kOBCS©: a novel software calculator program of the Objective Breast Cosmesis Scale (OBCS)

Radiomics in early detection of bilio-pancreatic lesions: A narrative review

Radiomics is transforming the field of early detection of bilio-pancreatic lesions, offering significant advancements in diagnostic accuracy and personalized treatment planning. By extracting high-dimensional data from medical images such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), radiomics reveals complex patterns that remain undetectable through traditional imaging evaluation. This review synthesizes recent developments in radiomics, particularly its application to early detection of pancreatic cancer (PC) and biliary duct cancer (BDC). It highlights the role of machine learning algorithms and multi-parametric models in improving diagnostic performance and discusses challenges such as standardization, reproducibility, and the need for larger, multicenter datasets. The integration of radiomics with genomic data and liquid biopsies also presents future opportunities for more individualized patient care.

Comparison of Postoperative Breast Asymmetry Using Vectra 3D Imaging in Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction

Background/Objectives: Implant-based breast reconstruction (IBBR) is increasingly favored over autologous reconstruction due to its procedural simplicity and recovery benefits. Conducting this reconstruction using either the subpectoral or prepectoral planes has varied aesthetic outcomes. This study utilizes VECTRA XT 3D imaging to objectively assess breast symmetry differences between these surgical techniques. Methods: A retrospective cohort study was conducted analyzing data from patients undergoing unilateral total mastectomy followed by immediate silicone implant reconstruction via subpectoral or prepectoral techniques. The VECTRA XT 3D system provided measurements, including sternal-notch-to-nipple (SN-N), midline-to-nipple (ML-N), and nipple-to-inframammary fold (N-IMF) distances, as well as breast width, volume, and projection, taken more than a year postoperatively, to assess symmetry and aesthetic outcomes. Results: The study included 63 patients-29 in the subpectoral group and 38 in the prepectoral group. The SN-N ratio was 0.91 for the subpectoral group compared to 0.95 for the prepectoral group (p = 0.014). Among patients with a BMI of 25 or higher, the prepectoral group had an SN-N ratio significantly closer to 1 (0.97 ± 0.07) than the subpectoral group (0.89 ± 0.06) (p = 0.027). No statistically significant differences were found in metrics based on the surgical method across age categories divided at 50. Conclusions: The prepectoral IBBR technique shows improved nipple positioning and breast symmetry compared to subpectoral methods, as assessed via precise 3D imaging. This finding suggests potential advantages for surgical planning and patient satisfaction, indicating the need for large cohort studies to further investigate the factors influencing breast symmetry.

A Novel Artificial Intelligence Model for Symmetry Evaluation in Breast Cancer Patients

INTRODUCTION

Artificial intelligence (AI) is a milestone for human technology. In medicine, AI is set to play an important role as we progress into a new era. In plastic surgery, AI can participate in breast symmetry assessment, which until now has been mainly subjective, allowing for inconsistencies. This study aims to improve this evaluation process by integrating a novel trained neural network with the breast symmetry calculator, BAS-Calc.

MATERIALS AND METHODS

We combined the BAS-Calc tool with a custom-made neural network trained to automatically detect key features of the breast. This integrated system was tested on 81 images of patients who had undergone breast reconstruction post-breast cancer treatment. Its performance was evaluated against two human observers using statistical analysis.

RESULTS

Our model successfully detected 399/405 (98.51%) of landmarks. Spearman and Pearson correlation indicated a strong positive relationship while Cohen's kappa demonstrated moderate to strong agreement between human observers and AI model. Notably, the average calculation time for the AI was 0.92 seconds, 16 times faster than the 14.09 seconds for humans.

CONCLUSIONS

Our AI model successfully calculated breast symmetry from images of patients who had undergone reconstructive oncological breast surgery, demonstrating high correlation with human assessments and a markedly reduced processing time. As AI continues to evolve, it is poised to become a pivotal tool in Medicine. Therefore, it is crucial for medical professionals to proactively engage in implementing AI technologies safely and effectively. Further studies are required to broaden our understanding and maximize the potential benefits in this area. Takeaway bullet points Artificial intelligence (AI) is an upcoming force to be reckoned with. AI should find its way into practical applications in plastic surgery. AI can be applied to improve patient care and evaluate aesthetic results. In this work, we present a novel AI model that automatically evaluates breast symmetry.

