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Cosmetic outcomes following breast conservation therapy: in search of a reliable scale

  • CLINICAL STUDY
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Abstract

Introduction

Multiple scales to evaluate breast cosmesis following breast conserving treatment (BCT) have been developed, however reliability is a problem. Panel scores, where scores from two or more individuals are combined, were assessed to examine their effect on reliability for two different cosmetic scales.

Methods

Women, two or more years following BCT, were recruited from a single breast centre. Photographs of each participant were evaluated independently by six health care professionals on two separate occasions. A simple four-point scale and more involved multi-item scale were used to assess cosmetic outcome. Reliability was assessed with the weighted kappa statistic for increasing panel sizes.

Results

Ninety-nine women were evaluated. Intra rater reliability increased from 0.73 to 0.83 for the four-point scale, for increasing panel sizes, however 95% confidence intervals generally overlapped. A smaller and more unpredictable effect was seen on the multi-item subscale, range 0.69 to 0.73. Inter rater reliability increased from 0.68 to 0.93 for the four-point scale, and 0.75 to 0.96 for the multi-item scale, for increasing panel sizes; 95% confidence intervals did not overlap. A panel of three for either scale provided almost perfect kappa values with only small improvements with larger panel sizes.

Conclusions

Care should be used in interpreting results where cosmetic outcomes have been obtained from a single evaluator. Panel scores can be used to significantly improve inter-rater, but not intra rater reliability, for the scales studied. Comparable reliability, in combination with simplicity of use and interpretation, would favour the four-point scale for breast cosmetic evaluation over the multi-item scale.

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Acknowledgements

We are grateful to the Health Sciences Centre Foundation and Health Sciences Centre Medical Staff Council Fellowship Fund for financial support for this project. S. Latosinsky was provided salary support during this project through the Rudy Falk Clinician–Scientist Award. B. Szuck and J. Janzen provided much appreciated assistance in data collection. We are indebted to the evaluators E. Saettler, D. Inglis, V. Rosolowich, J. Marion, R. Skoracki and K. Murray. We would also like to thank all the nurses and surgeons at the Winnipeg Regional Health Authority Breast Health Centre for assistance in recruitment and the many surgeons within the Division of Plastic Surgery who provided input and assistance along the way. We would finally like to thank all the women at the Breast Health Centre that participated in the study.

Author’s contribution: A.J. and S.L. contributed to the conception and design, analysis and interpretation of data and drafting the manuscript. A.J. was primarily responsible for acquisition of data. M.C. contributed to the analysis and interpretation of data and reviewing the manuscript critically for important intellectual content. A.J., S.L. and M.C. have all approved the final version to be published.

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Authors and Affiliations

  1. Divsion of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada

    Amanda J. Fortin

  2. Divsion of Surgical Oncology, University of Manitoba, GF-434 820 Sherbrook Street, R3A 1R9, Winnipeg, Manitoba, Canada

    Steven Latosinsky

  3. Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

    Mary Cheang & Steven Latosinsky

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  1. Amanda J. Fortin
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  2. Mary Cheang
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Correspondence to Steven Latosinsky.

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Fortin, A.J., Cheang, M. & Latosinsky, S. Cosmetic outcomes following breast conservation therapy: in search of a reliable scale. Breast Cancer Res Treat 100, 65–70 (2006). https://doi.org/10.1007/s10549-006-9223-y

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