Patient-reported outcome measurement compared with professional judgment of cosmetic results after breast-conserving therapy

A.T.P.M. Brands-Appeldoorn, A.J.G. Maaskant-Braat, W.A.R Zwaans, J.P. Dieleman, K.E. Schenk, C.L. Broekhuysen, H. Weerdenburg, R. Daniels, V.C.G. Tjan-Heijnen, R.M.H. Roumen


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.


Breast neoplasms; breast-conserving surgery; cosmetic outcomes; cosmetic evaluations; patient satisfaction

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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)