A COMPARISON OF METHODS OF COSMETIC ASSESSMENT IN BREAST-CONSERVATIONTREATMENT

The aim of this study was to compare live and photographic methods of assessing variables which can influence cosmetic outcome following bre ast conserving treatment. This study was undertaken in 47 patients who had previously received breast conserving surgery, radiotherapy and s imultaneous chemotherapy for stage I and PI breast cancer and a matche d group of patients who had received surgery and radiotherapy alone. T he assessment consisted of patient and spouse self-assessment, a live assessment by two trained observers and a photographic assessment by f ive observers, two trained and three untrained. Patients rated their o utcome more favourably than their spouses, and both rated the outcomes above those of the other observers. Quantitative variables such as me asurement of nipple retraction were assessed by different observers mo re consistently than qualitative variables such as overall perception of assessed cosmetic outcome. Upward retraction of the nipple emerged as the most powerful determinant of cosmetic outcome In the eyes of bo th the patient and the trained observers and was reproducibly measured by both live and photographic techniques, The distinction between pos t-surgical effects and post-radiation effects was more readily made by live assessment, Photographic assessment is as effective as live asse ssment in post-surgical cosmetic assessment. It provides reliable info rmation about all of the factors which were important to both the pati ent and observers in formulating an overall cosmetic outcome score, Th e effects of surgery, which include nipple retraction, need to be take n into account in future trials of adjuvant therapy in which cosmesis is an important outcome measure. Stratification using upward retractio n of the nipple is a possibility.