Volumetric breast density is essential for predicting cosmetic outcome at the late stage after breast-conserving surgery

Shiina, Nobumitsu; Sakakibara, Masahiro; Fujisaki, Kaoru; Iwase, Toshiaki; Nagashima, Takeshi; Sangai, Takafumi; Kubota, Yoshitaka; Akita, Shinsuke; Takishima, Hazuki; Miyazaki, Masaru

doi:10.1016/j.ejso.2016.01.004

Cited by 14 publications

(6 citation statements)

References 21 publications

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“…Other studies showed that satisfaction with cosmetic outcome in patients treated with breast-conserving therapy depends on the amount of tissue excised during surgery, with a larger amount of tissue excised resulting in a lower level of satisfaction [14,19,[24][25][26][27]. The higher proportion of dissatisfied patients in comparison to the neutral and satisfied patients treated with locoregional radiation therapy could be explained by the increased risk of fibrosis due to radiation therapy of the breast tissue even years after the start of radiation therapy, as the administration of an additional radiation therapy boost was distributed equally in local and locoregional treated patients [19,[28][29][30][31][32]. In the "boost vs. no boost" trial, 5318 early-stage breast cancer patients were randomized to additional boost on the tumor bed or no further treatment [19].…”

Section: Discussionmentioning

confidence: 99%

Patient-reported cosmetic satisfaction and the long-term association with quality of life in irradiated breast cancer patients

Batenburg

Gregorowitsch

Maarse

et al. 2019

Breast Cancer Res Treat

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Purpose To evaluate patient-reported cosmetic satisfaction in women treated with radiation therapy for breast cancer and to determine the association between dissatisfaction and quality of life (QoL) and depression. Methods Within the prospective UMBRELLA breast cancer cohort, all patients ≥ 1 year after breast conserving treatment or mastectomy with immediate reconstruction were selected. Self-reported cosmetic satisfaction was measured on a 5-point Likert scale. QoL, social functioning, and emotional functioning were measured using EORTC QLQ-C30 and BR23 at 1, 2, and 3 years after inclusion. Mixed model analysis was performed to assess the difference in different domains of QoL between patients with good versus poor self-reported cosmetic satisfaction over time after adjustment for potential confounders. Depression scores were collected by means of the HADS-NL questionnaire. Chi-square test or Fisher's exact test was used to assess the difference in proportions of HADS score ≥ 8, indicating increased depression risk, between satisfied and dissatisfied patients. Results 808 patients were selected for analysis. Respectively one, two, and three years after surgery, 8% (63/808), 7% (45/626), and 8% (31/409) of patients were dissatisfied with their cosmetic outcome. Poor patient-reported cosmetic satisfaction was independently associated with impaired QoL, body image, and lower emotional and social functioning. Scores ≥ 8 on the HADS depression subscale were significantly more common in dissatisfied patients. Conclusions Dissatisfaction with cosmetic outcome was low after breast cancer surgery followed by radiation therapy during 3 years follow-up. Knowing the association between dissatisfaction with cosmetic outcome and QoL and depression could help to improve the preoperative counseling of breast cancer patients.

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Section: Discussionmentioning

confidence: 99%

Patient-reported cosmetic satisfaction and the long-term association with quality of life in irradiated breast cancer patients

Batenburg

Gregorowitsch

Maarse

et al. 2019

Breast Cancer Res Treat

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“…Added to that, further research is necessary specifying the implication of other variables such as volumetric breast density calculated on mammography which has been shown to correlate with unfavourable long-term AO measured by BCCT.core [24]. Tests for identification of patients with increased risk of radiation-induced subcutaneous fibrosis are also being investigated and some are even validated, such as single nucleotide polymorphisms and gene expression analysis [25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Validation of a normal tissue complication probability model for late unfavourable aesthetic outcome after breast-conserving therapy

et al. 2019

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Purpose: To validate a normal tissue complication probability (NTCP) model for late unfavourable aesthetic outcome (AO) after breast-conserving therapy. Materials/Methods: The BCCT.core software evaluated the AO using standardized photographs of patients treated at the University Hospitals Leuven between April 2015 and April 2016. Dose maps in 2 Gy equivalents were calculated assuming a/b ¼ 3.6 Gy. The discriminating ability of the model was described by the AUC of the receiver operating characteristic curve. A 95% confidence interval (CI) of AUC was calculated using 10,000 bootstrap replications. Calibration was evaluated with the calibration plot and Nagelkerke R 2. Patients with unfavourable AO at baseline were excluded. Patient, tumour and treatment characteristics were compared between the development and the validation cohort. The prognostic value of the characteristics in the validation cohort was further evaluated in univariable and multivariable analysis. Results: Out of 175 included patients, 166 were evaluated two years after RT and 44 (26.51%) had unfavourable AO. AUC was 0.66 (95% CI 0.56; 0.76). Calibration was moderate with small overestimations at higher risk. When applying all of the univariable significant clinicopathological and dosimetrical variables from the validation cohort in a multivariable model, the presence of a seroma and V45 were selected as significant risk factors for unfavourable AO (Odds Ratio 4.40 (95% CI 1.96; 9.86) and 1.14 (95% CI 1.03; 1.27), p-value <.001 and .01, respectively). Conclusions: The NTCP model for unfavourable AO shows a moderate discrimination and calibration in the present prospective validation cohort with a small overestimation in the high risk patients.

