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Evolution, current challenges, and future possibilities in the objective assessment of aesthetic outcome of breast cancer locoregional treatment. Breast 2019; 49:123-130. [PMID: 31790958 PMCID: PMC7375658 DOI: 10.1016/j.breast.2019.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/09/2022] Open
Abstract
The Breast Cancer overall survival rate has raised impressively in the last 20 years mainly due to improved screening and effectiveness of treatments. This increase in survival paralleled the awareness over the long-lasting impact of the side effects of treatments on patient quality of life, emphasizing the motto “a longer but better life for breast cancer patients”. In breast cancer more strikingly than in other cancers, besides the side effects of systemic treatments, there is the visible impact of surgery and radiotherapy on patients’ body image. This has sparked interest on the development of tools for the aesthetic evaluation of Breast Cancer locoregional treatments, which evolved from manual, subjective approaches to computerized, automated solutions. However, although studied for almost four decades, past solutions were not mature enough to become a standard. Recent advancements in machine learning have inspired trends toward deep-learning-based medical image analysis, also bringing new promises to the field of aesthetic assessment of locoregional treatments. In this paper, a review and discussion of the previous state-of-the-art methods in the field is conducted and the extracted knowledge is used to understand the evolution and current challenges. The aim of this paper is to delve into the current opportunities as well as motivate and guide future research in the aesthetic assessment of Breast Cancer locoregional treatments. Past, present and future of objective assessment of aesthetic outcome of breast cancer treatments. Critical discussion of the role and impact of deep-learning-based methodologies in the field. Recommendation for future efforts in the objective assessment of aesthetic outcome of breast cancer treatments.
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Seibold P, Webb A, Aguado-Barrera ME, Azria D, Bourgier C, Brengues M, Briers E, Bultijnck R, Calvo-Crespo P, Carballo A, Choudhury A, Cicchetti A, Claßen J, Delmastro E, Dunning AM, Elliott RM, Fachal L, Farcy-Jacquet MP, Gabriele P, Garibaldi E, Gómez-Caamaño A, Gutiérrez-Enríquez S, Higginson DS, Johnson K, Lobato-Busto R, Mollà M, Müller A, Payne D, Peleteiro P, Post G, Rancati T, Rattay T, Reyes V, Rosenstein BS, De Ruysscher D, De Santis MC, Schäfer J, Schnabel T, Sperk E, Symonds RP, Stobart H, Taboada-Valladares B, Talbot CJ, Valdagni R, Vega A, Veldeman L, Ward T, Weißenberger C, West CML, Chang-Claude J. REQUITE: A prospective multicentre cohort study of patients undergoing radiotherapy for breast, lung or prostate cancer. Radiother Oncol 2019; 138:59-67. [PMID: 31146072 DOI: 10.1016/j.radonc.2019.04.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE REQUITE aimed to establish a resource for multi-national validation of models and biomarkers that predict risk of late toxicity following radiotherapy. The purpose of this article is to provide summary descriptive data. METHODS An international, prospective cohort study recruited cancer patients in 26 hospitals in eight countries between April 2014 and March 2017. Target recruitment was 5300 patients. Eligible patients had breast, prostate or lung cancer and planned potentially curable radiotherapy. Radiotherapy was prescribed according to local regimens, but centres used standardised data collection forms. Pre-treatment blood samples were collected. Patients were followed for a minimum of 12 (lung) or 24 (breast/prostate) months and summary descriptive statistics were generated. RESULTS The study recruited 2069 breast (99% of target), 1808 prostate (86%) and 561 lung (51%) cancer patients. The centralised, accessible database includes: physician- (47,025 forms) and patient- (54,901) reported outcomes; 11,563 breast photos; 17,107 DICOMs and 12,684 DVHs. Imputed genotype data are available for 4223 patients with European ancestry (1948 breast, 1728 prostate, 547 lung). Radiation-induced lymphocyte apoptosis (RILA) assay data are available for 1319 patients. DNA (n = 4409) and PAXgene tubes (n = 3039) are stored in the centralised biobank. Example prevalences of 2-year (1-year for lung) grade ≥2 CTCAE toxicities are 13% atrophy (breast), 3% rectal bleeding (prostate) and 27% dyspnoea (lung). CONCLUSION The comprehensive centralised database and linked biobank is a valuable resource for the radiotherapy community for validating predictive models and biomarkers. PATIENT SUMMARY Up to half of cancer patients undergo radiation therapy and irradiation of surrounding healthy tissue is unavoidable. Damage to healthy tissue can affect short- and long-term quality-of-life. Not all patients are equally sensitive to radiation "damage" but it is not possible at the moment to identify those who are. REQUITE was established with the aim of trying to understand more about how we could predict radiation sensitivity. The purpose of this paper is to provide an overview and summary of the data and material available. In the REQUITE study 4400 breast, prostate and lung cancer patients filled out questionnaires and donated blood. A large amount of data was collected in the same way. With all these data and samples a database and biobank were created that showed it is possible to collect this kind of information in a standardised way across countries. In the future, our database and linked biobank will be a resource for research and validation of clinical predictors and models of radiation sensitivity. REQUITE will also enable a better understanding of how many people suffer with radiotherapy toxicity.
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Affiliation(s)
- Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Adam Webb
- Department of Genetics and Genome Biology, University of Leicester, UK
| | - Miguel E Aguado-Barrera
- Fundación Pública Galega de Medicina Xenómica, Grupo de Medicina Xenómica (USC), Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela, Spain
| | - David Azria
- Department of Radiation Oncology, Montpellier Cancer Institute, Université Montpellier, Inserm U1194, France
| | - Celine Bourgier
- Department of Radiation Oncology, Montpellier Cancer Institute, Université Montpellier, Inserm U1194, France
| | - Muriel Brengues
- Institut de Recherche en Cancérologie de Montpellier, Montpellier Cancer Institute, Inserm U1194, France
| | | | - Renée Bultijnck
- Department of Human Structure and Repair, Ghent University, Belgium
| | - Patricia Calvo-Crespo
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Ana Carballo
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Ananya Choudhury
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, UK
| | - Alessandro Cicchetti
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Johannes Claßen
- Klinik für Strahlentherapie, Radiologische Onkologie und Palliativmedizin, ViDia Christliche Kliniken Karlsruhe, Germany
| | - Elena Delmastro
- Department of Radiation Oncology, Candiolo Cancer Institute - FPO, IRCCS, TO, Italy
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Research Labs, UK
| | - Rebecca M Elliott
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, UK
| | - Laura Fachal
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Strangeways Research Labs, UK
| | | | - Pietro Gabriele
- Department of Radiation Oncology, Candiolo Cancer Institute - FPO, IRCCS, TO, Italy
| | - Elisabetta Garibaldi
- Department of Radiation Oncology, Candiolo Cancer Institute - FPO, IRCCS, TO, Italy
| | - Antonio Gómez-Caamaño
- Instituto de Investigación Sanitaria de Santiago de Compostela, Spain; Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | | | - Daniel S Higginson
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Kerstie Johnson
- Leicester Cancer Research Centre, University of Leicester, UK
| | - Ramón Lobato-Busto
- Department of Medical Physics, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Meritxell Mollà
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Anusha Müller
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Debbie Payne
- Centre for Integrated Genomic Medical Research (CIGMR), University of Manchester, UK
| | - Paula Peleteiro
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Giselle Post
- Department of Human Structure and Repair, Ghent University, Belgium
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tim Rattay
- Leicester Cancer Research Centre, University of Leicester, UK
| | - Victoria Reyes
- Radiation Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Barry S Rosenstein
- Department of Radiation Oncology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Dirk De Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands; KU Leuven, Radiation Oncology, Leuven, Belgium
| | - Maria Carmen De Santis
- Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Thomas Schnabel
- Klinik für Strahlentherapie und Radiologische Onkologie, Klinikum der Stadt Ludwigshafen gGmbH, Germany
| | - Elena Sperk
- Department of Radiation Oncology, Universitätsklinikum Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - R Paul Symonds
- Leicester Cancer Research Centre, University of Leicester, UK
| | | | - Begoña Taboada-Valladares
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | | | - Riccardo Valdagni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Haematology-Oncology, University of Milan, Italy
| | - Ana Vega
- Fundación Pública Galega de Medicina Xenómica, Grupo de Medicina Xenómica (USC), Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela, Spain; Biomedical Network on Rare Diseases (CIBERER), Spain
| | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University, Belgium; Department of Radiation Oncology, Ghent University Hospital, Belgium
| | - Tim Ward
- Trustee Pelvic Radiation Disease Association, NCRI CTRad Consumer, UK
| | | | - Catharine M L West
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, UK
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Germany
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De-escalation of complexity in oncoplastic breast surgery: Case series from a specialized breast center. Breast 2019; 46:12-18. [DOI: 10.1016/j.breast.2019.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/17/2019] [Accepted: 04/08/2019] [Indexed: 11/21/2022] Open
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A prospective comparison of subjective and objective assessments of cosmetic outcomes following breast brachytherapy. J Contemp Brachytherapy 2019; 11:207-214. [PMID: 31435427 PMCID: PMC6701386 DOI: 10.5114/jcb.2019.85414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose We evaluated agreement between subjective and objective methods of cosmesis scoring in an accelerated partial breast irradiation (APBI) cohort. Material and methods Consecutive women treated with APBI using interstitial brachytherapy reported for clinical follow-up every 6 months. Single cross-sectional assessment of the breast cosmesis was done by a radiation oncologist (subjective method) using Harvard scale and by photographic assessment using BCCT.core (Breast Cancer Conservative Treatment. Cosmetic results, version 3.1) software (objective method) at 18-36 months post-APBI. The agreement between subjective and objective methods for the overall score as well as individual subjective/objective subdomains was computed using kappa statistics. ANOVA was used to test the correlation between objective indices and subjective subdomains. Results The agreement between the subjective (physician) and objective assessment was good with a kappa of 0.673. Overall, 77 (98.7%) patients were satisfied with the overall outcomes of breast conservation therapy. The kappa agreement between physician and patient scoring was 0.457 (95% CI: 0.240-0.674). Among the subjective subdomains, location of the nipple areola complex (NAC) had good agreement with both the overall subjective and objective score, with the kappa of 0.778 and 0.547, respectively. In the objective indices, BCE (breast compliance evaluation), LBC (lower breast contour), and UNR (unilateral nipple retraction) correlated significantly with the subjective subdomains: location of the NAC, breast size, and shape (p < 0.05 for all indices). Conclusions Good agreement exists for overall cosmetic outcomes measured by subjective and objective methods. Location of the NAC, breast size and shape are the most important parameters determining cosmetic outcomes irrespective of the method of assessment.
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Tagliaferri L, Lancellotta V, Zinicola T, Gentileschi S, Sollena P, Garganese G, Guinot JL, Rembielak A, Soror T, Autorino R, Cammelli S, Gambacorta MA, Aristei C, Valentini V, Kovacs G. Cosmetic assessment in brachytherapy (interventional radiotherapy) for breast cancer: A multidisciplinary review. Brachytherapy 2019; 18:635-644. [PMID: 31171462 DOI: 10.1016/j.brachy.2019.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/18/2019] [Accepted: 03/25/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE This review was to focus on breast brachytherapy cosmetic assessment methods state of the art and to define the advantages and disadvantages related to. METHODS AND MATERIALS We conducted a literature review of the major experience on breast brachytherapy cosmetic assessment methods in several databases (PubMed, Scopus, and Google Scholar databases). To identify the relevant works, a task force screened citations at title and abstract level to identify potentially relevant paper. An expert board reviewed and approved the text. The assessment systems were classified into three main groups: (1) the Oncological Toxicity Scales, (2) the Independent Patients Perspective Measures, (3) the Patient-Related Outcome Measures. Each cosmetic assessment method was evaluated following six parameters: (1) anatomical site, (2) advantages, (3) disadvantages, (4) subjective/objective, (5) quantitative/qualitative, (6) computers or pictures needs. RESULTS Eleven assessment methods were selected. Three methods were classified as Oncological Toxicity Scale, six in the Independent Patients Perspective Measures classification, and two as Patient-Related Outcome Measures. Six methods are subjective, while eight are objective. Four systems are classified as quantitative, four as qualitative while three both. Five systems need informatics support. Moreover, each method was discussed individually reporting the main characteristics and peculiarities. CONCLUSIONS Cosmesis is one major end point for the patient who has a malignancy of low lethal potential. In modern personalized medicine, there is a need for standardized cosmetic outcome assessments to analyze and compare the results of treatments. No gold standard methods currently exist. The result of this review is to summarize the various cosmesis methods, defining the strengths and weaknesses of each one and giving a line in research and clinical practice.
