Interobserver agreement and consensus over the esthetic evaluation of conservative treatment for breast cancer

Abstract

Twenty-four experts from 13 different countries were asked to evaluate photographs taken of 60 women following conservative breast cancer treatment. The esthetic result of each case was classified as poor, fair, good or excellent. Agreement was evaluated using the kappa (k) and weighted kappa (wk) statistics, for all observers, male and female participants, those younger and older than 50 years, those seeing more than 250 cases a year, and those with previous publications in this area. Consensus was obtained by way of a modified Delphi approach, when more than 50% of participants provided the same classification. In a second round, consensual cases were disclosed and a revised opinion was asked in non-consensual ones. Agreement between all participants was fair (k=0.24, wk=0.37) and remained within the same range (k=0.20-0.31, wk=0.31-0.45) in the subgroups analyzed. First round consensus was obtained in 46 out of 60 cases (77%) and in the second round in 59 out of 60 cases (98%). Evaluation of the esthetic results of conservative treatment for breast cancer is only fairly reproducible when performed by experts working in different geographical areas. Consensus is obtainable if a relatively low threshold of agreement is considered acceptable.

Comparing two objective methods for the aesthetic evaluation of breast cancer conservative treatment

“…Their evaluation is fraught with difficulty, subjectivity and limited reproducibility. The BCCT.core and BAT softwares, were developed in different institutions but share the goals of providing a simple tool for reproducible evaluation of aesthetic results in BCCT [14,15] Different methodologies were used to arrive at a consensus analysis in the two datasets of photographs [7,14]. The difficult and time consuming process of obtaining a consensus analysis in a large number of cases compelled us to use previous results obtained with different observers and scales.…”

“…A Delphi procedure was used to obtain a consensus between observers, which was possible in 59 of the 60 cases [7].…”

“…Subjective methods have been largely used, either through direct patient evaluation or through a photograph, performed by one or several observers [3]. However, results of subjective evaluation show only a modest interobserver agreement, even when performed by experts [7,8]. Objective methods use measurements taken directly from the patient or from photographs, and are based essentially on asymmetries between treated and non-treated breasts [9,10].…”

Submental-Cervical Angle: Perceived Attractiveness and Threshold Values of Desire for Surgery

“…Additional statistical analysis including Spearman's rank correlation and paired Wilcoxon tests were performed using Minitab v16 (Minitab Inc, State College, PA, USA). The Ryan-Joiner test in Minitab was used to examine if data were consistent with a normal distribution [12].…”

An accurate and interpretable model for BCCT.core

“…The importance of a good aesthetic outcome is well recognized by experts in this field although it is known that this is often not achieved. In breast-conserving surgery for example, approximately 33% of women will have a fair or poor aesthetic outcome [1], [2].…”