title: Aesthetics in breast conserving therapy: do objectively measured results match patients' evaluations?
abstract: BACKGROUND
  To analyze the relationship of objective and subjective evaluation tools of breast aesthetics, we compare the results of the BCCT.core (breast cancer conservative treatment.cosmetic results) software, a semiautomated objective symmetry evaluation tool, with those of the Aesthetic Status of the BCTOS (Breast Cancer Treatment Outcome Scale) patient questionnaire.
  
  
  METHODS
  We included 128 patients with one-sided, primary breast cancer, treated conservatively in a prospective, exploratory study in order to assess the inter-rater reliability of the BCCT.core and the agreement between the BCCT.core and the BCTOS preoperatively, shortly and 1 year after surgery. Therefore, we use agreement rates, multiple (mk), and weighted (wk) kappa coefficients as statistical methods. Furthermore, we analyzed patient-, tumor-, and therapy-related variables as possible covariates to explain agreement.
  
  
  RESULTS
  The inter-rater reliability for the semiautomated BCCT.core is very good with agreement rates up to 84% (mk = 0.80). The agreement rates of the BCCT.core and the BCTOS Aesthetic Status range between 35 and 44% subject to the different times of assessment (wk = 0.34 at best). Moreover, the patients judge their aesthetic outcome more positively than the software. None of the considered patient-, tumor-, and therapy-related covariates turned out to explain agreement.
  
  
  CONCLUSIONS
  The BCCT.core is a reliable instrument that shows fair agreement with patient's perspective.
authors.affiliation: University Breast Center Heidelberg, Heidelberg, Germany. joerg.heil@med.uni-heidelberg.de
authors.forename: Joerg
authors.initials: J
authors.lastname: Heil
authors.forename: Julia
authors.initials: J
authors.lastname: Dahlkamp
authors.forename: Michael
authors.initials: M
authors.lastname: Golatta
authors.forename: Joachim
authors.initials: J
authors.lastname: Rom
authors.forename: Christoph
authors.initials: C
authors.lastname: Domschke
authors.forename: Geraldine
authors.initials: G
authors.lastname: Rauch
authors.forename: Maria Joao
authors.initials: MJ
authors.lastname: Cardoso
authors.forename: Christof
authors.initials: C
authors.lastname: Sohn
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D015588:Observer Variation; D017060:Patient Satisfaction; D011379:Prognosis; D011446:Prospective Studies; D012984:Software; D015996:Survival Rate