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Affiliation(s)
- Luca Tagliaferri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Valentina Lancellotta
- Department of Surgery and Biomedical Sciences, Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italia
| | - Tiziano Zinicola
- Università Cattolica del Sacro Cuore, Istituto di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia.
| | - Stefano Gentileschi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Chirurgia Plastica e Ricostruttiva, Centro di Trattamento Chirurgico del Linfedema, Roma, Italia
| | - Pietro Sollena
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia, Roma, Italia
| | - Giorgia Garganese
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna e del Bambino, Roma, Italia
| | - José L Guinot
- Department of Radiation Oncology, Foundation Instituto Valenciano de Oncologia (I.V.O.), València, Spain
| | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester and Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Tamer Soror
- Department of Clinical Radiation Oncology, Ernst von Bergmann Medical Center, Academic Teaching Hospital of Humboldt University Berlin (Charité), Berlin, Germany; National Cancer Institute (NCI), Radiation Oncology Department, Cairo University, Cairo, Egypt
| | - Rosa Autorino
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Silvia Cammelli
- Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italia
| | - Maria A Gambacorta
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia; Università Cattolica del Sacro Cuore, Istituto di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Cynthia Aristei
- Department of Surgery and Biomedical Sciences, Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italia
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia; Università Cattolica del Sacro Cuore, Istituto di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - György Kovacs
- Interdisciplinary Brachytherapy Unit, UKSH CL, Lübeck, Germany
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Gardfjell A, Dahlbäck C, Åhsberg K. Patient satisfaction after unilateral oncoplastic volume displacement surgery for breast cancer, evaluated with the BREAST-Q™. World J Surg Oncol 2019; 17:96. [PMID: 31167659 PMCID: PMC6551885 DOI: 10.1186/s12957-019-1640-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/27/2019] [Indexed: 11/11/2022] Open
Abstract
Background Oncoplastic breast-conserving surgery allows larger resections in unfavorable locations, with an improved chance of preserving esthetics. Indications and timing for potential contralateral surgery to obtain symmetry are not clear. The aim of this study was to evaluate patient satisfaction after unilateral oncoplastic volume displacement surgery, to investigate potential risk factors for lower patient satisfaction and to assess patient wish for contralateral surgery. Method A cohort of 144 women, consecutively treated for breast cancer with unilateral breast-conserving oncoplastic volume displacement surgery, followed by radiotherapy and with an unoperated contralateral breast, was sent the BREAST-Q™ breast-conserving therapy (BCT) and a study-specific questionnaire. In all, 120 women (83%) responded. For these women, the median value for resected specimen weight was 92 g (range 14–345) and for the estimated percentage of the breast volume excised 15% (range 3–35%). Results The median patient-reported score for “Satisfaction with breast” (BREAST-Q™ BCT) was 74/100. Factors associated with a score below median value in a simple logistic regression model adjusted for age and BMI were axillary clearance (OR 2.46, 95% CI 1.09–5.56), neoadjuvant chemotherapy (OR 3.26, 95% CI 1.15–9.24), and low breast density (OR 2.32 95% CI 1.02–5.29). Thirteen women (11%) were interested in contralateral surgery. Conclusion Most patients in this study cohort, who had undergone breast-conserving therapy with oncoplastic volume displacement techniques, were satisfied with their breasts without surgery to the contralateral breast. This indicates that contralateral surgery to achieve symmetry only should be performed after individual evaluation and as a delayed procedure.
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Affiliation(s)
- Anna Gardfjell
- Department of Surgery, Region Blekinge Hospital, Karlskrona, Sweden
| | - Cecilia Dahlbäck
- Department of Clinical Sciences Lund, Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Kristina Åhsberg
- Department of Clinical Sciences Lund, Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
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Vella Baldacchino R, Bellizzi A, Madada-Nyakauru RN, Kazzazi F, Oni G, Forouhi P, Malata CM. Assessment of breast symmetry in breast cancer patients undergoing therapeutic mammaplasty using the Breast Cancer Conservation Therapy cosmetic results software (BCCT.core). Gland Surg 2019; 8:218-225. [PMID: 31328100 DOI: 10.21037/gs.2018.09.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Therapeutic mammaplasty (TM) is a standard oncoplastic technique utilising aesthetic breast reduction principles to facilitate tumour resection and breast reshaping. Simultaneous contralateral mammaplasties are often performed to maintain symmetry. BCCT.core software, which principally assesses breast symmetry, has been previously employed for evaluating cosmetic results after standard breast conservation therapy and latterly TMs for upper pole tumours. The purpose of this study was to validate this novel tool for TMs in all breast zones. Methods Standardised photographs of 20 consecutive patients who underwent TM were evaluated for symmetry using BCCT.core versus a plastic surgical panel completing a visual analogue scale. Results were rated as (excellent/good/fair/poor). Outcomes between the two methods were compared. Results Twenty patients aged 37 to 63 years with a median 36G bra size had 22 TMs (18 unilateral, 2 bilateral). Indications were invasive breast cancer (87%) and ductal carcinoma in situ (DCIS) (13%). The median (range) tumour size was 22.5 mm (6-90 mm) with a resection weight of 245.8 g (16-1,079 g). Primary nipple pedicles were superomedial (63%), inferior (21%) and superolateral (16%). Five patients required a secondary glandular pedicle for volume redistribution to maintain breast shape. The BCCT.core software vs. panel symmetry assessments were 37% vs. 39% (excellent), 63% vs. 50% (good) and 0% vs. 11% (fair). Wilcoxon matched-pairs sign rank tests and Spearman rank correlations found the pairings to be statistically significant (P<0.05). Conclusions Despite small patient numbers, BCCT.core gave comparable findings with the panel and is thus useful for objectively assessing cosmesis of TMs in all breast zones.
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Affiliation(s)
| | - Annalise Bellizzi
- Mater Dei Hospital, Malta Medical School, University of Malta, Msida, Malta
| | - Rudo N Madada-Nyakauru
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fawz Kazzazi
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Georgette Oni
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Parto Forouhi
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Charles M Malata
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Anglia Ruskin School of Medicine, Anglia Ruskin University, Chelmsford and Cambridge, UK
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Quality of life in breast cancer patients and surgical results of immediate tissue expander/implant-based breast reconstruction after mastectomy. Arch Gynecol Obstet 2019; 300:409-420. [PMID: 31144025 DOI: 10.1007/s00404-019-05201-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/22/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The purpose of this study was to analyze the effects of prior radiotherapy (RT) as well as postmastectomy radiotherapy (PMRT) on patient-reported quality of life (QoL) and on surgical/aesthetic outcomes in patients with expander-/implant-based delayed immediate reconstruction (EIBR) compared to patients that underwent EIBR without any RT. MATERIAL AND METHODS QoL was assessed by BREAST-Q, the surgical/aesthetic outcome by a structured examination and a picture analysis (BCCT.CORE software) and subsequently compared between the three cohorts. RESULTS Of 161 eligible patients, 97 followed the invitation (no RT n = 54, 9 of them with bilateral EIBR; PMRT n = 26; history of RT n = 15). The surgical/aesthetic results were better in the RT-naive cohort than in the PMRT cohort, but satisfaction with outcome and psychosocial well-being were better in the PMRT cohort. The RT-naive cohort showed (significantly) higher scores in satisfaction with breast, satisfaction with implant and sexual well-being compared to the history of RT cohort, although satisfaction with outcome was comparable. The PMRT cohort reached significantly more points in almost all categories and better BCCT.CORE and examination results than the history of RT cohort. Of all patients, 92.7%, 84.6% and 78.6% (RT naive, PMRT, history of RT) would agree to undergo EIBR again. CONCLUSION EIBR results in acceptable QoL and surgical results. In patients with a prior RT, QoL is significantly lower and surgical results are significantly worse. However, high acceptance rates suggest EIBR being a justifiable option even for this group. Prospective studies and long-term follow-up are required for definitive conclusions.
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Catanuto G, Taher W, Rocco N, Catalano F, Allegra D, Milotta FLM, Stanco F, Gallo G, Nava MB. Breast Shape Analysis With Curvature Estimates and Principal Component Analysis for Cosmetic and Reconstructive Breast Surgery. Aesthet Surg J 2019; 39:164-173. [PMID: 29579138 DOI: 10.1093/asj/sjy070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Breast shape is defined utilizing mainly qualitative assessment (full, flat, ptotic) or estimates, such as volume or distances between reference points, that cannot describe it reliably. Objectives The authors quantitatively described breast shape with two parameters derived from a statistical methodology denominated by principal component analysis (PCA). Methods The authors created a heterogeneous dataset of breast shapes acquired with a commercial infrared 3-dimensional scanner on which PCA was performed. The authors plotted on a Cartesian plane the two highest values of PCA for each breast (principal components 1 and 2). Testing of the methodology on a preoperative and posttreatment surgical case and test-retest was performed by two operators. Results The first two principal components derived from PCA characterize the shape of the breast included in the dataset. The test-retest demonstrated that different operators obtain very similar values of PCA. The system is also able to identify major changes in the preoperative and posttreatment stages of a two-stage reconstruction. Even minor changes were correctly detected by the system. Conclusions This methodology can reliably describe the shape of a breast. An expert operator and a newly trained operator can reach similar results in a test/re-testing validation. Once developed and after further validation, this methodology could be employed as a good tool for outcome evaluation, auditing, and benchmarking. Level of Evidence 4
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Affiliation(s)
- Giuseppe Catanuto
- U.O.C. Multidisciplinare di Senologia, Azienda Ospedaliera Cannizzaro Catania, Catania, Italy
- Group for Reconstructive and Therapeutic Advancements, Milano-Napoli-Catania, Italy
| | - Wafa Taher
- Fellow of the International Fellowship Mr G. Querci della Rovere and Locum Consultant, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Nicola Rocco
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
| | - Francesca Catalano
- U.O.C. Multidisciplinare di Senologia, Azienda Ospedaliera Cannizzaro Catania, Catania, Italy
| | - Dario Allegra
- Dipartimento di Matematica e Informatica, Università degli Studi di Catania, Catania, Italy
| | | | - Filippo Stanco
- Dipartimento di Matematica e Informatica, Università degli Studi di Catania, Catania, Italy
| | - Giovanni Gallo
- Dipartimento di Matematica e Informatica, Università degli Studi di Catania, Catania, Italy
| | - Maurizio Bruno Nava
- Group for Reconstructive and Therapeutic Advancements, Milano-Napoli-Catania, Italy
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Brandini da Silva FC, José da Silva J, Sarri AJ, Paiva CE, Aloisio da Costa Vieira R. Comprehensive Validation Study of Quality-of-Life Questionnaire Using Objective Clinical Measures: Breast Cancer Treatment Outcome Scale (BCTOS), Brazilian Portuguese Version. Clin Breast Cancer 2018; 19:e85-e100. [PMID: 30473244 DOI: 10.1016/j.clbc.2018.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/19/2018] [Accepted: 10/21/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION When evaluating a quality-of-life questionnaire (QLQ), many validation studies do not correlate quality-of-life scores with objective measurements of complications associated with treatment. PATIENTS AND METHODS We performed a cross-sectional observational study with 300 patients submitted to breast-conserving therapy. The patients answered the European Organization for Research and Treatment of Cancer (EORTC) QLQs C-30 and BR23, as well as the Brazilian Portuguese version of the Breast Cancer Treatment Outcome Scale (BCTOS) questionnaire. Retest, internal consistency, factorial analysis, convergent/divergent analysis, and Rasch evaluation were performed. All patients underwent physical evaluations to assess lymphedema, handgrip strength, shoulder range of motion, breast cosmesis, and breast pain, and these groups were compared on the basis of BCTOS scores. Receiver operating characteristic curve determined the predictive value of BCTOS scores associated with clinical practice. RESULTS The internal consistencies of the BCTOS domains ranged from 0.785 to 0.895. Factor analysis grouped according to the original questionnaire. Convergent validation showed differences in the sexual functioning and sexual enjoyment domains of the EORTC BR23. Analysis of known groups found that in most domains, the scores were higher in patients with lymphedema, strength deficit, shoulder range-of-motion alteration, poor breast cosmesis, breast pain, and axillary lymphadenectomy. Using a cutoff of 1.26, lymphedema was associated with the edema domain; using a cutoff of 1.33, Late Effects Normal Tissue Task Force/Subjective, Objective, Management, Analytic pain was associated with the pain domain; and using a cutoff of 2.37, the cosmetic domain was associated with subjective cosmesis. CONCLUSION The association of objective measurements in a validation study of quality of life qualified the study and allowed us to develop better parameters for comparisons of results of breast-conserving therapy between populations.
