New objective method in reporting the breast cosmesis after breast-conservative treatment based on nonstandardized photographs: The Objective Breast Cosmesis Scale

Tamer Soror; György Kovács; Ádám Kovács; Nina Seibold; Corinna Melchert; Kristin Baumann; Eike Wenzel; Suzana Stojanovic-Rundic

doi:10.1016/j.brachy.2016.06.008

New objective method in reporting the breast cosmesis after breast-conservative treatment based on nonstandardized photographs: The Objective Breast Cosmesis Scale

Brachytherapy. 2016 Sep-Oct;15(5):631-6. doi: 10.1016/j.brachy.2016.06.008. Epub 2016 Jul 27.

Authors

Tamer Soror¹, György Kovács², Ádám Kovács³, Nina Seibold², Corinna Melchert², Kristin Baumann⁴, Eike Wenzel⁵, Suzana Stojanovic-Rundic⁶

Affiliations

¹ 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.
² Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Germany.
³ Department of Applied Mechanics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Hungary.
⁴ Clinic for Gynecology and Obstetrics, University of Luebeck/UKSH-CL, Germany.
⁵ Clinic for Plastic Surgery, University of Luebeck/UKSH-CL, Germany.
⁶ Radiation Oncology Department, Institute for Oncology and Radiology (IORS), Medical School, University of Belgrade, Belgrade, Serbia.

PMID: 27475485
DOI: 10.1016/j.brachy.2016.06.008

Abstract

Purpose: 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.

Methods and materials: 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.

Results: 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).

Conclusions: The OBCS seems to be eligible for the objective assessment of cosmesis after breast-conservative therapy using nonstandardized photographs without scale calibration.

Keywords: Breast cancer; Cosmetic assessment; Objective assessment.

MeSH terms

Anatomic Landmarks
Brachytherapy*
Breast Neoplasms / therapy*
Breast* / pathology
Conservative Treatment
Esthetics*
Female
Humans
Mastectomy, Segmental*
Patient Care Team
Patient Satisfaction
Photography
Radiotherapy, Adjuvant
Treatment Outcome