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“…However, there was one study that found that small breasts affected cosmetic outcome negatively [37]. [6] RT, RTb, CHT, HT 2421 prospective BCCT.core, Harvard, Sneeuw pro + pat Negenborn [7] RT, RTb 109 unknown 7-item questionnaire (4-point scale) pro Hennigs [8] CHT, RT 21 prospective BCTOS pat Ojala [9] RT, RTb 379 retrospective BCTOS, questionnaire (5-point scale) pat Shiina [10] RT 250 unknown Harvard, BCCT.core pro Yu [11] RT, RTb, CHT, HT 51 retrospective BCCT.core, Harvard pat Dahlback [12] RT, RTb, CHT, HT 297 prospective 6-item questionnaire (4-point scale) pat Hennigs [13] RT 294 prospective BCCT.core pro Olfatbakhsh [14] RT, CHT 103 retrospective 5-item questionnaire (0-10 rating scale) pro Ozmen [15] RT, CHT, HT 284 retrospective Harvard pro Foersterling [16] RT 709 prospective BCTOS pat Lyngholm [17] RT, RTb, CHT, HT 214 retrospective 4-point scale, BCCT.core pro + pat Medina-Franco [18] RT, CHT 133 unknown BCTOS, photos (breast volume difference) pro + pat Kelemen [19] RT, RTb, CHT, HT 198 prospective 4-point scale pro + pat Barnett [20] RT, RTb, CHT, HT 1014 prospective photos (3-point scale) + clinical assessment (3 or 4-point) pro Waljee [21] RT 714 retrospective BCTOS pat Wang [22] RT 46 retrospective 4-point scale pro + pat Johansen [23] RT, RTb, CHT, HT 266 prospective 4-point scale pro + pat Cardoso [24] RT, CHT, HT 120 retrospective Harvard scale pro Chie [25] RT, RTb, CHT, HT 424 retrospective symmetry index, 4-point-scaleb pro Arenas [26] RT, RTb 145 retrospective 4-point scale pro + pat Fedorcik [27] RT, RTb 100 prospective 5-item questionnaire (0-10 score) pro + pat Pawlaczyk [28] RT, RTb, CHT, HT 67 prospective 4-point scale, photos (symmetry measurements) pro Fabry [29] RT, RTb, CHT, HT 40 retrospective pBRA pro Yamamoto [30] RT 106 unknown 4-point scale pro Cochrane [31] RT 151 retrospective 3-point scale pro + pat Deutch [32] RT, RTb, CHT, HT 265 retrospective 4-point scale pro Johansen [33] RT, RTb, CHT, HT 266 prospective 4-point scale pro + pat...…”

Section: Patient Related Factorsmentioning

confidence: 99%

“…Extensiveness of resection was the major factor associated with breast retraction [45]. Some investigators described the extensiveness of resection in cm 3 [5,10,27,40,44], while others describe it in weight [8,9,13,16,24,37]. It is obvious that this surgical extensiveness is related to the above mentioned tumor related factor: size.…”

Section: Surgery Related Factorsmentioning

confidence: 99%

Factors influencing cosmetic outcome of breast-conserving treatment in breast cancer: a narrative review

Brands-Appeldoorn¹,

Maaskant-Braat²,

Janssen³

et al. 2021

European Journal of Gynaecological Oncology

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Background: A deformed breast following Breast-Conserving Treatment (BCT) is influenced by an array of factors encompassing final cosmesis. This overview examines the factors that may influence cosmetic outcome for BCT patients. Methods: Literature search was performed using PubMed and EMBASE databases. Research articles published in English (1990English ( -2018 pertaining to patients that had previously undergone unilateral BCT for breast cancer were included. Results: 42 articles were used for our final analysis that utilized subjective and objective tools to assess cosmetic outcome. Factors can be allocated as patient, tumor, surgery, radiotherapy or systemic therapy associated. Based on significance in both univariable as well as multivariable analysis and frequency of reporting, extensiveness of primary tumor resection, tumor size, tumor location, adjuvant radiotherapy and adjuvant chemotherapy, were the factors affecting cosmetic outcome the most. Conclusions: In this study, we reviewed and discussed several patient-, tumor-and treatment related factors affecting cosmetic outcome. Many different tools, either subjective or objective, are observed worldwide.

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Volumetric breast density is essential for predicting cosmetic outcome at the late stage after breast-conserving surgery

Cited by 14 publications

References 21 publications

Patient-reported cosmetic satisfaction and the long-term association with quality of life in irradiated breast cancer patients

Patient-reported cosmetic satisfaction and the long-term association with quality of life in irradiated breast cancer patients

Validation of a normal tissue complication probability model for late unfavourable aesthetic outcome after breast-conserving therapy

Factors influencing cosmetic outcome of breast-conserving treatment in breast cancer: a narrative review

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