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Affiliation(s)
- Fabíola Cristina Brandini da Silva
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Barretos, Brazil; Department of Physiotherapy, Barretos Cancer Hospital, Barretos, Brazil
| | - Jonathas José da Silva
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Barretos, Brazil; Department of Physiotherapy, Barretos Cancer Hospital, Barretos, Brazil
| | - Almir José Sarri
- Department of Physiotherapy, Barretos Cancer Hospital, Barretos, Brazil
| | - Carlos Eduardo Paiva
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Barretos, Brazil; Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - René Aloisio da Costa Vieira
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Barretos, Brazil; Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Barretos, Brazil.
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Predictors for poor cosmetic outcome in patients with early stage breast cancer treated with breast conserving therapy: Results of the Young boost trial. Radiother Oncol 2018; 128:434-441. [DOI: 10.1016/j.radonc.2018.06.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/27/2018] [Accepted: 06/12/2018] [Indexed: 11/21/2022]
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Dahlbäck C, Ringberg A, Manjer J. Aesthetic outcome following breast-conserving surgery assessed by three evaluation modalities in relation to health-related quality of life. Br J Surg 2018; 106:90-99. [DOI: 10.1002/bjs.10963] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/24/2018] [Accepted: 06/29/2018] [Indexed: 11/08/2022]
Abstract
Abstract
Background
The aim of this study was to compare the agreement between three different methods for evaluation of aesthetic outcome following breast-conserving surgery and adjuvant radiotherapy: a patient questionnaire, panel evaluation of photographs and the software BCCT.core. A further aim was to examine how these modalities predict health-related quality of life as measured by the validated Breast-Q™ questionnaire.
Methods
At 1-year follow-up after breast-conserving surgery, patients completed a study-specific questionnaire. Postoperative photographs were evaluated using the software BCCT.core. A panel of three healthcare professionals assessed preoperative and postoperative photographs. Agreement between methods was assessed using Spearman's correlation coefficients (rs). The Breast-Q™ questionnaire was sent to study participants. The ability of the different evaluation methods to predict Q-scores for the health-related quality-of-life (HRQoL) domains satisfaction with breasts and psychosocial well-being was investigated using receiver operating characteristic (ROC) curves.
Results
A total of 532 patients undergoing breast-conserving surgery were examined before surgery. At 1-year follow-up, 334 patients completed the study-specific questionnaire. Postoperative photographs from 310 patients were evaluated using BCCT.core. The panel of healthcare professionals assessed photographs from 215 patients. Agreement between the different evaluation modalities was poor. The strongest agreement was noted between the panel evaluation for symmetry and BCCT.core results (rs = 0·59, P < 0·001). The Breast-Q™ questionnaire was returned by 348 patients. Patient satisfaction ratings at 1-year follow-up best predicted long-term HRQoL measured using the Breast-Q score, both in terms of satisfaction with breasts (area under the curve (AUC) 0·80, P < 0·001) and psychosocial well-being (AUC 0·73, P < 0·001).
Conclusion
There is currently no ideal method for evaluating aesthetic outcome after breast-conserving surgery and adjuvant radiotherapy. These results emphasize the use of patient-related outcome measures.
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Affiliation(s)
- C Dahlbäck
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - A Ringberg
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - J Manjer
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
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Cardoso MJ, Vrieling C, Cardoso JS, Oliveira HP, Williams NR, Dixon JM. The value of 3D images in the aesthetic evaluation of breast cancer conservative treatment. Results from a prospective multicentric clinical trial. Breast 2018; 41:19-24. [PMID: 29940498 DOI: 10.1016/j.breast.2018.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/18/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE BCCT.core (Breast Cancer Conservative Treatment. cosmetic results) is a software created for the objective evaluation of aesthetic result of breast cancer conservative treatment using a single patient frontal photography. The lack of volume information has been one criticism, as the use of 3D information might improve accuracy in aesthetic evaluation. In this study, we have evaluated the added value of 3D information to two methods of aesthetic evaluation: a panel of experts; and an augmented version of the computational model - BCCT.core3d. MATERIAL AND METHODS Within the scope of EU Seventh Framework Programme Project PICTURE, 2D and 3D images from 106 patients from three clinical centres were evaluated by a panel of 17 experts and the BCCT.core. Agreement between all methods was calculated using the kappa (K) and weighted kappa (wK) statistics. RESULTS Subjective agreement between 2D and 3D individual evaluation was fair to moderate. The agreement between the expert classification and the BCCT.core software with both 2D and 3D features was also fair to moderate. CONCLUSIONS The inclusion of 3D images did not add significant information to the aesthetic evaluation either by the panel or the software. Evaluation of aesthetic outcome can be performed using of the BCCT.core software, with a single frontal image.
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Affiliation(s)
- Maria João Cardoso
- Breast Unit, Champalimaud Foundation and Nova Medical School, Lisbon, Portugal.
| | | | | | | | | | - J M Dixon
- Breast Cancer Now Research Unit, Edinburgh, UK
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Myung Y, Son Y, Nam TH, Kang E, Kim EK, Kim IA, Eom KY, Heo CY, Jeong JH. Objective assessment of flap volume changes and aesthetic results after adjuvant radiation therapy in patients undergoing immediate autologous breast reconstruction. PLoS One 2018; 13:e0197615. [PMID: 29782518 PMCID: PMC5962051 DOI: 10.1371/journal.pone.0197615] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/05/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The use of immediate breast reconstruction and adjuvant radiation therapy is increasing in breast cancer patients. This study aimed to analyze the aesthetic outcome and changes in flap volume in patients with breast cancer undergoing radiation therapy of the surgical site after immediate autologous tissue reconstruction. METHODS Immediate abdominal free flap breast reconstruction following unilateral mastectomy was performed in 42 patients; 21 patients received adjuvant radiation (study group) and 21 patients did not (control group). To compare flap volume, three-dimensional computed tomography (CT) was performed before and after radiation. Also, aesthetic analysis was performed in both groups to evaluate shape changes. RESULTS There was a 12.3% flap volume reduction after the completion of radiation in the experimental group that was significantly greater than the 2.6% volume reduction observed in the non-radiation group (P<0.01). There was no significant difference in the short- and long-term aesthetic results between the groups. CONCLUSIONS When performing immediate autologous breast reconstruction, 14% volume overcorrection is recommended for patients in whom adjuvant radiation therapy is anticipated to improve aesthetic outcomes.
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Affiliation(s)
- Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yousung Son
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Tae-hyun Nam
- Department of Diagnostic Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- * E-mail:
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Catsman CJLM, Beek MA, Voogd AC, Mulder PGH, Luiten EJT. The COSMAM TRIAL a prospective cohort study of quality of life and cosmetic outcome in patients undergoing breast conserving surgery. BMC Cancer 2018; 18:456. [PMID: 29688847 PMCID: PMC5914027 DOI: 10.1186/s12885-018-4368-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 04/12/2018] [Indexed: 11/23/2022] Open
Abstract
Background Cosmetic result in breast cancer surgery is gaining increased interest. Currently, some 30–40% of the patients treated with breast conserving surgery (BCS) are dissatisfied with their final cosmetic result. In order to prevent disturbing breast deformity oncoplastic surgical techniques have been introduced. The extent of different levels of oncoplastic surgery incorporated in breast conserving surgery and its value with regard to cosmetic outcome, patient satisfaction and quality of life remains to be defined. The aim of this prospective cohort study is to investigate quality of life and satisfaction with cosmetic result in patients with breast cancer, undergoing standard lumpectomy versus level I or II oncoplastic breast conserving surgery. Methods Female breast cancer patients scheduled for BCS, from 18 years of age, referred to our outpatient clinic from July 2015 are asked to participate in this study. General, oncologic and treatment information will be collected. Patient satisfaction will be scored preceding surgery, and at 1 month and 1 year follow up. Photographs of the breast will be used to score cosmetic result both by the patient, an independent expert panel and BCCT.Core software. Quality of life will be measured by using the BREAST-Q BCT, EORTC-QLQ and EQ-5D-5 L questionnaires. Discussion The purpose of this prospective study is to determine the clinical value of different levels of oncoplastic techniques in breast conserving surgery, with regard to quality of life and cosmetic result. Analysis will be carried out by objective measurements of the final cosmetic result in comparison with standard breast conserving surgery. The results of this study will be used to development of a clinical decision model to guide the use oncoplastic surgery in future BCS. Trial registration Central Commission of Human Research (CCMO), The Netherlands: NL54888.015.15. Medical Ethical Commission (METC), Maxima Medical Centre, Veldhoven, The Netherlands: 15.107. Dutch Trial Register: NTR5665, retrospectively registered, 02-25-2016. Electronic supplementary material The online version of this article (10.1186/s12885-018-4368-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Coriene J L M Catsman
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands.
| | - Martinus A Beek
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Paul G H Mulder
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands
| | - Ernest J T Luiten
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands
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Corica T, Nowak AK, Saunders CM, Bulsara MK, Taylor M, Williams NR, Keshtgar M, Joseph DJ, Vaidya JS. Cosmetic outcome as rated by patients, doctors, nurses and BCCT.core software assessed over 5 years in a subset of patients in the TARGIT-A Trial. Radiat Oncol 2018; 13:68. [PMID: 29653541 PMCID: PMC5899392 DOI: 10.1186/s13014-018-0998-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/13/2018] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this research was to assess agreement between four rating systems of cosmetic outcome measured in a subset of patients with early breast cancer participating in the randomised TARGIT-A trial. TARGIT-A compared risk-adapted single-dose intra-operative radiotherapy (TARGIT-IORT) to whole breast external beam radiotherapy (EBRT). Methods Patients, their Radiation Oncologist and Research Nurse completed a subjective cosmetic assessment questionnaire before radiotherapy and annually thereafter for five years. Objective data previously calculated by the validated BCCT.core software which utilizes digital photographs to score symmetry, colour and scar was also used. Agreement was assessed by the Kappa statistic and longitudinal changes were assessed by generalized estimating equations. Results Overall, an Excellent-Good (EG) cosmetic result was scored more often than a Fair-Poor (FP) result for both treatment groups across all time points, with patients who received TARGIT-IORT scoring EG more often than those who received EBRT however this was statistically significant at Year 5 only. There was modest agreement between the four rating systems with the highest Kappa score being moderate agreement which was between nurse and doctor scores at Year 1 with Kappa = 0.46 (p < 0.001), 95% CI (0.24, 0.68). Conclusion Despite similar overall findings between treatment groups and rating systems, the inter-rater agreement was only modest. This suggests that the four rating systems utilized may not necessarily be used interchangeably and it is arguable that for an outcome such as cosmetic appearance, the patient’s point of view is the most important. Trial Registration TARGIT-A ISRCTN34086741, Registered 21 July 2004, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s13014-018-0998-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tammy Corica
- Radiation Oncology Clinical Trials and Research Unit, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia. .,Medical School, University of Western Australia, Nedlands, WA, 6009, Australia.