LEVEL OF EVIDENCE IV

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 .

Identification of Key Breast Features Using a Neural Network: Applications of Machine Learning in the Clinical Setting of Plastic Surgery

BACKGROUND

In plastic surgery, evaluation of breast symmetry is an important aspect of clinical practice. Computer programs have been developed for this purpose, but most of them require operator input. Artificial intelligence has been introduced into many aspects of medicine. In plastic surgery, automated neural networks for breast evaluation could improve quality of care. In this work, the authors evaluate the identification of breast features with an ad hoc trained neural network.

METHODS

An ad hoc convolutional neural network was developed on the YOLOV3 platform to detect key features of the breast that are commonly used in plastic surgery for symmetry evaluation. The program was trained with 200 frontal photographs of patients who underwent breast surgery and was tested on 47 frontal images of patients who underwent breast reconstruction after breast cancer surgery.

RESULTS

The program was able to detect key features in 97.74% of cases (boundaries of the breast in 94 of 94 cases, the nipple-areola complex in 94 of 94 cases, and the suprasternal notch in 41 of 47 cases). Mean time of detection was 0.52 seconds.

CONCLUSIONS

The ad hoc neural network was successful in localizing key breast features, with a total detection rate of 97.74%. Neural networks and machine learning have the potential to improve the evaluation of breast symmetry in plastic surgery by automated and quick detection of features used by surgeons in practice. More studies and development are needed to further knowledge in this area.

KIT 1 (Keep in Touch) Project-Televisits for Cancer Patients during Italian Lockdown for COVID-19 Pandemic: The Real-World Experience of Establishing a Telemedicine System

To evaluate the adoption of an integrated eHealth platform for televisit/monitoring/consultation during the COVID-19 pandemic.

METHODS

During the lockdown imposed by the Italian government during the COVID19 pandemic spread, a dedicated multi-professional working group was set up in the Radiation Oncology Department with the primary aim of reducing patients' exposure to COVID-19 by adopting de-centralized/remote consultation methodologies. Each patient's clinical history was screened before the visit to assess if a traditional clinical visit would be recommended or if a remote evaluation was to be preferred. Real world data (RWD) in the form of patient-reported outcomes (PROMs) and patient reported experiences (PREMs) were collected from patients who underwent televisit/teleconsultation through the eHealth platform.

RESULTS

During the lockdown period (from 8 March to 4 May 2020) a total of 1956 visits were managed. A total of 983 (50.26%) of these visits were performed via email (to apply for and to upload of documents) and phone call management; 31 visits (1.58%) were performed using the eHealth system. Substantially, all patients found the eHealth platform useful and user-friendly, consistently indicating that this type of service would also be useful after the pandemic.

CONCLUSIONS

The rapid implementation of an eHealth system was feasible and well-accepted by the patients during the pandemic. However, we believe that further evidence is to be generated to further support large-scale adoption.

Integration of art and technology in personalized radiation oncology care: Experiences, evidence, and perspectives

Cancer diagnoses expose patients to traumatic stress, sudden changes in daily life, changes in the body and autonomy, with even long-term consequences, and in some cases, to come to terms with the end-of-life. Furthermore, rising survival rates underline that the need for interventions for emotional wellbeing is in growing demand by patients and survivors. Cancer patients frequently have compliance problems, difficulties during treatment, stress, or challenges in implementing healthy behaviors. This scenario was highlighted during the COVID-19 emergency. These issues often do not reach the clinical attention of dedicated professionals and could also become a source of stress or burnout for professionals. So, these consequences are evident on individual, interpersonal, and health system levels. Oncology services have increasingly sought to provide value-based health care, considering resources invested, with implications for service delivery and related financing mechanisms. Value-based health care can improve patient outcomes, often revealed by patient outcome measures while seeking balance with economical budgets. The paper aims to show the Gemelli Advanced Radiation Therapy (ART) experience of personalizing the patients' care pathway through interventions based on technologies and art, the personalized approach to cancer patients and their role as "co-stars" in treatment care. The paper describes the vision, experiences, and evidence that have guided clinical choices involving patients and professionals in a co-constructed therapeutic pathway. We will explore this approach by describing: the various initiatives already implemented and prospects, with particular attention to the economic sustainability of the paths proposed to patients; the several pathways of personalized care, both from the patient's and healthcare professional perspective, that put the person's experience at the Gemelli ART Center. The patient's satisfaction with the treatment and economic outcomes have been considered. The experiences and future perspectives described in the manuscript will focus on the value of people's experiences and patient satisfaction indicators, patients, staff, and the healthcare organization.

