Cardoso Maria João, Cardoso Jaime, Amaral Natália, Azevedo Isabel, Barreau Lise, Bernardo Mario, Christie David, Costa Susy, Fitzal Florian, Fougo José L, Johansen Jørgen, Macmillan Douglas, Mano Maria Piera, Regolo Lea, Rosa José, Teixeira Luís, Vrieling Conny
Department of Surgery, Faculdade de Medicina do Porto, Hospital S. João, Alameda do Prof. Hernãni Monteiro 4200-319, Porto, Portugal.
Breast. 2007 Oct;16(5):456-61. doi: 10.1016/j.breast.2007.05.002. Epub 2007 Jul 2.
Twelve expert observers from nine different countries convened in a workshop to evaluate the validity of the Breast Cancer Conservative Treatment. Cosmetic results (BCCT.core) software, an objective method for the aesthetic evaluation of breast cancer conservative treatment. Experts were initially asked to subjectively classify the aesthetic results of 30 photographed cases submitted to breast cancer conservative treatment according to the four-point Harris scale. It was pre-established that if at least two-thirds [Cardoso MJ, Cardoso J, Santos AC, Barros H, Oliveira MC. Interobserver agreement and consensus over the esthetic evaluation of conservative treatment for breast cancer. Breast 2005] of participants provided the same classification this would be considered a consensual evaluation for that case. For cases where such agreement was not reached, consensus was obtained using a nominal group technique. Experts then individually performed objective evaluation of the same set of photographs using the BCCT.core software. This provides an automatic rating of aesthetic results, once scale and reference points in the photograph have been chosen. Agreement between observers, between each observer and the consensus, for computer evaluation obtained by the different participants and between software and consensus was calculated using multiple kappa (k) and weighted kappa (wk) statistics. In the subjective assessment, first-round consensus was achieved in 17 (57%) cases. Overall interobserver agreement was fair to moderate (k=0.40, wk=0.57). In the objective assessment there was a higher level of concordance between participants (k=0.86, wk=0.90). Agreement between software and consensus classification was fair (k=0.34, wk=0.53), but was higher in the 17 cases that reached first-round consensus (k=0.60, wk=0.73). Merging the two middle classes of the Harris scale, to form a three-point scale, led to an improvement of all non-weighted measures of agreement. These results show that the BCCT.core software provides consistent evaluation of cosmesis. It has the potential to become a gold standard method for assessment of breast cosmesis in clinical trials, as it can be used simultaneously by a panel of observers from different parts of the world to provide more reliable assessments than has been possible previously.
来自九个不同国家的12位专家观察员齐聚一个研讨会，以评估乳腺癌保守治疗的有效性。美容效果（BCCT.core）软件是一种用于乳腺癌保守治疗美学评估的客观方法。专家们首先被要求根据四点哈里斯量表对30例接受乳腺癌保守治疗的病例照片的美学效果进行主观分类。预先确定，如果至少三分之二的参与者给出相同的分类[卡尔多索MJ，卡尔多索J，桑托斯AC，巴罗斯H，奥利维拉MC。乳腺癌保守治疗美学评估的观察者间一致性和共识。乳腺2005年]，那么这将被视为该病例的共识性评估。对于未达成此类共识的病例，使用名义群体技术达成共识。然后，专家们使用BCCT.core软件对同一组照片进行客观评估。一旦在照片中选择了量表和参考点，该软件就能自动给出美学效果评分。使用多重卡帕（k）和加权卡帕（wk）统计量计算不同参与者获得的计算机评估中观察者之间、每个观察者与共识之间、软件与共识之间的一致性。在主观评估中，17例（57%）病例达成了第一轮共识。观察者间总体一致性为中等（k = 0.40，wk = 0.57）。在客观评估中，参与者之间的一致性水平更高（k = 0.86，wk = 0.90）。软件与共识分类之间的一致性为中等（k = 0.34，wk = 0.53），但在达成第一轮共识的17例病例中更高（k = 0.60，wk = 0.73）。将哈里斯量表的两个中间类别合并，形成一个三点量表，使得所有非加权一致性测量指标都得到了改善。这些结果表明，BCCT.core软件提供了一致的美容评估。它有可能成为临床试验中评估乳房美容的金标准方法，因为它可以被来自世界各地的一组观察者同时使用，以提供比以往更可靠的评估。