| | - Anna K Nowak
- Medical School, University of Western Australia, Nedlands, WA, 6009, Australia
| | | | - Max K Bulsara
- Institute for Health Research, University of Notre Dame, 19 Mouat Street, Fremantle, WA, 6160, Australia
| | - Mandy Taylor
- Radiation Oncology, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
| | - Norman R Williams
- Surgical & Interventional Trials Unit, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, NW1 2FD, UK
| | - Mohammed Keshtgar
- Royal Free London Foundation NHS Trust, Division of Surgical Sciences, The Breast Unit, Pond Street, Hampstead, London, NW3 2QG, UK
| | - David J Joseph
- Medical School, University of Western Australia, Nedlands, WA, 6009, Australia.,Radiation Oncology, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia
| | - Jayant S Vaidya
- Division of Surgery & Interventional Science, University College London, London W1W 7TS, UK; Whittington Hospital, Royal Free Hospital and University College Hospital, University College London, London, NW1 2FD, UK
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67
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Winters ZE, Benson JR. Surgical treatment of multiple ipsilateral breast cancers. Br J Surg 2018; 105:466-468. [DOI: 10.1002/bjs.10738] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 01/03/2023]
Abstract
Abundant research
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Affiliation(s)
- Z E Winters
- Surgical and Interventional Trials Unit, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, 1 Euston Square, 40 Melton Street, London NW1 2FD, UK
| | - J R Benson
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge, UK
- School of Medicine, Anglia Ruskin University, Cambridge and Chelmsford, UK
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Matkowski R, Szynglarewicz B, Kasprzak P, Forgacz J, Skalik R, Zietek M, Kornafel D. Batwing Mastopexy as Oncoplastic Surgical Approach to Periareolar Tumors in Upper Quadrants. TUMORI JOURNAL 2018; 98:421-7. [DOI: 10.1177/030089161209800404] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Batwing mastopexy (BWM) is an oncoplastic technique most commonly used in the treatment of 12 o'clock periareolar tumors. The aim of this study was to assess the early cosmetic results of BWM performed for periareolar lesions located in the upper quadrants, i.e. from 10 to 2 o'clock position. Methods and study design A prospective analysis of a preliminary group of 35 women with periareolar intraductal or invasive breast cancer in the upper quadrants was done. All patients underwent wide lumpectomy with clear margins followed by BWM in order to obtain favorable cosmesis. For invasive cancers axillary biopsy or dissection was performed by separate incision. Cosmetic outcome was assessed 4 weeks after surgery by the patient with reference to breast shape, nipple-areola complex (NAC) position and scar arrangement. The result was rated as poor, medium or good for each parameter. Results There were no poor ratings of cosmetic outcome. The result was rated as medium by 5 women (14%) regarding breast shape and by 3 regarding NAC position (9%). The remaining women evaluated these parameters as good (86% and 91%, respectively). In contrast, scar arrangement was assessed as good by 26 patients (74%), medium by 8 (23%), and poor by 1 (3%). All women rating scar arrangement as other than good had a lesion located in the upper lateral quadrant. Considering the reasons for the relatively low scar acceptance by these women, the only important cause of disappointment was the placement of one of the radial parts of the scar in the area of decolletage in the upper medial quadrant. Conclusions BWM allows to achieve favorable breast shape and NAC position for lesions located in the upper quadrants regardless of the medial or lateral side. However, when performed in the lateral quadrant it produces a scar that can be hard to accept for some women.
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Affiliation(s)
- Rafal Matkowski
- Department of Oncology and Division of Oncological Surgery, Wroclaw Medical University, Wroclaw
- Second Department of Surgical Oncology, Lower Silesian Oncology Center–Regional Comprehensive Cancer Center, Wroclaw
| | - Bartlomiej Szynglarewicz
- Second Department of Surgical Oncology, Lower Silesian Oncology Center–Regional Comprehensive Cancer Center, Wroclaw
| | - Piotr Kasprzak
- Breast Imaging and Minimally Invasive Biopsy Service, Lower Silesian Oncology Center-Regional Comprehensive Cancer Center, Wroclaw
| | - Jozef Forgacz
- Second Department of Surgical Oncology, Lower Silesian Oncology Center–Regional Comprehensive Cancer Center, Wroclaw
| | - Robert Skalik
- Department of Physiology, Wroclaw Medical University, Wroclaw
| | - Marcin Zietek
- Second Department of Surgical Oncology, Lower Silesian Oncology Center–Regional Comprehensive Cancer Center, Wroclaw
| | - Danuta Kornafel
- Department of Anthropology, Faculty of Biological Sciences, University of Wroclaw, Wroclaw, Poland
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Lagendijk M, Vos EL, Nieboer D, Verhoef C, Corten EML, Koppert LB. Evaluation of cosmetic outcome following breast-conserving therapy in trials: panel versus digitalized analysis and the role of PROMs. Breast J 2018; 24:519-525. [PMID: 29316049 DOI: 10.1111/tbj.12980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 07/31/2017] [Accepted: 08/03/2017] [Indexed: 11/28/2022]
Abstract
Cosmetic outcome is an important quality of life-related end point following breast-conserving therapy (BCT). To advise on a gold standard, we compare cosmetic outcome evaluated by panel and an objective evaluation (BCCT.core software). Second, patient-reported outcome measures (PROMs) are compared to cosmetic outcome evaluation by panel and BCCT.core. Sixty-eight breast cancer patients were included following BCT between 2007 and 2012. Two independent 6-member panels and two observers using the BCCT.core evaluated cosmetic outcome. First, reproducibility, repeatability, and relatedness of panel and BCCT.core were analyzed using the interclass correlation coefficient (ICC). Second, the association between panel/BCCT.core with PROMs (EORTC-QLQ-C30/BR23, EQ-5D-5L, and BREAST-Q) was analyzed with a linear regression and the goodness of fit by the R2 . Both panel and BCCT.core evaluations showed "excellent" intraobserver agreement (ICC 0.93 [95% CI: 0.83; 0.97] and 0.93 [95% CI: 0.84; 0.97]) for respectively panel 1 and BCCT.core 1 and "excellent" interobserver agreement (ICC 0.94 [95% CI: 0.90; 0.96] and 0.85 [95% CI: 0.77; 0.91]) respectively for panel and BCCT.core. Association between panel and BCCT.core varied, ICC 0.59-0.69. Only the PROM BREAST-Q showed a significant association with both panel evaluations and BCCT.core observers (panel 1 and BCCT.core 1; R2 of .157 [P = .002] and .178 [P = .001]). Both panel and BCCT.core showed comparable "excellent" intraobserver and interobserver agreement. For future trials evaluating cosmetic outcome following BCT, one of those can be chosen. Solely, the PROM BREAST-Q showed a significant association with panel and/or BCCT.core evaluation. To enable standardized cosmetic outcome evaluation and corresponding patient satisfaction in future trials, at least the BREAST-Q should be combined with a panel or BCCT.core evaluation.
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Affiliation(s)
- Mirelle Lagendijk
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Elvira L Vos
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Evelien M L Corten
- Department of Plastic and Reconstructive Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Brouwers P, van Loon J, Houben R, Paulissen J, Engelen S, Heuts M, de Boer M, Verhoeven K, De Ruysscher D, Boersma L. Are PROMs sufficient to record late outcome of breast cancer patients treated with radiotherapy? A comparison between patient and clinician reported outcome through an outpatient clinic after 10 years of follow up. Radiother Oncol 2018; 126:163-169. [DOI: 10.1016/j.radonc.2017.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
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Merie R, Browne L, Cardoso JS, Cardoso MJ, Chin Y, Clark C, Graham P, Szwajcer A, Hau E. Proposal for a gold standard for cosmetic evaluation after breast conserving therapy: Results from the St George and Wollongong Breast Boost trial. J Med Imaging Radiat Oncol 2017; 61:819-825. [DOI: 10.1111/1754-9485.12645] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/02/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Roya Merie
- St George Cancer Care Centre; Kogarah New South Wales Australia
| | - Lois Browne
- St George Cancer Care Centre; Kogarah New South Wales Australia
| | | | - Maria J Cardoso
- Breast Cancer Unit; Champalimaud Cancer Centre; Lisbon Portugal
| | - Yaw Chin
- St George Cancer Care Centre; Kogarah New South Wales Australia
| | - Catherine Clark
- St George Cancer Care Centre; Kogarah New South Wales Australia
| | - Peter Graham
- St George Cancer Care Centre; Kogarah New South Wales Australia
| | - Alison Szwajcer
- St George Cancer Care Centre; Kogarah New South Wales Australia
| | - Eric Hau
- Crown Princess Mary Westmead Cancer Care Centre; Westmead New South Wales Australia
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O'Connell RL, Di Micco R, Khabra K, Wolf L, deSouza N, Roche N, Barry PA, Kirby AM, Rusby JE. The potential role of three-dimensional surface imaging as a tool to evaluate aesthetic outcome after Breast Conserving Therapy (BCT). Breast Cancer Res Treat 2017; 164:385-393. [PMID: 28447239 PMCID: PMC5487698 DOI: 10.1007/s10549-017-4256-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 04/17/2017] [Indexed: 11/13/2022]
Abstract
PURPOSE To establish whether objective measurements of symmetry of volume and shape using three-dimensional surface imaging (3D-SI) can be used as surrogate markers of aesthetic outcome in patients who have undergone breast conserving therapy (BCT). METHODS Women who had undergone unilateral BCT in the preceding 1-6 years were invited to participate. Participants completed a satisfaction questionnaire (BREAST-Q) and underwent 3D-SI. Volume and surface symmetry were measured on the images. Assessment of aesthetic outcome was undertaken by a panel of clinicians. The Kruskal-Wallis test was used to assess the relationship between volume and shape symmetry measurements with the panel score. Spearman's rho correlations were used to assess the relationship between the measurements and patient satisfaction. RESULTS 200 women participated. Median volume symmetry was 87% (IQR 78-93) and shape symmetry was 5.9 mm (IQR 4.2-8.0). The participants were grouped according to panel assessment of aesthetic outcome (poor, fair, good, excellent) and the median volume and shape symmetry was calculated for each group. Volume symmetry significantly differed between the groups. Post hoc pairwise comparisons demonstrated that these differences existed between panel scores of fair versus good and good versus excellent. Median shape symmetry also differed according to patient panel groups with four significant pairwise comparisons between poor versus good, poor versus excellent, fair versus good and fair versus excellent. There was a significant but weak correlation of both volume symmetry and surface asymmetry with BREAST-Q scores (correlation coefficients 0.187 and -0.229, respectively). CONCLUSION Breast volume and shape symmetry are both associated with panel assessment scores and patient satisfaction. The objective volume and shape symmetry measures were strongly associated with panel assessment scores, such that a 3D-SI tool could replace panel assessment as a faster and more objective method of evaluating aesthetic outcomes.
