Hubungan Microvessel Density (MVD) Berdasarkan Ekspresi Imunohistokimia Cluster of Differentiation 31 (CD31) dengan Klinikopatologi Karsinoma Payudara Invasif

Abstract

Background: The prognosis of invasive breast carcinoma depends on clinicopathological parameters including tumor size, lymph node involvement, metastasis, stage, histopathological subtype and grade, lymphovascular invasion (LVI) and tumor infiltrating lymphocytes (Tils). Assessment of microvessel density (MVD) is a quantitative calculation of blood vessels that reflects the process of angiogenesis. MVD correlated with aggressive tumor behavior identified with the CD31 monoclonal antibody. This study analyze the correlation between MVD based on immunohistochemical expression of CD31 with clinicopathological parameters of invasive breast carcinoma. Methods: Cross sectional analytic study with 42 samples diagnosed as invasive breast carcinoma at H. Adam Malik Hospital Medan. Immunohistochemical staining was performed with CD31 monoclonal antibody. MVD is an average of small blood vessels, seen from the size and diameter (arterioles and venules) of the round lumen that is stained positively with CD31 in 10 high power fields, categorized as low if < 45 blood vessels/10 LPB and high if ≥ 45 blood vessels/ 10 LPB. Expression differences were analyzed using Chi Square, Fisher's Exact and Mann Whitney tests. Results: There was a relationship between tumor size (p=0.029), metastasis (p=0.014), stage (p=0.002), histopathological grade (p=0.0043), LVI (p=0.002), Tils (p=0.007) and there was no association between lymph node involvement (p=0.570) and MVD based on CD31 immunohistochemical expression. Conclusion: MVD based on CD31 immunohistochemical expression plays a role in angiogenesis on the clinicopathology of invasive breast carcinoma.

Latar belakang: Prognostik karsinoma payudara invasif tergantung pada parameter klinikopatologi antara lain ukuran tumor, keterlibatan kelenjar getah bening, metastasis, stadium, subtipe dan grade histopatologi, lymphovascular invasion (LVI) dan tumor infiltrating lymphocytes (Tils). Penilaian microvessel density (MVD) merupakan perhitungan kuantitatif terhadap pembuluh darah yang mencerminkan proses angiogenesis. MVD berkorelasi dengan perilaku tumor agresif yang diidentifikasi dengan antibodi monoklonal CD31. Tujuan: Menganalisis hubungan MVD berdasarkan ekspresi imunohistokimia CD31 dengan parameter klinikopatologi karsinoma payudara invasif. Metode: Studi analitik cross sectional dengan 42 sampel yang didiagnosis sebagai karsinoma payudara invasif di RSUP H. Adam Malik Medan. Dilakukan pulasan imunohistokimia dengan antibodi monoklonal CD31. MVD merupakan rata-rata pembuluh darah kecil, dilihat dari ukuran dan diameter (arteriol dan venule) lumen bulat yang terpulas positif dengan CD31 pada 10 lapangan pandang besar, dikategorikan low bila < 45 Pembuluh darah/10 LPB dan high bila ≥ 45 Pembuluh darah/10 LPB. Perbedaan ekspresi dianalisis dengan uji Chi Square, Fisher‟s Exact dan Mann Whitney. Hasil: Terdapat hubungan ukuran tumor (p=0,029), metastasis (p=0,014), stadium (p=0,002), grade histopatologi (p=0,0043), LVI (p=0,002), Tils (p=0,007) dan tidak terdapat hubungan keterlibatan KGB (p=0,570) dengan MVD berdasarkan ekspresi imunohistokimia CD31. Kesimpulan: MVD berdasarkan ekspresi imunohistokimia CD31 berperan pada angiongenesis terhadap klinikopatologi karsinoma payudara invasif.