Quantitative 3-Dimensional Photographic Assessment of Breast Cosmesis After Whole Breast Irradiation for Early Stage Breast Cancer: A Secondary Analysis of a Randomized Clinical Trial

Abstract

Purpose Our purpose was to use 3-dimensional (3D) surface photography to quantitatively measure breast cosmesis within the framework of a randomized clinical trial of conventionally fractionated (CF) and hypofractionated (HF) whole breast irradiation (WBI); to identify how 3D measurements are associated with patient- and physician-reported cosmesis; and to determine whether objective measures of breast symmetry varied by WBI treatment arm or transforming growth factor β 1 ( TGFβ1 ) status. Methods and Materials From 2011 to 2014, 287 women age ≥40 with ductal carcinoma in situ or early-stage invasive breast cancer were enrolled in a multicenter trial and randomized to HF-WBI or CF-WBI with a boost. Three-dimensional surface photography was performed at 3 years posttreatment. Patient-reported cosmetic outcomes were recorded with the Breast Cancer Treatment Outcome Scale. Physician-reported cosmetic outcomes were assessed by the Radiation Therapy Oncology Group scale. Volume ratios and 6 quantitative measures of breast symmetry, termed F1-6C, were calculated using the breast contour and fiducial points assessed on 3D surface images. Associations between all metrics, patient- and physician-reported cosmesis, treatment arm, and TGFβ1 genotype were performed using the Kruskal-Wallis test and multivariable logistic regression models. Results Among 77 (39 CF-WBI and 38 HF-WBI) evaluable patients, both patient- and physician-reported cosmetic outcomes were significantly associated with the F1C vertical symmetry measure (both P < .05). Higher dichotomized F1C and volumetric symmetry measures were associated with improved patient- and physician-reported cosmesis on multivariable logistic regression (both P ≤ .05). There were no statistically significant differences in vertical symmetry or volume measures between treatment arms. Increased F6C horizontal symmetry was observed in the CF-WBI arm ( P = .05). Patients with the TGFβ1 C-509T variant allele had lower F2C vertical symmetry measures ( P = .02). Conclusions Quantitative 3D image-derived measures revealed comparable cosmetic outcomes with HF-WBI compared with CF-WBI. Our findings suggest that 3D surface imaging may be a more sensitive method for measuring subtle cosmetic changes than global patient- or physician-reported assessments.

Objective Analysis of Breast Symmetry in Female Patients Undergoing Breast Reconstruction After Total Mastectomy

“…The distance from SN-to-LVP provides a measure of vertical positional symmetry. Prior studies using two-dimensional (2D) images 7 and 3D images 27 have shown vertical positional symmetry, and not horizontal positional symmetry, to be correlated with patient-reported breast cosmesis. Therefore, in this study, we utilized vertical positional symmetry, referred to as positional symmetry, henceforth.…”

Quantification of breast lymphoedema following conservative breast cancer treatment: a systematic review

“…Signs of breast lymphoedema were quantified using multiple tools and approaches (Table 1 ). Breast tissue dermal thickness was measured using ultrasound ( n = 12) [ 21 – 24 , 35 , 36 , 54 , 57 – 60 , 72 ] and mammography ( n = 3) [ 26 – 28 ]; local tissue water was measured using tissue dielectric constant (TDC) ( n = 8) [ 19 , 20 , 51 – 53 , 59 , 61 , 73 ]; breast volume was measured using three-dimensional surface imagery (3D-SI: n = 4) [ 37 , 40 , 56 , 63 ], magnetic resonance imaging (MRI: n = 1) [ 41 ] and anthropomorphic techniques ( n = 1) [ 36 ]; extracellular fluid volume was measured using bioimpedance spectroscopy (BIS: n = 3) [ 54 , 62 , 74 ]; tissue resistance was measured using tonometry ( n = 3) [ 55 , 59 , 62 ], the pitting test ( n = 2) [ 59 , 61 ] and indentation force ( n = 1) [ 52 ]; and dermal backflow/compensatory drainage pathways was visualised with indocyanine green imaging (ICG: n = 1) [ 73 ]. Additionally, clinician rating scales ( n = 8) [ 29 , 31 , 33 – 35 , 37 , 47 , 72 ] were used to identify presence of changes to the appearance, size or texture of the breast tissue.…”

“…Seven randomised controlled trials were included and assessed using the RoB 2 tool [ 18 ] (Table 1 ) [ 39 , 40 , 46 , 51 , 53 , 54 , 56 ]. Three RCTs had low overall risk of bias [ 46 , 53 , 54 ], and four were rated as having some concerns [ 39 , 40 , 51 , 56 ].…”

“…Seven randomised controlled trials were included and assessed using the RoB 2 tool [ 18 ] (Table 1 ) [ 39 , 40 , 46 , 51 , 53 , 54 , 56 ]. Three RCTs had low overall risk of bias [ 46 , 53 , 54 ], and four were rated as having some concerns [ 39 , 40 , 51 , 56 ]. Quality assessment for the 49 non-randomised studies [ 19 – 38 , 41 – 45 , 47 – 50 , 52 , 55 , 57 – 74 ] was completed using the NHLBI quality assessment tool (URL: www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools [accessed 26 October 2020]).…”

“…Measurement of signs and symptoms of breast lymphoedema, including both clinician- and patient-reported outcomes, would provide a comprehensive assessment of the underlying changes occurring. Forty-six percent of the included studies in this systematic review assessed more than one measurement outcome to quantify breast lymphoedema with 14 reporting both patient-reported and clinician-reported outcomes [ 31 , 36 , 40 , 41 , 47 , 51 , 53 – 56 , 58 , 59 , 72 , 73 ]. Inclusion of both ClinROMs and PROMs can also highlight the discord between patient and clinician reported outcomes, such as has been found in arm lymphoedema [ 12 , 79 ], For example, measurements of dermal thickness provided information on the secondary tissue changes that can occur within the oedematous breast, but this does not necessarily relate to symptoms experienced by women [ 60 ].…”