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Affiliation(s)
- Rachel L O'Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Orchard House, Downs Road, Sutton, SM2 5PT, UK
| | - Rosa Di Micco
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Orchard House, Downs Road, Sutton, SM2 5PT, UK
- Department of Medicine and Surgery, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Komel Khabra
- Department of Statistics, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Lisa Wolf
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Orchard House, Downs Road, Sutton, SM2 5PT, UK
| | - Nandita deSouza
- Cancer Research UK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Nicola Roche
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Orchard House, Downs Road, Sutton, SM2 5PT, UK
| | - Peter A Barry
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Orchard House, Downs Road, Sutton, SM2 5PT, UK
| | - Anna M Kirby
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Jennifer E Rusby
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Orchard House, Downs Road, Sutton, SM2 5PT, UK.
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Dahlbäck C, Ullmark JH, Rehn M, Ringberg A, Manjer J. Aesthetic result after breast-conserving therapy is associated with quality of life several years after treatment. Swedish women evaluated with BCCT.core and BREAST-Q™. Breast Cancer Res Treat 2017; 164:679-687. [PMID: 28536951 PMCID: PMC5495840 DOI: 10.1007/s10549-017-4306-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/17/2017] [Indexed: 11/23/2022]
Abstract
Purpose A gold standard for evaluation of aesthetic outcome after breast-conserving therapy (BCT) is still lacking. The BCCT.core software has been developed to assess aesthetic result in a standardised way. We aimed to study how the result of BCCT.core after BCT is associated with quality of life, measured with the BREAST-Q™, a validated questionnaire. Methods Women eligible for BCT were consecutively recruited between February 1st 2008 and January 31st 2012 (n = 653). Photographs of 310 women, taken one year after BCT, were evaluated using the BCCT.core software. The postoperative BCT module of the BREAST-Q™ questionnaire was administered by mail and 348 questionnaires were returned (median 5.5 years after BCT). In all, 216 women had both BCCT.core results and completed BREAST-Q™ questionnaires available. Results The results from the BCCT.core evaluation were: excellent n = 49 (15.8%); good n = 178 (57.4%); fair n = 73 (23.5%); poor n = 10 (3.2%). The median BREAST-Q™ score for satisfaction with breasts was 66 [interquartile range (IQR) 57–80] and for psychosocial well-being 82 (IQR 61–100). Poor/fair results on BCCT.core were associated with Q-scores below median for both satisfaction with breasts [odds ratio (OR) 3.4 (confidence interval (CI) 1.7–6.8)] as well as for psychosocial well-being [OR 2.2 (CI 1.1–4.2)]. Conclusions A statistically significant association between BCCT.core results one year after BCT and quality of life ratings using BREAST-Q™ several years later is shown in this study. This implies that the BCCT.core may be valuable in BCT follow-up and used as a standardised instrument in the evaluation of aesthetic results.
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Affiliation(s)
- Cecilia Dahlbäck
- Department of Surgery, Skåne University Hospital, Malmö, Sweden. .,Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
| | - Jenny Heiman Ullmark
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Martin Rehn
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Anita Ringberg
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.,Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Jonas Manjer
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
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Lagendijk M, Vos EL, Koning AHJ, Hunink MGM, Pignol JP, Corten EML, de Monye C, van Deurzen CHM, van Dam JH, Vrijland WW, Contant CME, Verhoef C, van Lankeren W, Koppert LB. TUmor-volume to breast-volume RAtio for improving COSmetic results in breast cancer patients (TURACOS); a randomized controlled trial. BMC Cancer 2017; 17:336. [PMID: 28514945 PMCID: PMC5436425 DOI: 10.1186/s12885-017-3280-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 04/12/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cosmetic result following breast conserving surgery (BCS) for cancer influences quality of life and psychosocial functioning in breast cancer patients. A preoperative prediction of expected cosmetic result following BCS is not (yet) standard clinical practice and therefore the choice for either mastectomy or BCS is still subjective. Recently, we showed that tumour volume to breast volume ratio as well as tumour location in the breast are independent predictors of superior cosmetic result following BCS. Implementation of a prediction model including both factors, has not been studied in a prospective manner. This study aims to improve cosmetic outcome by implementation of a prediction model in the treatment decision making for breast cancer patients opting for BCS. METHODS/DESIGN Multicentre, single-blinded, randomized controlled trial comparing standard preoperative work-up to a preoperative work-up with addition of the prediction model. Tumour volume to breast volume ratio and tumour location in the breast will be used to predict cosmetic outcome in invasive breast cancer patients opting for BCS. Three dimensional (3D)-ultrasonography will be used to measure the tumour volume to breast volume ratio needed for the prediction model. Sample size was estimated based on a 14% improvement in incidence of superior cosmetic result one year after BCS (71% in the control group versus 85% in the intervention group). Primarily cosmetic outcome will be evaluated by a 6-member independent panel. Secondary endpoints include; (1) patient reported outcome measured by BREAST-Q, EORTC-QLQ-C30/BR23 and EQ-5D-5 L (2) cosmetic outcome as assessed through the BCCT.core software, (3) radiation-induced reaction (4) surgical treatment performed, (5) pathological result and (6) cost-effectiveness. Follow-up data will be collected for 3 years after surgery or finishing radiotherapy. DISCUSSION This randomized controlled trial examines the value of a preoperative prediction model for the treatment-decision making. It aims for a superior cosmetic result in breast cancer patients opting for BCS. We expect improvement of patients' quality of life and psychosocial functioning in a cost-effective way. TRIAL REGISTRATION Prospectively registered, February 17th 2015, at 'Nederlands Trialregister - NTR4997 '.
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Affiliation(s)
- M. Lagendijk
- Department of Oncological Surgery, Erasmus MC Cancer Institute, DHA-102, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - E. L. Vos
- Department of Oncological Surgery, Erasmus MC Cancer Institute, DHA-102, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - A. H. J. Koning
- Department of Bioinformatics, Erasmus MC, Rotterdam, the Netherlands
| | - M. G. M. Hunink
- Department of Epidemiology and Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - J. P. Pignol
- Department of Radiotherapy, Erasmus MC, Rotterdam, the Netherlands
| | - E. M. L. Corten
- Department of plastic and reconstructive surgery, Erasmus MC, Rotterdam, the Netherlands
| | - C. de Monye
- Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
| | | | - J. H. van Dam
- Department of surgery, Havenziekenhuis, Rotterdam, the Netherlands
| | - W. W. Vrijland
- Department of surgery, Franciscus Gasthuis, Rotterdam, the Netherlands
| | - C. M. E. Contant
- Department of surgery, Maasstad ziekenhuis, Rotterdam, the Netherlands
| | - C. Verhoef
- Department of Oncological Surgery, Erasmus MC Cancer Institute, DHA-102, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - W. van Lankeren
- Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
| | - L. B. Koppert
- Department of Oncological Surgery, Erasmus MC Cancer Institute, DHA-102, PO Box 5201, 3008 AE Rotterdam, The Netherlands
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Reddy JP, Lei X, Huang SC, Nicklaus KM, Fingeret MC, Shaitelman SF, Hunt KK, Buchholz TA, Merchant F, Markey MK, Smith BD. Quantitative Assessment of Breast Cosmetic Outcome After Whole-Breast Irradiation. Int J Radiat Oncol Biol Phys 2017; 97:894-902. [PMID: 28333010 PMCID: PMC5685181 DOI: 10.1016/j.ijrobp.2016.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/17/2016] [Accepted: 12/14/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE To measure, by quantitative analysis of digital photographs, breast cosmetic outcome within the setting of a randomized trial of conventionally fractionated (CF) and hypofractionated (HF) whole-breast irradiation (WBI), to identify how quantitative cosmesis metrics were associated with patient- and physician-reported cosmesis and whether they differed by treatment arm. METHODS AND MATERIALS From 2011 to 2014, 287 women aged ≥40 with ductal carcinoma in situ or early invasive breast cancer were randomized to HF-WBI (42.56 Gy/16 fractions [fx] + 10-12.5 Gy/4-5 fx boost) or CF-WBI (50 Gy/25 fx + 10-14 Gy/5-7 fx). At 1 year after treatment we collected digital photographs, patient-reported cosmesis using the Breast Cancer Treatment and Outcomes Scale, and physician-reported cosmesis using the Radiation Therapy Oncology Group scale. Six quantitative measures of breast symmetry, labeled M1-M6, were calculated from anteroposterior digital photographs. For each measure, values closer to 1 imply greater symmetry, and values closer to 0 imply greater asymmetry. Associations between M1-M6 and patient- and physician-reported cosmesis and treatment arm were evaluated using the Kruskal-Wallis test. RESULTS Among 245 evaluable patients, patient-reported cosmesis was strongly associated with M1 (vertical symmetry measure) (P<.01). Physician-reported cosmesis was similarly correlated with M1 (P<.01) and also with M2 (vertical symmetry, P=.01) and M4 (horizontal symmetry, P=.03). At 1 year after treatment, HF-WBI resulted in better values of M2 (P=.02) and M3 (P<.01) than CF-WBI; treatment arm was not significantly associated with M1, M4, M5, or M6 (P≥.12). CONCLUSIONS Quantitative assessment of breast photographs reveals similar to improved cosmetic outcome with HF-WBI compared with CF-WBI 1 year after treatment. Assessing cosmetic outcome using these measures could be useful for future comparative effectiveness studies and outcome reporting.
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Affiliation(s)
- Jay P Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sheng-Cheng Huang
- Department of Biomedical Engineering, University of Texas, Austin, Texas
| | - Krista M Nicklaus
- Department of Biomedical Engineering, University of Texas, Austin, Texas
| | - Michelle C Fingeret
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas A Buchholz
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fatima Merchant
- Department of Engineering Technology, University of Houston, Houston, Texas
| | - Mia K Markey
- Department of Biomedical Engineering, University of Texas, Austin, Texas; Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Volders JH, Negenborn VL, Haloua MH, Krekel NMA, Jóźwiak K, Meijer S, M van den Tol P. Cosmetic outcome and quality of life are inextricably linked in breast-conserving therapy. J Surg Oncol 2017; 115:941-948. [PMID: 28334419 DOI: 10.1002/jso.24615] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/26/2017] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Cosmetic results and quality of life (QoL) are increasingly important in the treatment of breast cancer. This study was designed to determine the relationship between QoL and both subjectively and objectively measured cosmetic outcomes of breast-conserving therapy (BCT), and its course over time. METHODS A total of 128 breast cancer patients who underwent BCT as part of a prospective randomized controlled trial were included. QoL was measured using the EORTC QLQ-C30 and QLQ-BR23 at baseline, 3, 6, 12, and 36 months. Cosmetic outcome was determined by patient self-evaluation, panel evaluation, and BCCT.core software. RESULTS By 36 months, all QoL factors except arm symptoms had returned to baseline or improved. After adjustment for patient and tumor characteristics, a significantly better QoL in terms of body image, pain, and arm and breast symptoms was found for good/excellent cosmetic outcomes compared to fair/poor outcomes, as measured by both patient self-evaluation and panel evaluation. The BCCT.core showed no correlation with any QoL factors. CONCLUSION There is a high correlation between poor cosmetic outcome and low scores on quality of life indicators, underlining the importance of achieving a good cosmetic outcome after BCT.
