Comparing three methods for scoring late breast cosmesis in patients treated with lumpectomy and radiation therapy (RT).

Abstract

128 Background: For intact breast, the Harvard and LENTSOMA criteria are widely used to report late cosmesis. These scales require clinician’s interpretation and thus may be subject to variation between evaluators. Computerized tools exempt from evaluator bias are available to assess cosmesis. The objective of this study was to perform a comparative review of late breast cosmesis using the Harvard, LENTSOMA, and BCCT.core scales (Cardoso JS. et al; doi:10.1016/j.artmed.2007.02.007). Methods: A frontal bilateral breast photograph was used for analysis. Late cosmesis was scored with reference to the baseline breast appearance, ~ 1 year from RT distant from the acute treatment effects. Cosmesis was graded as excellent, good, fair, or poor using the Harvard scale. For LENTSOMA, only atrophy/retraction was assessed from the frontal breast photographs. The BCCT.core software was used as a validated tool for objectively scoring cosmesis and computes a score based on symmetry, color, and scar visibility. All outcomes were assessed by the same investigator (AW). Results: A total of 33 patients had 1-year baseline and follow up photographs. All were treated on a 3-week hypofractionated RT schedule, and none received chemotherapy. One hundred photographs, 1 to 5.7 years from end of RT, were scored. Late cosmesis among patients with good/excellent scores at 1-year remained unchanged by all 3 methods. Among patients graded as fair at 1-year, there was improvement in late comesis detected by Harvard and BCCT.core scoring. Late cosmesis by LENTSOMA criteria remained unchanged from baseline. Conclusions: Our experience suggests easy applicability of BCCT.core for scoring cosmesis in clinical practice. We observed no significant differences in cosmetic score by the methods used. However, these observations were made on a small cohort of patients and evaluation on a larger cohort is needed. The role of objective user-independent grading of cosmesis might be helpful in large comparative studies of clinical outcomes. [Table: see text]