title: Preoperative prediction of cosmetic results in breast conserving surgery.
abstract: BACKGROUND
  Preoperative objective predictions of cosmetic result after breast conserving surgery (BCS) has the potential to aid in surgical treatment decision making. Our aim was to investigate the predictive value of tumor volume in relation to breast volume (TV/BV ratio) for cosmetic result.
  
  
  METHODS
  Sixty-nine invasive breast cancer women with preoperative MRI and treated by BCS and radiotherapy in 2007-2012 were prospectively included. Simple excision or basic oncoplastic techniques were used, but no volume displacement. TV/BV ratio was measured in the MRI while 3D-projected in virtual reality environment (I-Space). Cosmetic result was assessed by patient questionnaire, panel evaluation, and breast retraction assessment (BRA). Quality-of-life was assessed by EORTC QLQ-C30 and BR23.
  
  
  RESULTS
  Intraobserver and interobserver correlation coefficients for tumor and breast volume were all >0.95. Increasing TV/BV ratio correlated with decreasing cosmetic result as determined by patient, panel, and BRA. TV/BV ratio was a significant independent predictor for the panel evaluation (P=0.028), as was tumor location (P<0.05), and together they constituted a good prediction model (AUC 0.83).
  
  
  CONCLUSIONS
  TV/BV ratio was a precise and independent predictor for cosmetic result determined by a panel and can be used as preoperative prediction tool to enable more informed surgical treatment decision making.
authors.affiliation: Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Elvira L
authors.initials: EL
authors.lastname: Vos
authors.forename: Anton H J
authors.initials: AH
authors.lastname: Koning
authors.forename: Inge-Marie
authors.initials: IM
authors.lastname: Obdeijn
authors.forename: Victorien M T
authors.initials: VM
authors.lastname: van Verschuer
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.forename: Peter J
authors.initials: PJ
authors.lastname: van der Spek
authors.forename: Marian B
authors.initials: MB
authors.lastname: Menke-Pluijmers
authors.forename: Linetta B
authors.initials: LB
authors.lastname: Koppert
mesh_terms: D000368:Aged; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D004954:Esthetics; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D057234:Preoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D047368:Tumor Burden
keywords: breast cancer; breast volume; preoperative MRI; tumor volume; virtual reality system