title: New objective method in reporting the breast cosmesis after breast-conservative treatment based on nonstandardized photographs: The Objective Breast Cosmesis Scale.
abstract: Subjective scoring is the most widely used approach in reporting the cosmetic outcome after breast-conservative therapy. This work introduces an objective system to document the breast cosmetic changes using nonstandardized photographs without scale calibration.
  
  
  
  Two hundred twenty-eight photographs of 114 breast cancer patients were analyzed. Baseline photographs were taken after breast-conservation surgery and before partial breast irradiation. Further photographs were taken during followup. The photographs were taken with a frontal view of the patient and without any skin marks for scaling. The baseline and the last followup photographs were analyzed by measuring certain anatomic distances (representing the nipple displacement and the asymmetry in breast dimensions and contour) to calculate the objective breast cosmesis score (OBCS). The measurements represent the nipple displacement and the asymmetry in breast dimensions and contour. Same photographs were scored subjectively by a multidisciplinary team (MDT) using the Harvard breast cosmesis scale. The patient-reported self-scoring was also recorded.
  
  
  
  The MDT results were favorable (excellent∖good) in 72.3% of the photographs and adverse in 27.7%. Agreement among the MDT members was strong (intraclass correlation coefficient = 0.798, p < 0.001, 95% CI: 0.753-0.937, Cronbach's alpha = 0.809). The patient self-scoring was satisfactory in 82.5% of the cases and nonsatisfactory in 17.5%. The results of the OBCS ranged between 0.0 and 20.4 with a median value of 4.5. There was a strong significant correlation between the OBCS and both the MDT subjective scoring (p < 0.001) and the patient self-scoring (p < 0.001).
  
  
  
  The OBCS seems to be eligible for the objective assessment of cosmesis after breast-conservative therapy using nonstandardized photographs without scale calibration.
authors.affiliation: Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Germany; Radiation Oncology Department, National Cancer Institute (NCI), Cairo University, Egypt. Electronic address: tamer.soror@uksh.de.
authors.forename: Tamer
authors.initials: T
authors.lastname: Soror
authors.affiliation: Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Germany.
authors.forename: György
authors.initials: G
authors.lastname: Kovács
authors.affiliation: Department of Applied Mechanics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Hungary.
authors.forename: Ádám
authors.initials: Á
authors.lastname: Kovács
authors.affiliation: Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Seibold
authors.affiliation: Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Melchert
authors.affiliation: Clinic for Gynecology and Obstetrics, University of Luebeck/UKSH-CL, Germany.
authors.forename: Kristin
authors.initials: K
authors.lastname: Baumann
authors.affiliation: Clinic for Plastic Surgery, University of Luebeck/UKSH-CL, Germany.
authors.forename: Eike
authors.initials: E
authors.lastname: Wenzel
authors.affiliation: Radiation Oncology Department, Institute for Oncology and Radiology (IORS), Medical School, University of Belgrade, Belgrade, Serbia.
authors.forename: Suzana
authors.initials: S
authors.lastname: Stojanovic-Rundic
mesh_terms: D059925:Anatomic Landmarks; D001918:Brachytherapy; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000628:therapy*; D000072700:Conservative Treatment; D004954:Esthetics; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D010348:Patient Care Team; D017060:Patient Satisfaction; D010781:Photography; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome
keywords: Breast cancer; Cosmetic assessment; Objective assessment