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Affiliation(s)
- José H Volders
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Vera L Negenborn
- Department of Plastic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Max H Haloua
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Nicole M A Krekel
- Department of Plastic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Katarzyna Jóźwiak
- Department of Epidemiology and Biostatistics, NKI-AVL, Amsterdam, The Netherlands
| | - Sybren Meijer
- Department of Plastic Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Charaghvandi RK, van Asselen B, Philippens MEP, Verkooijen HM, van Gils CH, van Diest PJ, Pijnappel RM, Hobbelink MGG, Witkamp AJ, van Dalen T, van der Wall E, van Heijst TC, Koelemij R, van Vulpen M, van den Bongard HJGD. Redefining radiotherapy for early-stage breast cancer with single dose ablative treatment: a study protocol. BMC Cancer 2017; 17:181. [PMID: 28274211 PMCID: PMC5343419 DOI: 10.1186/s12885-017-3144-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 02/15/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A shift towards less burdening and more patient friendly treatments for breast cancer is currently ongoing. In low-risk patients with early-stage disease, accelerated partial breast irradiation (APBI) is an alternative for whole breast irradiation following breast-conserving surgery. MRI-guided single dose ablative APBI has the potential to offer a minimally burdening, non-invasive treatment that could replace current breast-conserving therapy. METHODS The ABLATIVE study is a prospective, single arm, multicenter study evaluating preoperative, single dose, ablative radiation treatment in patients with early-stage breast cancer. Patients with core biopsy proven non-lobular invasive breast cancer, (estrogen receptor positive, Her2 negative, maximum tumor size 3.0 cm on diagnostic MRI) and a negative sentinel node biopsy are eligible. Radiotherapy (RT) planning will be performed using a contrast enhanced (CE) planning CT-scan, co-registered with a CE-MRI, both in supine RT position. A total of twenty-five consecutive patients will be treated with a single ablative RT dose of 20 Gy to the tumor and 15 Gy to the tumorbed. Follow-up MRIs are scheduled within 1 week, 2, 4 and 6 months after single-dose RT. Breast-conserving surgery is scheduled at six months following RT. Primary study endpoint is pathological complete response. Secondary study endpoints are the radiological response and toxicity. Furthermore, patients will fill out questionnaires on quality of life and functional status. Cosmetic outcome will be evaluated by the treating radiation oncologist, patient and 'Breast Cancer Conservation Treatment cosmetic results' software. Recurrence and survival rates will be assessed. The patients will be followed up to 10 years after diagnosis. If patients give additional informed consent, a biopsy and a part of the irradiated specimen will be stored at the local Biobank and used for future research on radiotherapy response associated genotyping. DISCUSSION The ABLATIVE study evaluates MRI-guided single dose ablative RT in patients with early-stage breast cancer, aiming at a less burdening and non-invasive alternative for current breast-conserving treatment. TRIAL REGISTRATION ClinicalTrials.gov registration number NCT02316561 . The trial was registrated prospectively on October 10th 2014.
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Affiliation(s)
- R K Charaghvandi
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - B van Asselen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M E P Philippens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H M Verkooijen
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C H van Gils
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R M Pijnappel
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M G G Hobbelink
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T van Dalen
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - E van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T C van Heijst
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Koelemij
- Department of Surgery, St. Antonius, Nieuwegein, The Netherlands
| | - M van Vulpen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H J G D van den Bongard
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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The Aesthetic Items Scale: A Tool for the Evaluation of Aesthetic Outcome after Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1254. [PMID: 28458968 PMCID: PMC5404439 DOI: 10.1097/gox.0000000000001254] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 01/10/2017] [Indexed: 11/28/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Valid tools to assess aesthetic outcomes after breast reconstructive surgery are scarce. Previously a professional aesthetic assessment scale was introduced, the Aesthetic Items Scale (AIS). We aim to determine if this method is a valid and reliable tool to assess aesthetic outcome after breast reconstructive surgery. Methods: The study population was consenting women who underwent prophylactic mastectomy with subsequent implant-based breast reconstruction. The aesthetic outcome with regard to breast volume, shape, symmetry, scars, and nipple areola complex was rated on a 5-point scale using standardized photographs to give a summed total score. Photographs were evaluated by the patient, 5 plastic surgeons, and 3 mammography nurses. An overall rating of aesthetic outcome on a 1–10 scale was given separately. We determined the intraclass correlation coefficient and assessed interobserver agreement. To assess validity, we calculated the correlation between total score and overall rating of aesthetic outcome. Results: Interobserver reliability was highest between plastic surgeons for the subitem and overall scores and ranged between 0.56 and 0.82. The summed score of the AIS correlates strongly with the overall rating in professionals but not in patients. Conclusions: The AIS is a valid and reliable method for evaluating aesthetic outcome of breast reconstruction by plastic surgeons. The results indicate that patients judge aesthetic outcome differently, taking into account factors that are not represented in the AIS. Professionals can use this method to evaluate surgical results, but other measurements are needed to map satisfaction of the patient with her breasts.
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79
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Jeong WS, Han W, Eom JS. Comparison of Aesthetic Outcomes Between Vertical and Horizontal Flap Insets in Breast Reconstruction with the TRAM or DIEP Flaps. Aesthetic Plast Surg 2017; 41:19-25. [PMID: 28032178 DOI: 10.1007/s00266-016-0757-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/30/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tissue transfer, such as use of the transverse rectus abdominis myocutaneous (TRAM) or deep inferior epigastric artery perforator (DIEP) free flaps, is considered a standard method. However, outcomes may vary among inset methods. Here we compared the aesthetic outcomes of breast reconstructions using vertical and horizontal flap inset methods. METHODS We, respectively, reviewed 274 patients who underwent unilateral post-mastectomy breast reconstruction using TRAM or DIEP free flaps between April 2006 and December 2013. Photographs (frontal and bilateral oblique views) obtained 6 months post-operatively were evaluated. Symmetry scores and regional volume discrepancy scores were compared between the vertical and horizontal inset groups. Symmetry scores were adjusted for 11 potential confounding factors on multivariate regression analysis. RESULTS The vertical inset method was associated with higher total symmetry scores, projection, and ptotic naturalness scores. On multivariate regression analysis, the inset method was an independent predictor of outcomes. Regional volume discrepancy score analysis showed a greater tendency for more symmetrical volumes in the upper, medial, and lateral poles with the vertical inset. CONCLUSION The flap inset method is one of the key determinants of aesthetic breast reconstruction outcomes. The vertical inset method was associated with superior aesthetic outcomes and enabled balanced distribution of flap volume to the four poles of the breast. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Woo Shik Jeong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Wooyeon Han
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jin Sup Eom
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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Haloua MH, Volders JH, Krekel NMA, Lopes Cardozo AMF, de Roos WK, de Widt-Levert LM, van der Veen H, Rijna H, Bergers E, Jóźwiak K, Meijer S, van den Tol MP. Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT). Ann Surg Oncol 2016; 23:30-7. [PMID: 26486999 PMCID: PMC4695494 DOI: 10.1245/s10434-015-4906-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Indexed: 01/06/2023]
Abstract
Background Ultrasound-guided breast-conserving surgery (USS) results in a significant reduction in both margin involvement and excision volumes (COBALT trial). Objective The aim of the present study was to determine whether USS also leads to improvements in cosmetic outcome and patient satisfaction when compared with standard palpation-guided surgery (PGS). Methods A total of 134 patients with T1–T2 invasive breast cancer were included in the COBALT trial (NTR2579) and randomized to either USS (65 patients) or PGS (69 patients). Cosmetic outcomes were assessed by a three-member panel using computerized software Breast Cancer Conservative Treatment cosmetic results (BCCT.core) and by patient self-evaluation, including patient satisfaction. Time points for follow-up were 3, 6, and 12 months after surgery. Overall cosmetic outcome and patient satisfaction were scored on a 4-point Likert scale (excellent, good, fair, or poor), and outcomes were analyzed using a multilevel, mixed effect, proportional odds model for ordinal responses. Results Ultrasound-guided breast-conserving surgery achieved better cosmetic outcomes, with 20 % excellence overall and only 6 % rated as poor, whereas 14 % of PGS outcomes were rated excellent and 13 % as poor. USS also had consistently lower odds for worse cosmetic outcomes (odds ratio 0.55, p = 0.067) than PGS. The chance of having a worse outcome was significantly increased by a larger lumpectomy volume (ptrend = 0.002); a volume >40 cc showed odds 2.78-fold higher for a worse outcome than a volume ≤40 cc. USS resulted in higher patient satisfaction compared with PGS. Conclusion Ultrasound-guided breast-conserving surgery achieved better overall cosmetic outcomes and patient satisfaction than PGS. Lumpectomy volumes >40 cc resulted in significantly worse cosmetic outcomes.
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Affiliation(s)
- Max H. Haloua
- />Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - José H. Volders
- />Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Nicole M. A. Krekel
- />Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Wifred K. de Roos
- />Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands
| | | | - Henk van der Veen
- />Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Herman Rijna
- />Department of Surgery, Kennemergasthuis, Haarlem, The Netherlands
| | - Elisabeth Bergers
- />Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Katarzyna Jóźwiak
- />Department of Epidemiology and Biostatistics, NKI-AVL, Amsterdam, The Netherlands
| | - Sybren Meijer
- />Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
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Single dose IOERT versus whole breast irradiation : Cosmetic results in breast-conserving therapy. Strahlenther Onkol 2016; 192:705-13. [PMID: 27538776 DOI: 10.1007/s00066-016-1029-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Scarce data are available about the cosmetic result of single dose intraoperative electron radiotherapy (IOERT) in breast-conserving radiotherapy. METHODS AND MATERIALS We included 71 breast cancer patients. Breast-conserving surgery and sentinel node procedure had started almost 3 years earlier. Subsequently, 26 patients were treated with IOERT and 45 patients received postoperative whole breast irradiation (WBI). For both groups we determined seven dimensionless asymmetry features. We compared the subjectively and the objectively derived cosmetic scores with each other. RESULTS For four asymmetry features we noted significantly smaller differences for patients treated with IOERT when compared to those treated with WBI: relative breast contour difference, relative breast area difference and relative breast overlap difference. After correcting for excision volume a significant difference was noticed also for relative lower breast contour. For the IOERT group the cosmetic scores "excellent or good" as determined by each patient and one physician were 88 and 96 %, respectively. When the overall cosmetic scores for patients treated with IOERT and WBI were compared to those of the objectively derived scores, there was a fair level of agreement. CONCLUSION For patients treated with IOERT we noted less asymmetry and high rates of "good or excellent" subjectively derived cosmetic scores. The level of agreement between the subjectively and the objectively derived cosmetic scores was limited. Due to the small sample size and the design of the study no definitive conclusions can be drawn.
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82
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Factors associated with patient-reported cosmetic outcome in the Young Boost Breast Trial. Radiother Oncol 2016; 120:107-13. [DOI: 10.1016/j.radonc.2016.04.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/12/2016] [Accepted: 04/12/2016] [Indexed: 11/19/2022]
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83
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The 2-Year Cosmetic Outcome of a Randomized Trial Comparing Prone and Supine Whole-Breast Irradiation in Large-Breasted Women. Int J Radiat Oncol Biol Phys 2016; 95:1210-7. [DOI: 10.1016/j.ijrobp.2016.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/22/2016] [Accepted: 03/03/2016] [Indexed: 11/24/2022]
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84
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Evaluation of Aesthetic and Quality-of-Life Results after Immediate Breast Reconstruction with Definitive Form-Stable Anatomical Implants. Plast Reconstr Surg 2016; 137:278e-286e. [PMID: 26818317 DOI: 10.1097/01.prs.0000475746.17968.f4] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Although there are many reports on different techniques in breast reconstruction, there are few data regarding immediate breast reconstruction with definitive form-stable anatomical implants in terms of aesthetics and quality-of-life outcomes. METHODS Ninety-four patients underwent mastectomy with immediate breast reconstruction using anatomical implants and contralateral symmetrization. Aesthetic results were evaluated by three different methods: the patient's self-report, the assessment of four independent specialists (two breast surgeons and two plastic surgeons from different institutions), and the BCCT.core software. Quality of life was evaluated by means of the BREAST-Q instrument. RESULTS Average age ± SD was 52.1 ± 11.6 years. Most of patients had medium size breasts and T1 tumors. Patients had evaluated their aesthetic results better than did software and specialists. There was no significant difference in the comparison between software and specialist's evaluation. Multifactorial analysis showed that age older than 70 years and radiotherapy were significant risk factors for poor aesthetic outcomes after immediate breast reconstruction with implants. Considering quality of life, most of the patients were satisfied with their outcome and psychosocial and sexual well-being. CONCLUSION Immediate breast reconstruction with implants and contralateral symmetrization had a positive impact on the quality of life and showed satisfactory outcomes when evaluated by subjective and objective methods.
