California Northstate University College of Medicine Elk Grove, CA
A. H. Okabe1, W. L. Ho2, M. L. Tao3, and J. C. Ye3; 1California Northstate University College of Medicine, Sacramento, CA, 2Morsani College of Medicine, University of South Florida, Tampa, FL, 3Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, CA
Purpose/Objective(s): There is no consensus regarding the most appropriate method to determine cosmetic scores in breast cancer patients. Researchers in Portugal have developed BCCT.core, a computer software designed to objectively measure the cosmetic outcome. This study aims to evaluate the agreement of BCCT.core software assessed cosmesis/symmetry (SAC) and physician-assessed cosmesis/symmetry (PAC) scores.Materials/
Methods: A retrospective chart review for 156 female patients with early-stage breast cancer who underwent breast conserving therapy (BCT) from 2013 to 2023 was performed. Demographic, clinical, surgical, and cosmetic data were collected. PAC was measured on the 4-point Harvard scale by the treating radiation oncologist at the time of consultation and follow-up. Frontal photographs of the patient’s breasts were evaluated using the BCCT.core software (version 3.0) for SAC. Descriptive statistics was used to report the distribution of ratings. Agreement between methods was scored using Cohen’s Kappa and Spearman’s Rho analysis and compared using Fisher’s exact test. Results: The median age at diagnosis was 60 years and the median follow-up was 23 months. PAC scores at baseline were 10.0% Fair, 27.1% Good, and 62.9% Excellent, while those at the last follow-up were 14.1% Fair, 41.5% Good, and 44.4% Excellent. The SAC scores at baseline were 28.3% Fair, 52.8% Good, and 18.9% Excellent, while those at the last follow-up were 1.8% Poor, 31.0% Fair, 52.2% Good, and 15.0% Excellent. PAC scores at baseline were substantially agreeable with the scores at the final follow-up (kappa=0.601, p<0.001), while SAC scores were moderately agreeable (kappa=0.403, p<0.001). PAC scores had a moderate correlation with SAC scores with a correlation coefficient of 0.46 (p<0.001). The PAC and SAC scores at 3 years had a fair agreement (kappa=0.213, p=0.018) while scores at the last follow-up had a slight agreement (kappa=0.088, p>0.05). No significant association existed between the SAC scores and patient demographics, chemotherapy status, hormonal therapy status, radiation dose/boost, radiation position (supine or prone), surgical and radiation toxicities. However, there was a slight negative correlation between the patient’s BMI and the SAC score with a correlation coefficient of -0.190 (p=0.044), which was not observed with the PAC score. Conclusion: Overall, PAC reported better outcomes than SAC. The score discrepancy was consistent at all time points, indicating consistent physician rating. The use of BCCT.core software as a measurement of breast cosmesis following BCT may be useful as an objective tool for longitudinal analysis to detect changes to the treated breast. However, it may not be a reliable tool to determine the human-perceived cosmetic outcome and thus should not replace provider or patient reported cosmetic score.
