In Search of a Gold Standard Scoring System for the Subjective Evaluation of Cosmetic Outcomes Following Breast-Conserving Therapy.
The absence of a widely accepted method for aesthetic evaluation following breast-conserving surgery for breast cancer limits the ability to evaluate cosmetic outcomes. In this study, two different panel scoring approaches were compared in an attempt to identify a gold standard scoring system for subjectively assessing cosmetic outcomes following breast-conserving therapy. Standardized photographs of each participant were evaluated independently by twelve health care professionals involved in breast cancer diagnosis and treatment using the Danoff four-point scale. Individual Danoff scores were combined using two methods, a random sample "three-panel" score and an iterative "Delphi-panel" score, in order to create a final cosmetic score for each patient. Agreement between these two aggregative approaches was assessed with a weighted kappa (wk) statistic. Patient and professional recruitment occurred at two separate tertiary care multi-disciplinary breast health centers. Women with unilateral breast cancer who underwent breast-conserving therapy (segmental mastectomy or lumpectomy and radiotherapy) and were at least 2 years after radiotherapy were asked to participate. Ninety-seven women were evaluated. The Delphi approach required three rounds of evaluation to obtain greater than 50% agreement in all photographs. The wk statistic between scores generated from the "three-panel" and "Delphi-panel" approaches was 0.80 (95% CI: 0.71-0.89), thus demonstrating substantial agreement. Evaluation of cosmetic outcomes following breast-conserving therapy using a "three-panel" and "Delphi-panel" score provide similar results, confirming the reliability of either approach for subjective evaluation. Simplicity of use and interpretation favors the "three-panel" score. Future work should concentrate on the integration of the three-panel score with objective and patient-reported scales to generate a comprehensive cosmetic evaluation platform.
Department of Surgery, London Health Sciences Center, Western University Canada, London, Ontario, Canada.
Jennifer M
JM
Racz
Division of Surgical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Nicole Look
NL
Hong
Department of Surgery, London Health Sciences Center, Western University Canada, London, Ontario, Canada.|Western University Canada Schulich School of Medicine and Dentistry, London, Ontario, Canada.
Steven
S
Latosinsky
D000328:Adult; D001828:Body Image; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery*; D003697:Delphi Technique; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D010781:Photography; D016387:Women's Health
Delphi; breast cancer; breast conservation; cosmetic outcome; cosmetic scales; subjective evaluation