Cosmetic Outcome Assessment following Breast-Conserving Therapy: A Comparison between BCCT.core Software and Panel Evaluation

Abstract

Purpose. Over recent decades, no consensus has yet been reached on the optimal approach to cosmetic evaluation following breast-conserving therapy (BCT). The present study compared the strengths and weaknesses of the BCCT.core software with a 10-member panel from various backgrounds. Methods. Digital photographs of 109 consecutive patients after BCT were evaluated for 7 items by a panel consisting of 2 breast surgeons, 2 residents, 2 laypersons, and 4 plastic surgeons. All photographs were objectively evaluated using the BCCT.core software (version 20), and an overall cosmetic outcome score was reached using a four-point Likert scale. Results. Based on the mean BCCT.core software score, 41% of all patients had fair or poor overall cosmetic results (10% poor), compared with 51% (14% poor) obtained with panel evaluation. Mean overall BCCT.core score and mean overall panel score substantially agreed (weighted kappa: 0.68). By contrast, analysis of the evaluation of scar tissue revealed large discrepancies between the BCCT.core software and the panel. The analysis of subgroups formed from different combinations of the panel members still showed substantial agreement with the BCCT.core software (range 0.64–0.69), independent of personal background. Conclusions. Although the analysis of scar tissue by the software shows room for improvement, the BCCT.core represents a valid and efficient alternative to panel evaluation.

Aesthetic outcome following breast-conserving surgery assessed by three evaluation modalities in relation to health-related quality of life

“…In other studies, the agreement between panel evaluation and BCCT.core has been measured using κ statistics. Haloua and colleagues and Heil et al . reported a level of agreement of 0·64 and 0·27 respectively.…”

“…This clearly shows a methodological limitation. In a study by Haloua and co‐workers involving ten assessors, intraobserver agreement varied between 0·54 and 0·80. Vrieling and colleagues reported a weighted κ value of 0·70 for intraobserver agreement in a panel of five assessors.…”

Aesthetic result after breast-conserving therapy is associated with quality of life several years after treatment. Swedish women evaluated with BCCT.core and BREAST-Q™

“…In 2014 Haloua et al reported BCCT.core results of excellent in 10 cases (9%), good in 54 (50%), fair in 34 (31%) and poor in 11 cases (10%) in a study cohort who had undergone BCT at least one year before the evaluation [23]. …”

Cosmetic outcome and quality of life are inextricably linked in breast‐conserving therapy

“…Furthermore, two retrospective studies reported no correlation between objectively assessed cosmetic outcomes (Breast Analyzing Tool and Cosmesis Index) and quality of life . Computerized measurements are known to result in a significantly worse cosmetic outcome compared to patient and panel evaluation, with a fair to moderate agreement between BCCT.core and panel evaluation . Patient and panel evaluations are based on observer evaluation of the breast, taking into account specific factors, whereas some computerized measurements fail to include aspects such as scar appearance and color differences between breasts .…”

“…Although BCT is considered to be the least disfiguring choice in the surgical treatment of breast cancer, fair or poor cosmetic outcomes are still observed in up to one third of all patients and will negatively influence several aspects of QoL . At the current time, it is advisable to use both objective and subjective evaluation methods for cosmetic outcome assessment . Objective (computerized) methods have the advantage that they facilitate comparison of cosmetic outcomes between different studies and treatment methods.…”