A T P M Brands-Appeldoorn1, A J G Maaskant-Braat1, W A R Zwaans1, J P Dieleman2, K E Schenk1, C L Broekhuysen3, H Weerdenburg4, R Daniels1, V C G Tjan-Heijnen5, R M H Roumen1,5. 1. Department of Surgery, Máxima Medical Center, Veldhoven, Netherlands. 2. Department of mmc Academy, Máxima Medical Center, Veldhoven, Netherlands. 3. Department of Plastic Surgery, Máxima Medical Center, Veldhoven, Netherlands. 4. Department of Radiology, Máxima Medical Center, Veldhoven, Netherlands. 5. Division of Medical Oncology, grow-School for Oncology and Developmental Biology, Maastricht, Netherlands.
Abstract
Background: In the present study, we set out to compare patient-reported outcomes with professional judgment about cosmesis after breast-conserving therapy (bct) and to evaluate which items (position of the nipple, color, scar, size, shape, and firmness) correlate best with subjective outcome. Methods: Dutch patients treated with bct between 2008 and 2009 were analyzed. Exclusion criteria were prior amputation or bct of the contralateral breast, metastatic disease, local recurrence, or any prior cosmetic breast surgery. Structured questionnaires and standardized six-view photographs were obtained with a minimum of 3 years' follow-up. Cosmetic outcome was judged by the patients and, based on photographs, by 5 different medical professionals using 3 different scoring systems: the Harvard scale, the Sneeuw questionnaire, and a numeric rating scale. Agreement was scored using the intraclass correlation coefficient (icc). The association between items of the Sneeuw questionnaire and a fair-poor Harvard score was estimated using logistic regression analysis. Results: The study included 108 female patients (age: 40-91 years). Based on the Harvard scale, agreement on cosmetic outcome between the professionals was good (icc: 0.78). In contrast, agreement between professionals as a group compared with the patients was found to be fair to moderate (icc range: 0.38-0.50). The items "size" and "shape" were identified as the strongest determinants of cosmetic outcome. Conclusions: Cosmetic outcome was scored differently by patients and professionals. Agreement was greater between the professionals than between the patients and the professionals as a group. In general, size and shape were the most prominent items on which cosmetic outcome was judged by patients and professionals alike.
Background: In the present study, we set out to compare patient-reported outcomes with professional judgment about cosmesis after breast-conserving therapy (bct) and to evaluate which items (position of the nipple, color, scar, size, shape, and firmness) correlate best with subjective outcome. Methods: Dutch patients treated with bct between 2008 and 2009 were analyzed. Exclusion criteria were prior amputation or bct of the contralateral breast, metastatic disease, local recurrence, or any prior cosmetic breast surgery. Structured questionnaires and standardized six-view photographs were obtained with a minimum of 3 years' follow-up. Cosmetic outcome was judged by the patients and, based on photographs, by 5 different medical professionals using 3 different scoring systems: the Harvard scale, the Sneeuw questionnaire, and a numeric rating scale. Agreement was scored using the intraclass correlation coefficient (icc). The association between items of the Sneeuw questionnaire and a fair-poor Harvard score was estimated using logistic regression analysis. Results: The study included 108 female patients (age: 40-91 years). Based on the Harvard scale, agreement on cosmetic outcome between the professionals was good (icc: 0.78). In contrast, agreement between professionals as a group compared with the patients was found to be fair to moderate (icc range: 0.38-0.50). The items "size" and "shape" were identified as the strongest determinants of cosmetic outcome. Conclusions: Cosmetic outcome was scored differently by patients and professionals. Agreement was greater between the professionals than between the patients and the professionals as a group. In general, size and shape were the most prominent items on which cosmetic outcome was judged by patients and professionals alike.
Authors: A de la Rochefordière; A L Abner; B Silver; F Vicini; A Recht; J R Harris Journal: Int J Radiat Oncol Biol Phys Date: 1992 Impact factor: 7.038
Authors: M A Fagundes; H M Fagundes; C S Brito; M H Fagundes; A Daudt; L A Bruno; S J Azevedo; L A Fagundes Journal: Int J Radiat Oncol Biol Phys Date: 1993-10-20 Impact factor: 7.038
Authors: Christine E Hill-Kayser; Carolyn Vachani; Margaret K Hampshire; Gloria A Di Lullo; James M Metz Journal: Int J Radiat Oncol Biol Phys Date: 2011-12-02 Impact factor: 7.038
Authors: Chang Ye Wang; Jacob Dudzinski; Derek Nguyen; Eric Armbrecht; Ian A Maher Journal: JAMA Facial Plast Surg Date: 2019-09-01 Impact factor: 4.611