Aesthetics in breast conserving therapy: do objectively measured results match patients' evaluations?
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.
Heil
Joerg
J
University Breast Center Heidelberg, Heidelberg, Germany. joerg.heil@med.uni-heidelberg.de
Dahlkamp
Julia
J
Golatta
Michael
M
Rom
Joachim
J
Domschke
Christoph
C
Rauch
Geraldine
G
Cardoso
Maria Joao
MJ
Sohn
Christof
C
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