Cosmetic outcomes following breast conservation therapy: In search of a reliable scale

Divsion of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Breast Cancer Research and Treatment (Impact Factor: 3.94). 12/2006; 100(1):65-70. DOI: 10.1007/s10549-006-9223-y
Source: PubMed


Multiple scales to evaluate breast cosmesis following breast conserving treatment (BCT) have been developed, however reliability is a problem. Panel scores, where scores from two or more individuals are combined, were assessed to examine their effect on reliability for two different cosmetic scales.
Women, two or more years following BCT, were recruited from a single breast centre. Photographs of each participant were evaluated independently by six health care professionals on two separate occasions. A simple four-point scale and more involved multi-item scale were used to assess cosmetic outcome. Reliability was assessed with the weighted kappa statistic for increasing panel sizes.
Ninety-nine women were evaluated. Intra rater reliability increased from 0.73 to 0.83 for the four-point scale, for increasing panel sizes, however 95% confidence intervals generally overlapped. A smaller and more unpredictable effect was seen on the multi-item subscale, range 0.69 to 0.73. Inter rater reliability increased from 0.68 to 0.93 for the four-point scale, and 0.75 to 0.96 for the multi-item scale, for increasing panel sizes; 95% confidence intervals did not overlap. A panel of three for either scale provided almost perfect kappa values with only small improvements with larger panel sizes.
Care should be used in interpreting results where cosmetic outcomes have been obtained from a single evaluator. Panel scores can be used to significantly improve inter-rater, but not intra rater reliability, for the scales studied. Comparable reliability, in combination with simplicity of use and interpretation, would favour the four-point scale for breast cosmetic evaluation over the multi-item scale.

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    • "The existing literature does not provide a clear picture regarding ethnic differences in cosmetic outcome following BCT. This is in large part due to the fact that currently there is no consensus regarding optimal methods of measurement of cosmetic outcome following BCT.4,5 Numerous researchers from different disciplines, including plastic surgery,8,9 surgical oncology,10 radiation oncology,1,3,11–15 and even multidisciplinary teams,16–20 have assessed cosmetic outcomes, using a variety of techniques. "
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    ABSTRACT: Background: One of the primary benefits of breast conserving therapy (BCT) is the potential ability to preserve the aesthetic appearance of the breast. However, current literature and clinical experience suggest that the aesthetic benefits of BCT may not be equally shared among ethnic groups. This is a pilot study that uses novel techniques to evaluate the cosmetic outcomes of African American and white women following BCT. Methods: A total of 21 participants (10 African American and 11 white) completed the study. Cosmetic outcomes following BCT were evaluated by a multidisciplinary team using both quantitative and qualitative measures, including 3-dimensional photographic analysis and a pilot questionnaire. Preliminary measures were taken to evaluate the validity of the questionnaire. Results: There were no statistically significant differences in objective measures of breast symmetry between African American patients and white patients (P > 0.05 in all cases). However, all raters reported the African American patients to have worse breast symmetry and appearance when compared with white patients. Interrater reliability was found to be fair with regard to the nipple complex questions [intraclass correlation (ICC), 0.56], good with regard to the breast mound questions (ICC, 0.66), and poor with regard to the scar appearance questions (ICC = 0.32). Conclusions: Although generalizing the results of this study is limited by the small sample size, it seems that there is a difference in the perception of cosmetic outcomes between white and African American patients. The novel techniques of cosmetic evaluation used in this study show promise toward identifying variables that can affect cosmetic outcome following BCT.
    01/2014; 2(1):e94. DOI:10.1097/GOX.0000000000000013
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    • "Long-term aesthetic result will be evaluated by a panel of three independent blinded observers using the three-point, five-item breast aesthetic score on standardized five-view photographic documentation at 12-month follow-up [29,30]. "
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    Trials 10/2013; 14(1):356. DOI:10.1186/1745-6215-14-356 · 1.73 Impact Factor
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