'Breast Cosmesis After Breast-Conserving Therapy' Who is the Judge, Patient or Surgeon?

INTRODUCTION

More than 80% of newly diagnosed breast cancers are managed with breast-conserving therapy (BCT). Preservation of cosmetically acceptable breasts is an inherent aim of all breast-conserving efforts-this can, however, be difficult to assess objectively. Compounding this is the difference in perception of breast cosmesis between patients and surgeons. This study compares the concordance of a new subscale-based cosmetic score (TCS) with the patient's perception.

METHOD

Eastern Health Breast and Cancer Centre conducted this study on patients who had completed their BCT and radiotherapy. Participation was voluntary and involved permitting an assessor (breast surgery fellow or consultant) to grade cosmetic outcomes to generate a Total Cosmesis Score (TCS). The patients blinded to this assessment were then asked to complete the postoperative segment of the BCT module of the Breast-Q questionnaire. TCS from surgeon assessment was compared against patient assessment (questions BQ1i and BQ1k specifically). Cohen's kappa was calculated to define the strength of the inter-rater agreement.

RESULTS

One hundred twelve patients with a mean age of 59 (range 27-89) participated in the study. TCS was low in 26% and high in 74% of participants. 76% and 69% of participants were satisfied when answering Breast-Q questions 'How your lumpectomy breast looks?' and 'How you look in the mirror unclothed?' respectively (Cohen's k = 0.464, 95% CI 0.337-0.591, p < 0.01). The agreement between the TCS and the patient assessment was poor (Cohen's k = 0.172, 95% CI - 0.020-2.093, p = 0.067).

CONCLUSION

Cosmetic outcomes scored using TCS by surgeons do not match patient's own assessment of the cosmetic result.

Art and digital technologies to support resilience during the oncological journey: The Art4ART project

INTRODUCTION

New digital technologies can become a tool for welcoming the patient through the artistic dimension. Cancer patients, in particular, need support that accompanies and supports them throughout their treatment.

MATERIALS AND METHODS

The Art4ART project consist in the structural proposal to cancer patients of a web-based digital platform containing several forms of art as video-entertainments; a multimedia immersive room; an art-based welcoming of the patients with several original paintings; an environment with a peacefulness vertical garden; a reconceptualization of the chemotherapy-infusion seats. Data regarding patients' preference and choices will be stored and analysed also using artificial intelligence (AI) algorithm to measure and predict impact indicators regarding clinical outcomes (survival and toxicity), psychological indicators. Moreover, the same digital platform will contribute to a better organization of the activities.

DISCUSSION

Through the systematic acquisition of patient preferences and through integration with other clinical parameters, it will be possible to measure the clinical, psychological, organisational, and social impact of the newly implemented Art4ART project. The use of digital technology leads us to apply the reversal of viewpoint from therapeutic acts to patient-centred care.

An Intraoperative Measurement Method of Breast Symmetry Using Three-Dimensional Scanning Technique in Reduction Mammaplasty

BACKGROUND

Intraoperative symmetrical assessment plays a decisive role in the aesthetic results of reduction mammaplasty, but it depends mostly on the surgeons' experience that may be biased by individual subjective factors. This study was intended to propose an objective method based on a hand-held three-dimensional (3D) scanner to assist intraoperative symmetrical assessment, aiming to achieve better aesthetic results in reduction mammaplasty.

METHODS

Sixty patients were enrolled in the study from April 2018 to January 2020. Intraoperative 3D scanning was routinely performed on 29 patients (study group) to assist symmetrical adjustments during breast shaping. 3D surface scanning data of both groups were obtained at 3 months postoperatively to objectively assess breast symmetry. Postoperative symmetry scores in five aspects, including nipple-areolar complex position, inframammary-fold height, breast size, shape, and footprint, were rated by six independent observers based on anonymized photographs to subjectively evaluate pre- and postoperative breast symmetry of the two groups.

