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3-Dimensional objective aesthetic evaluation to replace panel assessment after breast-conserving treatment.

ABSTRACT: Background: Two-thirds of patients with early breast cancer undergo breast-conserving treatment (BCT). Aesthetic outcome is important and has long term implications for psychosocial wellbeing. The aesthetic goal of BCT is symmetry for which there is no gold-standard measure. Panel scoring is the most widely adopted assessment but has well-described limitations. This paper describes a model to objectively report aesthetic outcome using measures derived from 3-dimensional surface images (3D-SI).

Method: Objective measures and panel assessment were undertaken independently for 3D-SI of women who underwent BCT 1-5 years previously. Univariate analysis was used to test for association between measures and panel score. A forward stepwise multiple linear regression model was fitted to identify 3D measurements that jointly predicted the mean panel score. The fitted model coefficients were used to predict mean panel scores for an independent validation set then compared to the mean observed panel score.

Results: Very good intra-panel reliability was observed for the training and validation sets (w??=?0.87, w??=?0.84). Six 3D-measures were used in the multivariate model. There was a good correlation between the predicted and mean observed panel score in the training (n?=?190) and validation (n?=?100) sets (r?=?0.68, r?=?0.65). The 3D model tended to predict scores towards the median. The model was calibrated which improved the distribution of predicted scores.

Conclusion: A six-variable objective aesthetic outcome model for BCT has been described and validated. This can predict and could replace panel assessment, facilitating the independent and unbiased evaluation of aesthetic outcome to communicate and compare results, benchmark practice, and raise standards.

SUBMITTER: Godden AR

PROVIDER: S-EPMC7717038 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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3-Dimensional objective aesthetic evaluation to replace panel assessment after breast-conserving treatment.

Godden Amy R AR O'Connell Rachel L RL Barry Peter A PA Krupa Katherine C D KCD Wolf Lisa M LM Mohammed Kabir K Kirby Anna M AM Rusby Jennifer E JE

Breast cancer (Tokyo, Japan) 20200619 6

<h4>Background</h4>Two-thirds of patients with early breast cancer undergo breast-conserving treatment (BCT). Aesthetic outcome is important and has long term implications for psychosocial wellbeing. The aesthetic goal of BCT is symmetry for which there is no gold-standard measure. Panel scoring is the most widely adopted assessment but has well-described limitations. This paper describes a model to objectively report aesthetic outcome using measures derived from 3-dimensional surface images (3D ...[more]

PMID: 32562188

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Project description:PurposeTo 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).MethodsWomen 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.Results200 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).ConclusionBreast 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.

Project description:ObjectiveAssessment of the quality of the final product (QFP) is critical in simulation training, such as the clock face suture (CFS) exercise that is used to assess trainees' needle handling and suturing accuracy. Objective Structured Assessment of Technical Skill (OSATS) scores are the gold standard for the evaluation of trainees. The aim was to investigate variability in the use of OSATS checklists and to evaluate a semi-automatic method of suture analysis vs. OSATS scores.MethodsDetails of 287 CFSs performed by trainees during Fundamentals in Vascular Surgery examinations were collected. All were rated according to a seven item OSATS checklist, including QFP score and an overall score by one or two expert surgeons immediately after completion. Interassessor variability was assessed for the CFS that were assessed by two assessors.In order to assess intra- and interassessor variability, 50 CFS pictures were chosen randomly and submitted to three expert surgeons to rate the QFP twice and to carry out a semi-automatic image analysis of each CFS and the estimated cumulative error (CE; mm) recorded. It was hypothesised that the CE correlates to OSATS checklist items or overall score. Variables were compared for correlation with OSATS results using a linear regression. A Pearson's test was used to confirm the proposed hypothesis.ResultsMean ± standard deviation overall score for the OSATS checklist was 20.61 ± 6.33. Inter- and intra-assessor correlation were statistically significant regarding OSATS checklist items. Both correlations presented a low coefficient of determination, indicating variability. The mean CE was 16.07 ± 4.84 mm, and the correlation between the QFP and CE was statistically significant, proving that CE is an objective metric by which to assess the QFP.ConclusionOSATS score demonstrated intra- and interassessor variability, although there was a significant correlation between scores. CE is an objective metric that is not subject to assessor subjectivity or interassessor variability and is correlated with the gold standard of evaluation.

Dataset Information

3-Dimensional objective aesthetic evaluation to replace panel assessment after breast-conserving treatment.

Publications

3-Dimensional objective aesthetic evaluation to replace panel assessment after breast-conserving treatment.

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