 63%, and accuracy 75.8%. This examination can be used for confirmation of tuberculous lymphadenitis from formalin fixed paraffin embedded. Conclussion: multiplex real time polymerase chain reaction has intermediate validity to diagnose tuberculous lymphadentis on formalin fixed paraffin embedded.

Key words: Deoxyribonucleic acid,  multiplex real time polymerase chain reaction, Mycobacterium tuberculosis

DOI: 10.15395/mkb.v46n3.314