title: Comparing two objective methods for the aesthetic evaluation of breast cancer conservative treatment.
abstract: Two programs were recently developed for the aesthetic evaluation of results in breast cancer conservative treatment: the Breast Cancer Conservative Treatment cosmetic results (BCCT.core) and the Breast Analyzing Tool (BAT). Both make use of a face-only photographic view of the patient and were developed to overcome the lack of reproducibility observed with subjective visual evaluation. The BCCT.core analyses several parameters related to asymmetry, color differences and scar appearance, while the BAT considers only asymmetry measurements. The purpose of this study was to compare the performance of these two methods.
  
  
  METHODS
  Digital pictures of 59 patients from Porto and 60 from Vienna were evaluated subjectively by two panels using the four-class Harris scale. The Porto photographs had a similar backlight and better quality, and were evaluated by an international panel of 23 experts. The Vienna photographs had different backlight and lower quality, and were evaluated by four students and two breast cancer specialists. All 119 cases were submitted to analysis using the BCCT.core and BAT. Agreement between the software programs and the subjective evaluation was calculated using kappa (k), weighted kappa statistics (wk) and error rate (er).
  
  
  RESULTS
  In overall analysis, BCCT.core program obtained a better agreement with the subjective evaluation (k = 0.56; wk = 0,64; er = 0.20) than the BAT software (k = 0.39; wk = 0.46; er = 0.42) (P < 0.0007). Results were again better for the BCCT.core program, when analysing the photographs obtained in Porto (k = 0.71; wk = 0.78; er = 0.14) than for the BAT (k = 0.35; wk = 0.41; er = 0.51) (P < 0.0003) while no significant differences in agreement were obtained regarding the Vienna images (P > 0.1).
  
  
  CONCLUSIONS
  The results suggest that the inclusion of multiple parameters in image analyses of aesthetic results has the potential to improve results. However, picture quality is probably important for analysis of other features besides asymmetry.
authors.affiliation: Department of Surgery, Faculdade de Medicina do Porto, Hospital S João, Alameda do Prof Hernâni Monteiro, Porto, Portugal. mjcard@mail.med.up.pt
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Cardoso
authors.forename: Jaime S
authors.initials: JS
authors.lastname: Cardoso
authors.forename: Thomas
authors.initials: T
authors.lastname: Wild
authors.forename: Wilfried
authors.initials: W
authors.lastname: Krois
authors.forename: Florian
authors.initials: F
authors.lastname: Fitzal
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D003952:Diagnostic Imaging / Q000379:methods*; D004954:Esthetics; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D010781:Photography / Q000379:methods*; D016896:Treatment Outcome