Comparing two objective methods for the aesthetic evaluation of breast cancer conservative treatment

Two programs were recently developed for the aesthetic evaluation of results in breast cancer conservative treatment: the Breast Cancer Conservative Treatment cosmetic results (BCCT.core) and the Breast Analyzing Tool (BAT). Both make use of a face-only photographic view of the patient and were developed to overcome the lack of reproducibility observed with subjective visual evaluation. The BCCT.core analyses several parameters related to asymmetry, color differences and scar appearance, while the BAT considers only asymmetry measurements. The purpose of this study was to compare the performance of these two methods.

Digital pictures of 59 patients from Porto and 60 from Vienna were evaluated subjectively by two panels using the four-class Harris scale. The Porto photographs had a similar backlight and better quality, and were evaluated by an international panel of 23 experts. The Vienna photographs had different backlight and lower quality, and were evaluated by four students and two breast cancer specialists. All 119 cases were submitted to analysis using the BCCT.core and BAT. Agreement between the software programs and the subjective evaluation was calculated using kappa (k), weighted kappa statistics (wk) and error rate (er).

In overall analysis, BCCT.core program obtained a better agreement with the subjective evaluation (k = 0.56; wk = 0,64; er = 0.20) than the BAT software (k = 0.39; wk = 0.46; er = 0.42) (P < 0.0007). Results were again better for the BCCT.core program, when analysing the photographs obtained in Porto (k = 0.71; wk = 0.78; er = 0.14) than for the BAT (k = 0.35; wk = 0.41; er = 0.51) (P < 0.0003) while no significant differences in agreement were obtained regarding the Vienna images (P > 0.1).

The results suggest that the inclusion of multiple parameters in image analyses of aesthetic results has the potential to improve results. However, picture quality is probably important for analysis of other features besides asymmetry.