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Cardoso MJ, Cardoso JS, Oliveira HP, Gouveia P. The breast cancer conservative treatment. Cosmetic results - BCCT.core - Software for objective assessment of esthetic outcome in breast cancer conservative treatment: A narrative review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 126:154-159. [PMID: 26707372 DOI: 10.1016/j.cmpb.2015.11.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 11/06/2015] [Accepted: 11/12/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Cosmetic outcome of breast cancer conservative treatment (BCCT) remains without a standard evaluation method. Subjective methods, in spite of their low reproducibility, continue to be the most frequently used. Objective methods, although more reproducible, seem unable to translate all the subtleties involved in cosmetic outcome. The breast cancer conservative treatment cosmetic results (BCCT.core) software was developed in 2007 to try to overcome these pitfalls. The software is a semi-automatic objective tool that evaluates asymmetry, color differences and scar visibility using patient's digital pictures. The purpose of this work is to review the use of the BCCT.core software since its availability in 2007 and to put forward future developments. METHODS All the online requests for BCCT.core use were registered from June 2007 to December 2014. For each request the department, city and country as well as user intention (clinical use/research or both) were questioned. A literature search was performed in Medline, Google Scholar and ISI Web of Knowledge for all publications using and citing "BCCT.core". RESULTS During this period 102 centers have requested the software essentially for clinical use. The BCCT.core software was used in 19 full published papers and in 29 conference abstracts. CONCLUSIONS The BCCT.core is a user friendly semi-automatic method for the objective evaluation of BCCT. The number of online requests and publications have been steadily increasing turning this computer program into the most frequently used tool for the objective cosmetic evaluation of BCCT.
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Affiliation(s)
- Maria João Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal; INESC TEC, Porto, Portugal.
| | | | | | - Pedro Gouveia
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal; INESC TEC, Porto, Portugal
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86
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Yu T, Eom KY, Jang NY, Kim KS, Koo TR, Kwon J, Kim BH, Kang E, Kim SW, Kim JS, Kim IA. Objective Measurement of Cosmetic Outcomes of Breast Conserving Therapy Using BCCT.core. Cancer Res Treat 2016; 48:491-8. [PMID: 26130667 PMCID: PMC4843745 DOI: 10.4143/crt.2015.088] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/11/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate objective cosmetic outcomes and factors related to breast-conserving therapy (BCT) using the BCCT.core software. MATERIALS AND METHODS Fifty-one patients who received BCT with informed consent were evaluated using the BCCT.core software. Patients were divided into two groups based on the BCCT score: excellent or good (n=42) vs. fair or poor (n=9). Analysis of clinical factors was performed to determine factors affecting cosmetic outcomes. RESULTS The objective cosmetic outcome of BCT measured using the BCCT.core software was excellent in 10% of patients, good in 72%, and fair in 18%. None of the patients were classified as poor outcome. Tumor characteristics, systemic adjuvant therapy (chemotherapy and hormonal therapy), and radiation dose or energy of electron boost did not show correlation with the score measured by the BCCT.core program (p > 0.05). In univariate analysis, maximum dose within the breast (Dmax), width of tangential field, and excised tumor volume were smaller in patients with excellent or good by the BCCT.core compared to those with fair or poor (Dmax, 110.2 ± 1.5% vs. 111.6 ± 1.7%, p=0.019; width of tangential field, 8.0 ± 1.1 cm vs. 8.6 ± 0.7 cm, p=0.034; excised tumor volume, 64.0 ± 35.8 cm(3) vs. 95.3 ± 54.4 cm(3), p=0.067). In multivariate analysis, only Dmax was a significant factor for breast cosmetic outcome with a risk ratio of 1.697 (95% confidence interval, 1.006 to 2.863; p=0.047). CONCLUSION Objective measurement of cosmetic outcome of BCT using the BCCT.core software was feasible. The cosmetic outcome of BCT may be affected by the maximum dose within the breast.
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Affiliation(s)
- Tosol Yu
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Na Young Jang
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Su Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Ryool Koo
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeanny Kwon
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byoung Hyuck Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Won Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
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87
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Kim KD, Kim Z, Kuk JC, Jeong J, Choi KS, Hur SM, Jeong GA, Chung JC, Cho GS, Shin EJ, Kim HC, Kang SG, Lee MH, Lim CW. Long-term results of oncoplastic breast surgery with latissimus dorsi flap reconstruction: a pilot study of the objective cosmetic results and patient reported outcome. Ann Surg Treat Res 2016; 90:117-23. [PMID: 26942154 PMCID: PMC4773455 DOI: 10.4174/astr.2016.90.3.117] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/06/2015] [Accepted: 10/26/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose The goal of oncoplastic breast surgery is to restore the appearance of the breast and improve patient satisfaction. Thus, the assessment of cosmetic results and patient-reported outcomes (PROs) using appropriately constructed and validated instruments is essential. The aim of the present study was to assess the long-term objective cosmetic results and corresponding PROs after oncoplastic breast surgery. Methods Cosmetic results were assessed by the patients, a medical panel, and a computer program (BCCT.core). PROs were assessed using BREAST-Q, a questionnaire that measures the perception of patients having breast surgery. The cosmetic results and PROs were analyzed in patients who underwent quadrantectomy and partial breast reconstruction utilizing the latissimus dorsi flap. Results The mean duration of the follow-up period was 91.6 months (range, 33.3–171.0 months), and mean age of the patients was 51 years old (range, 33–72 years). The mean tumor size was 2.1 cm (range, 0.9–5.5 cm). There was fair agreement between the medical panel and BCCT.core score (K = 0.32, P < 0.001), and a statistically significant correlation between the BCCT.core score and medical panel cosmetic results was identified (r = 0.606, P < 0.001). A better BCCT.core result was related to a higher PRO of each BREAST-Q domain—satisfaction with breasts (R2 = 0.070, P = 0.039), satisfaction with outcome (R2 = 0.087, P = 0.021), psychosocial well-being (R2 = 0.085, P = 0.023), sexual well-being (R2 = 0.082, P = 0.029), and satisfaction with information (R2 = 0.064, P = 0.049). Conclusion Our long-term results of oncoplastic surgery achieved a high level of patient satisfaction with good cosmetic results. The medical panel and BCCT.core results correlated well with the PROs of the patients using valid, reliable, and procedure-specific measures.
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Affiliation(s)
- Kyeong-Deok Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jung Cheol Kuk
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jaehong Jeong
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Kyu Sung Choi
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sung Mo Hur
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Gui Ae Jeong
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jun Chul Chung
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Gyu Seok Cho
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eung Jin Shin
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyung Chul Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sang-Gue Kang
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Min Hyuk Lee
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Cheol Wan Lim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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89
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Hille-Betz U, Vaske B, Bremer M, Soergel P, Kundu S, Klapdor R, Hillemanns P, Henkenberens C. Late radiation side effects, cosmetic outcomes and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy. Strahlenther Onkol 2015; 192:8-16. [DOI: 10.1007/s00066-015-0899-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/09/2015] [Indexed: 11/30/2022]
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90
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Hennigs A, Hartmann B, Rauch G, Golatta M, Tabatabai P, Domschke C, Schott S, Schütz F, Sohn C, Heil J. Long-term objective esthetic outcome after breast-conserving therapy. Breast Cancer Res Treat 2015; 153:345-51. [PMID: 26267662 DOI: 10.1007/s10549-015-3540-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/10/2015] [Indexed: 11/29/2022]
Abstract
The prediction of unfavorable long-term esthetic outcome (AO) is important for patient consultation. We aimed to analyze variables characterizing the improvement and impairment of AO over time after breast-conserving surgery. A subgroup of a prospective, monocenter cohort study was analyzed to evaluate the results of the BCCT.core software (Breast Cancer Conservative Treatment.cosmetic results) which was used to objectively assess the AO before (n = 356), shortly after (n = 294) and in median 3 years after surgery (n = 356). We analyzed potential influencing factors (such as body mass index, (y)pT-stage, weight of resected specimen, etc.) on the AO using logistic regression analyses (n = 256). Finally, we tried to characterize groups of patients with improving or impaired AO over time (n = 294). Predictors for an unfavorable AO were an axillary lymphadenectomy (OR = 4.05), a tumor in the 12 o'clock position (OR = 2.22), a tumor stage larger or equal to (y)pT2 stage (OR = 2.11), and a surgical specimen weight >75 g (OR = 2.71). Patients with lower specimen weight were more likely to improve in the long-term follow-up (p = 0.018), whereas patients with a higher (y)pT-stage tended to become impaired with time. Although overall AO decreased over time, nearly half of the patients with an unfavorable AO shortly after surgery improved in the long-term follow-up. Predictors of unfavorable AO can be used in patient consultation preoperatively to prepare them for the postsurgical period and/or to recommend surgical alternatives (e.g., more complex oncoplastic techniques). Knowledge of improvement and impairment may help patients and physicians in the postsurgical consultation setting.
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Affiliation(s)
- André Hennigs
- University Breast Unit, University Hospital of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
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91
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Santos G, Urban C, Edelweiss MI, Zucca-Matthes G, de Oliveira VM, Arana GH, Iera M, Rietjens M, de Lima RS, Spautz C, Kuroda F, Anselmi K, Capp E. Long-Term Comparison of Aesthetical Outcomes After Oncoplastic Surgery and Lumpectomy in Breast Cancer Patients. Ann Surg Oncol 2015; 22:2500-2508. [DOI: 10.1245/s10434-014-4301-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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92
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Review of three-dimensional (3D) surface imaging for oncoplastic, reconstructive and aesthetic breast surgery. Breast 2015; 24:331-42. [DOI: 10.1016/j.breast.2015.03.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/18/2015] [Accepted: 03/22/2015] [Indexed: 11/22/2022] Open
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93
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Nohara Y, Hanamura N, Zaha H, Kimura H, Kashikura Y, Nakamura T, Noro A, Imai N, Shibusawa M, Ogawa T. Cosmetic evaluation methods adapted to asian patients after breast-conserving surgery and examination of the necessarily elements for cosmetic evaluation. J Breast Cancer 2015; 18:80-6. [PMID: 25834615 PMCID: PMC4381128 DOI: 10.4048/jbc.2015.18.1.80] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 01/09/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose Although various strategies have been reported, there are no defined criteria for cosmetic evaluation methods after breast-conserving surgery (BCS). Since Asians tend to have smaller breasts, indistinct inframammary folds, and conspicuous scars, differences in the cosmetic results are expected. So we examined two subjective methods and one objective method to determine the differences, and elements necessary for a cosmetic evaluation after BCS. Methods Frontal photographs of 190 Japanese were evaluated using the Harris scale (Harris) and the evaluation method proposed by the Japanese Breast Cancer Society Sawai group (Sawai group) as the subjective methods, and the Breast Cancer Conservation Treatment cosmetic results (BCCT.core) as the objective method, respectively. In order to examine the necessary elements for developing a new ideal method, 100 out of 190 were selected and assessed separately by six raters using both the Harris and modified Sawai group methods in the observer assessment. The correlation between the two methods was examined using the Spearman rank-correlation coefficient. Results The results of the BCCT.core and the other two methods were clearly different. In the observer assessment, the consensuses of the six raters were evaluated as follows: 27, 27, 26, and 20 cases were evaluated as "excellent," "good," "fair," and "poor," respectively. For the Spearman rank-correlation coefficient, values higher than 0.7 indicated a strong correlation, as seen by the values of 0.909 for the breast shape and 0.345 for the scar. The breast shape accounted for the most significant part of the evaluation, and the scar had very little correlation. Conclusion In this study, we recognized a clear difference between the subjective and objective evaluation methods, and identified the necessary elements for cosmetic evaluation. We would like to continue developing an ideal cosmetic evaluation that is similar to subjective one and is independent from raters.
