Annals of Surgical Oncology

, Volume 18, Issue 1, pp 134–138 | Cite as

Aesthetics in Breast Conserving Therapy: Do Objectively Measured Results Match Patients’ Evaluations?

  • Joerg Heil
  • Julia Dahlkamp
  • Michael Golatta
  • Joachim Rom
  • Christoph Domschke
  • Geraldine Rauch
  • Maria Joao Cardoso
  • Christof Sohn
Breast Oncology



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.

Materials and 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.


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.


The BCCT.core is a reliable instrument that shows fair agreement with patient’s perspective.


Kappa Coefficient Nipple Aesthetic Result Agreement Rate Breast Conserve Therapy 
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  1. 1.
    Rew DA. Towards a scientific basis for oncoplastic breast surgery. Eur J Surg Oncol. 2003;29:105–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Arenas M, Sabater S, Hernandez V, Henriquez I, Ameijide A, Anglada L, et al. Cosmetic outcome of breast conservative treatment for early stage breast cancer. Clin Transl Oncol. 2006;8334–8.Google Scholar
  3. 3.
    Vrieling C, Collette L, Fourquet A, Hoogenraad WJ, Horiot JC, Jager JJ, et al. The influence of the boost in breast-conserving therapy on cosmetic outcome in the EORTC “boost versus no boost” trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. European Organization for Research and Treatment of Cancer. Int J Radiat Oncol Biol Phys. 1999;45:677–85.CrossRefPubMedGoogle Scholar
  4. 4.
    Sneeuw KC, Aaronson NK, Yarnold JR, Broderick M, Regan J, Ross G, et al. Cosmetic and functional outcomes of breast conserving treatment for early stage breast cancer. 2. Relationship with psychosocial functioning. Radiother Oncol. 1992;25:160–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Stanton AL, Krishnan L, Collins CA, Form or function? Part 1. Subjective cosmetic and functional correlates of quality of life in women treated with breast-conserving surgical procedures and radiotherapy. Cancer. 2001;91:2273–81.CrossRefPubMedGoogle Scholar
  6. 6.
    Heil J, Holl S, Golatta M, Rauch G, Rom J, Marmé F, et al. Aesthetic and functional results after breast conserving surgery as correlates of quality of life measured by a German version of the Breast Cancer Treatment Outcome Scale (BCTOS). Breast. 2010 [Epub ahead of print].Google Scholar
  7. 7.
    Pezner RD, Patterson MP, Hill LR, Vora N, Desai KR, Archambeau JO, et al. Breast retraction assessment: an objective evaluation of cosmetic results of patients treated conservatively for breast cancer. Int J Radiat Oncol Biol Phys. 1985;11:575–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Van Limbergen E, van der Schueren E, Van Tongelen K. Cosmetic evaluation of breast conserving treatment for mammary cancer. 1. Proposal of a quantitative scoring system. Radiother Oncol. 1989;16:159–67.CrossRefPubMedGoogle Scholar
  9. 9.
    Sacchini V, Luini A, Tana S, Lozza L, Galimberti V, Merson M, et al. Quantitative and qualitative cosmetic evaluation after conservative treatment for breast cancer. Eur J Cancer. 1991;27:1395–400.CrossRefPubMedGoogle Scholar
  10. 10.
    Tsouskas LI, Fentiman IS. Breast compliance: a new method for evaluation of cosmetic outcome after conservative treatment of early breast cancer. Breast Cancer Res Treat. 1990;15:185–90.CrossRefPubMedGoogle Scholar
  11. 11.
    Kim MS, Reece GP, Beahm EK, Miller MJ, Neely Atkinson E, et al. Objective assessment of aesthetic outcomes of breast cancer treatment: measuring ptosis from clinical photographs. Comput Biol Med. 2007;37:49–59.CrossRefPubMedGoogle Scholar
  12. 12.
    Cardoso MJ, Cardoso J, Amaral N, Azevedo I, Barreau L, Bernardo M, et al. Turning subjective into objective: the BCCT.core software for evaluation of cosmetic results in breast cancer conservative treatment. Breast. 2007;16:456–61.CrossRefPubMedGoogle Scholar
  13. 13.
    Cardoso JS, Pinto da Costa JF, Cardoso MJ. Modelling ordinal relations with SVMs: an application to objective aesthetic evaluation of breast cancer conservative treatment. Neural Netw. 2005;18:808–17.CrossRefPubMedGoogle Scholar
  14. 14.
    Cardoso, MJ, Cardoso J, Santos AC, Barros H, Cardoso de Oliveira M. Interobserver agreement and consensus over the esthetic evaluation of conservative treatment for breast cancer. Breast. 2006;15:52–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Clarke D, Martinez A, Cox RS. Analysis of cosmetic results and complications in patients with stage I and II breast cancer treated by biopsy and irradiation. Int J Radiat Oncol Biol Phys. 1983;9:1807–13.PubMedGoogle Scholar
  16. 16.
    Al-Ghazal SK, Fallowfield L, Blamey RW. Patient evaluation of cosmetic outcome after conserving surgery for treatment of primary breast cancer. Eur J Surg Oncol. 1999;25:344–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Taylor ME, Perez CA, Halverson KJ, Kuske RR, Philpott GW, Garcia DM, et al. Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys. 1995;31:753–64.CrossRefPubMedGoogle Scholar
  18. 18.
    Fleiss JL, Cohen J. The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas. 1973;33:613–9.CrossRefGoogle Scholar
  19. 19.
    Cicchetti D, Allison T. A new procedure for assessing reliability of scoring eeg sleep recordings. Am J EEG Technol. 1971;11:101–9.Google Scholar
  20. 20.
    Seigel DG, Podgor MJ, Remaley NA. Acceptable values of kappa for comparison of two groups. Am J Epidemiol. 1992;135:571–8.PubMedGoogle Scholar
  21. 21.
    Cardoso MJ, Cardoso JS, Wild T, Krois W, Fitzal F. Comparing two objective methods for the aesthetic evaluation of breast cancer conservative treatment. Breast Cancer Res Treat. 2009;116:149–52.CrossRefPubMedGoogle Scholar
  22. 22.
    Al-Ghazal SK, Blamey RW. Cosmetic assessment of breast-conserving surgery for primary breast cancer. Breast. 1999;8:162–8.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Joerg Heil
    • 1
  • Julia Dahlkamp
    • 1
  • Michael Golatta
    • 1
  • Joachim Rom
    • 1
  • Christoph Domschke
    • 1
  • Geraldine Rauch
    • 2
  • Maria Joao Cardoso
    • 3
  • Christof Sohn
    • 1
  1. 1.University Breast Center HeidelbergHeidelbergGermany
  2. 2.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany
  3. 3.Porto Faculty of MedicineBreast Research Group—INESC PortoPortoPortugal

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