RESULTS

The bilateral breast volume difference of the study group was significantly smaller than the control group (39.1 vs. 113.3 cm³, p = 0.001), as well as the difference in nipple to inframammary-fold distance (2.79 vs. 7.43 mm, p = 0.01). The observer-reported results showed that breast reduction significantly improved postoperative symmetry in all five aspects compared with preoperative symmetry in the study group (P<0.001). Furthermore, postoperative symmetrical ratings of all five aspects in the study group were statistically better than the control group (P<0.05).

CONCLUSIONS

Intraoperative 3D scanning provided a reliable method to assist symmetry adjustments and ensure better postoperative breast symmetry in reduction mammaplasty.

LEVEL OF EVIDENCE IV

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 .

Assessing Interobserver Variability of Cosmetic Outcome Assessment in Breast Cancer Patients Undergoing Breast-Conservation Surgery

BACKGROUND

Inter-rater reliability between breast surgical oncologists and reconstructive surgeons using cosmesis scales, and the correlation between their observations and patients' own subjective assessments, is poorly understood.

METHODS

Patients undergoing BCS in a prospective trial rated their cosmetic outcome on a Likert scale (poor/fair/good/excellent) at the postoperative and 1-year time points; photographs were also taken. Three breast surgical oncologists (not involved in these cases) and two reconstructive surgeons were asked to independently rate cosmesis using the Harvard/NSABP/RTOG scale.

RESULTS

Overall, 55 and 17 patients had photographs and Likert self-evaluations at the postoperative and 1-year time points, respectively. There was poor agreement between surgeon and patient ratings postoperatively [kappas - 0.042 (p = 0.659), 0.069 (p = 0.226), and 0.076 (p = 0.090) for the breast surgical oncologists; and 0.018 (p = 0.689) and 0.112 (p = 0.145) for the reconstructive surgeons], and poor interobserver agreement between surgeons of the same specialty (kappa - 0.087, 95% confidence interval [CI] - 0.091 to - 0.082, p = 0.223 for breast surgical oncologists; and kappa - 0.150, 95% CI - 0.157 to - 0.144, p = 0.150, for reconstructive surgeons). At 1 year, the interobserver agreement between breast surgical oncologists was better (kappa 0.507, 95% CI 0.501-0.512, p < 0.001); however, there was still poor correlation between the reconstructive surgeons (kappa - 0.040, 95% CI - 0.049 to - 0.031, p = 0.772). Agreement between surgeon and patient ratings remained poor at this time point [kappas - 0.115 (p = 0.477), 0.177 (p = 0.245), and 0.101 (p = 0.475) for breast surgical oncologists; and 0.335 (p = 0.037) and -0.118 (p = 0.221) for reconstructive surgeons].

CONCLUSION

Despite gradation scales for measuring cosmesis after BCS, high levels of agreement between surgeons is lacking and these do not always reflect patients' subjective assessments.

Reliability of the BCCT.core software in evaluation of breast cosmesis - A systematic review

Breast cancer conservative treatment software (BCCT.core) has the potential to provide objective results using digital photographs, thus increasing the reliability, limiting the subjective interpretation and standardising the evaluation of breast cosmesis in patients. The aim of this systematic review was to summarise the empirical evidence regarding the agreement between the BCCT.core and other methods used by health professionals and patients to assess breast cosmesis. The Ovid MEDLINE, Embase, CINAHL, PsycINFO and Scopus databases were systematically searched for studies comparing the agreement between BCCT.core and other methods used to assess breast cosmesis. A total of 14 studies involving 2703 patients were included in the review. In studies where patients undertook self-assessment, the percentage agreement ranged from 69.2% to 74.8% and the kappa values ranged from slight (k = 0.12) to fair agreement. There was a low correlation between the BCCT.core and the Harvard scale when patients assessed cosmetic outcomes using photographs of their breasts (r = 0.165). A 75% and 42.8% agreement was reported in studies where clinicians assessed breast cosmesis by directly visualising the patients' breasts and photographs, respectively. Assessment of breast cosmesis by the expert panel using patient photographs reported a percentage agreement ranging from 25% to 83%. The results of this systematic review demonstrated an overall agreement of fair to moderate between the BCCT.core and the subjective scales used to assess breast cosmesis. However, clinician experience and patient values should be considered in clinical decision-making.

