Abstract
The aim of this study was to evaluate the factors that determine esthetic outcome after breast cancer conservative treatment, based on a consensual classification obtained with an international consensus panel. Photographs were taken from 120 women submitted to conservative unilateral breast cancer surgery (with or without axillary surgery) and radiotherapy. The images were sent to a panel of observers from 13 different countries and consensus on the classification of esthetic result (recorded as excellent, good, fair or poor) was obtained in 113 cases by means of a Delphi method. For each patient, data were collected retrospectively regarding patient characteristics, tumor, and treatment factors. Univariate and multivariate analysis were used to evaluate the correlation between these factors and overall cosmetic results. On univariate analysis, younger and thinner patients as well as patients with lower body mass index (BMI) and premenopausal status obtained better cosmetic results. In the group of tumor- and treatment-related factors, larger removed specimens, clearly visible scars, the use of chemotherapy and longer follow-up period were associated with less satisfactory results. On multivariate analysis, only BMI and scar visibility maintained a significant association with cosmesis. BMI and scar visibility are the only factors significantly associated with cosmetic results of breast cancer conservative treatment, as evaluated by an international consensus panel.

Abstract
Breast Cancer Conservative Treatment (BCCT) is considered the gold standard of breast cancer treatment. However, the aesthetic outcome is diverse and very difficult to evaluate in a consistent way partly due to the weak reproducibility of the subjective methods in use. T his motivated the research on the objective methods. BCCT.core is a very recent software that objectively and automatically evaluates the aesthetic outcome of BCCT. However, as in other approaches, the system only uses frontal patient information, disregarding volumetric perception on lateral measurements. In the current work we investigate the improvement of the BCCT.core model by introducing lateral information extracted from patients images. We compare the performance of the model currently used on BCCT.core with the model developed in this study. Experimental results suggest that with lateral measurements the model presents better performance, however improvements are not significant. We can conclude that is essential to use robust models on the BCCT, and the input of 3D models will probably help to obtain better results. © 2010 IEEE.

Abstract
Cosmetic assessment or conservative breast cancer treatment plays a major role in the study of breast cancer techniques. Objective assessment methods are being preferred to overcome the drawbacks of subjective evaluation. In this paper a methodology for the objective assessment of conservative breast cancer treatment is proposed. The quantitative measures used in this research provide an objective way to calculate the overall cosmetic result. We report experiments using support vector machines to derive an optimal assessment rule. The results seem to indicate that it is possible to construct an algorithm for a complete objective classification of the aesthetic result of breast conservative treatment.

Abstract
In breast cancer treated with breast-conserving radiotherapy, the influence of the boost dose on cosmetic outcome after long-term follow-up is unknown. We included 348 patients participating in the EORTC 'boost versus no boost' mega trial with a minimum follow-up of 6 years. Digitalised pictures were analysed using specific software, enabling quantification of seven relative asymmetry features associated with different aspects of fibrosis. After 3 years, we noted a statistically significantly poorer outcome for the boost patients for six features compared with those of the no boost patients. Up to 9 years of follow-up, results continued to worsen in the same magnitude for the both patient groups. We noted the following determinants for poorer outcome: (i) boost treatment, (ii) larger excision volumes, (iii) younger age, (iv) tumours located in the central lower quadrants of the breast and (v) a boost dose administered with photons. A boost dose worsens the change in breast appearance in the first 3 years. Moreover, the development of fibrosis associated with whole-breast irradiation, as estimated with the relative asymmetry features, is an ongoing process until (at least) 9 years after irradiation.

Abstract

Abstract
Purpose: The subjective evaluation of aesthetic results in conservative breast cancer treatment has largely been used without questioning the observer's skills. The aim of this study was to evaluate interobserver agreement of the aesthetic results of breast cancer conservative treatment in three groups of observers with different levels of experience. Methods and Materials: Photographs were taken of 55 women who had undergone conservative unilateral breast cancer treatment and 5 control women with no breast disease. The images were then distributed to 13 observers who were divided into three groups according to their experience in breast cancer treatment: experienced, medium experienced, and inexperienced. They were first asked to distinguish the patients from the controls and for the patients to identify the operated side. Subsequently, they were asked to classify the aesthetic result as excellent, good, fair, or poor. The accuracy in identifying controls, patients, and side of treatment was calculated individually for all observers. The interobserver agreement for the aesthetic result was calculated using observed agreement and multiple K statistic (K) in each of the three groups. Results: Inexperienced observers performed significantly worse than experienced observers in identifying controls, patients, and the side of treatment. Agreement of the aesthetic result was significantly greater in the group of experienced observers (kappa = 0.59) than in the medium experienced (kappa = 0.35) and inexperienced (kappa= 0.33) observers. Conclusion: Previous experience in breast cancer conservative treatment should be considered a prerequisite for the evaluation of the aesthetic results. (C) 2005 Elsevier Inc.