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Affiliation(s)
- Yuki Nohara
- Department of Breast Surgery, Mie University Hospital, Mie, Japan
| | - Noriko Hanamura
- Department of Breast Surgery, Mie University Hospital, Mie, Japan
| | - Hisamitsu Zaha
- Department of Surgery, Nakagami Hospital, Okinawa, Japan
| | - Hiroko Kimura
- Department of Breast Surgery, Mie University Hospital, Mie, Japan
| | - Yumi Kashikura
- Department of Breast Surgery, Mie University Hospital, Mie, Japan
| | - Takashi Nakamura
- Department of Breast Surgery, Mie University Hospital, Mie, Japan
| | - Aya Noro
- Department of Breast Surgery, Mie University Hospital, Mie, Japan
| | - Nao Imai
- Department of Breast Surgery, Mie University Hospital, Mie, Japan
| | - Mai Shibusawa
- Department of Breast Surgery, Mie University Hospital, Mie, Japan
| | - Tomoko Ogawa
- Department of Breast Surgery, Mie University Hospital, Mie, Japan
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94
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Dermoglandular rotation flaps for breast-conserving therapy: aesthetic results, patient satisfaction, and morbidity in comparison to standard segmentectomy. Int J Breast Cancer 2014; 2014:152451. [PMID: 25436154 PMCID: PMC4236966 DOI: 10.1155/2014/152451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/21/2014] [Accepted: 10/02/2014] [Indexed: 11/17/2022] Open
Abstract
We compared a dermoglandular rotation flap (DGR) in the upper inner, lower inner, and upper outer quadrant regarding similar aesthetic results, patient satisfaction, and comfort after breast-conserving therapy with standard segmentectomy (SE). Between 2003 and 2011, 69 patients were treated with breast-conserving surgery using DGR for cancers with high tumor-to-breast volume ratios or skin resection in the three above mentioned quadrants; 161 patients with tumors in the same quadrants were treated with SE. The outcome of the procedures was assessed at least 7 months after completed radiation therapy using a patient and breast surgeon questionnaire and the BCCT.core software. Symmetry, visibility of the scars, the position of the nipple-areola complex, and the appearance of the treated breast were each assessed on a scale from 1 to 4 by an expert panel and by the patients. Univariate and multivariate analysis were used to evaluate the relationship between patient-, tumor-, and treatment-dependent factors and patient satisfaction. 94.2% of the patients with rotation flaps and 83.5% of the patients with lumpectomy were very satisfied with the cosmetic appearance of their breast. Younger patient age was significantly associated with a lower degree of satisfaction. DGR provides good cosmetic results compared with SE and shows high patient satisfaction despite longer scarring and higher median resection volume.
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95
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Cosmetic Outcome Assessment following Breast-Conserving Therapy: A Comparison between BCCT.core Software and Panel Evaluation. Int J Breast Cancer 2014; 2014:716860. [PMID: 25328712 PMCID: PMC4190270 DOI: 10.1155/2014/716860] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/09/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose. Over recent decades, no consensus has yet been reached on the optimal approach to cosmetic evaluation following breast-conserving therapy (BCT). The present study compared the strengths and weaknesses of the BCCT.core software with a 10-member panel from various backgrounds. Methods. Digital photographs of 109 consecutive patients after BCT were evaluated for 7 items by a panel consisting of 2 breast surgeons, 2 residents, 2 laypersons, and 4 plastic surgeons. All photographs were objectively evaluated using the BCCT.core software (version 20), and an overall cosmetic outcome score was reached using a four-point Likert scale. Results. Based on the mean BCCT.core software score, 41% of all patients had fair or poor overall cosmetic results (10% poor), compared with 51% (14% poor) obtained with panel evaluation. Mean overall BCCT.core score and mean overall panel score substantially agreed (weighted kappa: 0.68). By contrast, analysis of the evaluation of scar tissue revealed large discrepancies between the BCCT.core software and the panel. The analysis of subgroups formed from different combinations of the panel members still showed substantial agreement with the BCCT.core software (range 0.64-0.69), independent of personal background. Conclusions. Although the analysis of scar tissue by the software shows room for improvement, the BCCT.core represents a valid and efficient alternative to panel evaluation.
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96
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Oncoplastic mammaplasty with geometric compensation-A technique for breast conservation. J Surg Oncol 2014; 110:912-8. [DOI: 10.1002/jso.23751] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/16/2014] [Indexed: 12/17/2022]
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97
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Foersterling E, Golatta M, Hennigs A, Schulz S, Rauch G, Schott S, Domschke C, Schuetz F, Sohn C, Heil J. Predictors of early poor aesthetic outcome after breast-conserving surgery in patients with breast cancer: initial results of a prospective cohort study at a single institution. J Surg Oncol 2014; 110:801-6. [PMID: 25132148 DOI: 10.1002/jso.23733] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 04/15/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to explore features of patients reporting early poor aesthetic outcome after simple breast-conserving surgery. METHODS We prospectively evaluated 709 patients shortly after breast-conserving surgery. Aesthetic outcome was measured by aesthetic status scores of the Breast Cancer Treatment Outcome Scale. Clinical, surgical, and pathologic variables were assessed to identify predictors of poor aesthetic outcome. RESULTS Poor aesthetic outcome was reported by 46 (6.5%) patients, and 209 (29%) patients reported an intermediate aesthetic outcome. A single factor analysis of variance showed a negative impact of higher specimen weight (P < 0.001). Univariate logistic regression analysis revealed the following significant risk factors for poor aesthetic outcome: 12 o'clock positioning of tumor localization, a tumor behind the nipple areolar complex (NAC), fishmouth-shaped incision with resection of the NAC, quadrantectomy, central segmental resection, and pT stages 3 and 4. Multivariate logistic regression analysis indicated statistically independent associations between poor aesthetic outcome and tumor position in the inner half of the breast or behind the NAC, quadrantectomy, and pT stages 3 and 4. CONCLUSION Poor aesthetic outcome is relatively rare shortly after breast-conserving surgery, but predictable in specific situations.
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Affiliation(s)
- Eva Foersterling
- Breast Unit, University Hospital of Heidelberg, Heidelberg, Germany
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98
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Parvez E, Cornacchi SD, Hodgson N, Thoma A, Kong I, Foster G, Cheng J, Goldsmith CH, Dao D, Lovrics PJ. A cosmesis outcome substudy in a prospective, randomized trial comparing radioguided seed localization with standard wire localization for nonpalpable, invasive, and in situ breast carcinomas. Am J Surg 2014; 208:711-718. [PMID: 25201587 DOI: 10.1016/j.amjsurg.2014.05.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/30/2014] [Accepted: 05/31/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The primary study objective was to compare the cosmetic result of radioguided seed localization (RSL) with wire localization (WL). METHODS A subgroup of patients enrolled in a multicentered, randomized trial comparing WL with RSL participated. Frontal photographs were taken 1 and 3 years postsurgery. The European Organization for Research and Treatment of Cancer Cosmetic Rating System was used to evaluate cosmesis outcomes by the patient and a panel of 5 raters. RESULTS The study enrolled 73 patients (WL, n = 38; RSL, n = 35). Most patients rated their overall cosmesis as "excellent" or "good" (76% WL, 80% RSL). Patient and panel ratings on all cosmetic outcomes were similar between groups. Multivariable regression for overall cosmesis found larger specimen volume and reoperation to be predictors of worse ratings. CONCLUSIONS All cosmetic outcomes assessed were similar after WL and RSL. The comparable outcomes may reflect similar reoperation rates and volumes of excision between groups.
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Affiliation(s)
- Elena Parvez
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Nicole Hodgson
- Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada; Department of Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| | - Achilleas Thoma
- Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Iwa Kong
- Department of Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| | - Gary Foster
- Department of Clinical Epidemiology and Biostatistics, McMaster University and Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Ji Cheng
- Department of Clinical Epidemiology and Biostatistics, McMaster University and Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Charlie H Goldsmith
- Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University and Biostatistics Unit, St. Joseph's Healthcare, Hamilton, ON, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Dyda Dao
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Peter J Lovrics
- Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada; Department of Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada; Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada.
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The use of real-time digital video in the assessment of post-operative outcomes of breast reconstruction. J Plast Reconstr Aesthet Surg 2014; 67:1357-63. [PMID: 24923524 DOI: 10.1016/j.bjps.2014.05.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 01/20/2014] [Accepted: 05/20/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Outcome measures of breast reconstruction have used panel assessment of photographs. This provides limited information to the assessor as these images are static.. The aim of this study was to assess whether the use of digital video was a valid assessment tool and to compare its use against photography. METHODS 35 patients post-reconstruction underwent photography, digital video capture and completed Breast Cancer Treatment Outcomes Scale (BCTOS) questionnaires. The photographs/video clips were randomised and shown to a 21 member panel. Opinions on aesthetic aspects of the reconstruction were assessed using the BCTOS and Harris scale. Panel inter-rater agreement and patient-panel correlation was assessed using Kendall's Coefficient of Concordance and Spearman's rank correlation tests respectively. RESULTS There was a "moderate" degree of inter-rater agreement amongst panel members in all categories. Greater agreement occurred using video footage to assess overall cosmesis (0.548 vs 0.507) and shape (0.505 vs 0.486). Video showed a greater degree of correlation with patient self-assessment scores in comparison to photography (0.311 vs 0.281). CONCLUSION Video footage coupled with panel assessment is a valid method of assessing post-operative outcomes of breast reconstruction and appears superior to still photographs in terms of inter-rater agreement and correlation with patient self-assessment.
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Mestak O, Sukop A, Hsueh YS, Molitor M, Mestak J, Matejovska J, Zarubova L. Centrifugation versus PureGraft for fatgrafting to the breast after breast-conserving therapy. World J Surg Oncol 2014; 12:178. [PMID: 24898154 PMCID: PMC4053289 DOI: 10.1186/1477-7819-12-178] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 05/19/2014] [Indexed: 01/22/2023] Open
Abstract
Background Breast-conserving treatment (BCT) leads to a progressive and deteriorating breast deformity. Fatgrafting is ideal for breast reconstruction after BCT. The most frequently utilized technique for fat processing is centrifugation. The PureGraft device (Cytori Therapeutics, San Diego, CA, USA) is a new method that involves washing and filtering the fat to prepare the graft. We compared the subjective and objective outcomes of two fat-processing methods, centrifugation and PureGraft filtration. Methods Thirty patients underwent breast reconstruction performed by a single surgeon (OM) after BCT in our department between April 2011 and September 2012. The patients were preoperatively divided into two groups randomly: 15 received fatgrafts processed by centrifugation, and 15 received fatgrafts processed by washing in PureGraft bags. The patients were followed up for 12 to 30 months. To measure the subjective outcome, we distributed the BREAST-Q questionnaire to all the patients both preoperatively and 1 year postoperatively. The BCCT.core software evaluated the objective outcome of breast reconstruction by fatgrafting. Results The Breast-Q results indicated a tremendous improvement in the modules “Satisfaction with Breast” and “Psychosocial Well-being”. The “Sexual Well-being” scale also improved. Only the module “Satisfaction with Breasts” significantly differed between groups; patients treated with the PureGraft fat exhibited better outcomes. The BCCT.core results did not significantly differ between the groups. Conclusion One year postoperatively, the outcomes of the use of PureGraft bags or centrifugation to process fat for breast reconstruction after BCT did not differ. The unpredictability of the results following fatgrafting procedures is likely due to interindividual differences with yet-undisclosed causes.
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Affiliation(s)
- Ondrej Mestak
- Department of Plastic Surgery, Bulovka Hospital, 1st Medical Faculty of Charles University in Prague, Budinova 2, Prague 8 180 00, Czech Republic.
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