A Free Tool for Breast Aesthetic Scale Computation

BACKGROUND

Our work describes the concept of Breast Aesthetic Scale (BAS) as a score for quick and simple objective assessment of results in cosmetic breast surgery. It is obtained by running a software program that we created, based on the previous concept of Objective Breast Cosmesis Scale (OBCS). This was previously described to be used in the context of conservative breast cancer treatment to objectively assess the degree of asymmetry. We describe the implementation of BAS algorithm and study its reproducibility in a set of images.

METHODS

A new multiplatform software was developed by us and named Breast Aesthetic Scale Calculator (BAS-Calc), which can be executed on Windows Mac, and Linux. A set of 25 photographs were studied with this software twice by 2 different surgeons. Intrarater and interrater variability were studied, as well as concordance with categorization by another symmetry assessment software available called Breast Analyzing Tool®.

RESULTS

Concordance among raters was excellent (intraclass correlation coefficient = 0.953; Lin concordance and correlation coefficient = 0.950), as well as intrarater (0.952 and 0.965). Categorization of both systems (Breast Analyzing Tool and BAS-Calc) showed almost perfect concordance (Cohen κ = 0.920).

CONCLUSIONS

Objective estimation of symmetry after breast surgery can be assessed with BAS-Calc. The "symmetric" and "asymmetric" categories are accurately discriminated by this free software, and it can be used by surgeons as a simple method for objective assessment of results in cosmetic breast surgery.

Use of Symmetry Assessment Methods in the Context of Breast Surgery

BACKGROUND

Different procedures are available to help clinicians evaluate symmetry and cosmetic results in an objective manner after conservative breast cancer surgery. However, there are no similar methods in esthetic breast surgery, where the subjective assessment of the surgeon or the patient is usually considered the gold standard. The aim of this study is to evaluate the application of four software programs in the context of esthetic breast surgery and contrast their results with those of the subjective evaluation by a series of healthcare professionals.

MATERIALS AND METHODS

Sixty cosmetic breast surgery images were studied using four software programs considered appropriate for the objective evaluation (BCCT3.core^®, Breast Analyzing Tool^®, Objective Breast Cosmesis Scale^® and GBAI-Global Breast Asymmetry Index^®). The same cases were assessed by a group of 100 health professionals through an online survey as a subjective evaluation method.

RESULTS

Concordance among participants was high (κ = 0.753) as well as between three of the objective methods (BSI, OBCS, GBAI), but not with the BCCT parameter. There was no association between objective and subjective methods studied by the survey, according to the logistic regression model. The "symmetry" and "asymmetry" categories were accurately distinguished by the objective methods.

CONCLUSIONS

Objective evaluation in esthetic breast surgery has less variability than subjective assessment, and the estimation is possible through certain software previously restricted to conservative breast cancer surgery.

LEVEL OF EVIDENCE IV

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 .

Visual Breast Asymmetry Assessment with Optical-Flow Algorithm

Breast surgery is one of the most important procedures in cosmetic and reconstructive surgery. However, there is no ideal method to assess results. One of the greatest difficulties is the subjective aspect of evaluation. In recent years, several objective computer systems have been proposed and validated as assessment methods, such as BCCT®, OBCS®, GBAI©, etc. In this study, we propose a novel system named VIBA©, that uses an Optical Flow (OF) algorithm which objectively classifies results into symmetrical and asymmetrical categories, with a numerical score. Software was developed in MATLAB (MATLAB and Statistics Toolbox Release 2018b, The MathWorks, Inc., Natick, Massachusetts, USA) called VIBA-Calc© (VIBA stands for VIsual Breast Asymmetry). We compared our OF score with the well-established asymmetry scoring system called Objective Breast Cosmesis Scale (OBCS®). In order to do so, we studied 100 frontal photographs of patients who underwent aesthetic breast surgery between 2017 and 2018, from the senior author's private practice. VIBA-Calc© allows the user to load an image and then draw a rectangle containing both breasts. By simply clicking on a button, the program finds the midline of the rectangle and calculates the final score, as well as the color map of asymmetric regions. Classification into symmetric or asymmetric categories using OBCS and VIBA scores agreed in most cases. Concordance between both classification systems was almost perfect in the group of postoperative cases (k = 0.84; p < 0.001), and substantial in preoperative cases (k = 0.76; p < 0.001). Global Cohen's kappa coefficient was 0.80 (p < 0.001). VIBA© is a useful tool for pre- and post-operative evaluation of breasts, that could be used both in reconstructive and aesthetic surgery.