Pezner R D, Lipsett J A, Vora N L, Desai K R
Int J Radiat Oncol Biol Phys. 1985 Jun;11(6):1117-9. doi: 10.1016/0360-3016(85)90058-6.
We evaluated the relative usefulness of two observer-based scales commonly employed to assess the cosmetic outcome of patients treated by breast-preserving techniques for breast cancer. We asked 44 volunteer observers to employ one or the other scale to assess cosmetic outcome in a series of 14 projected color photographs of frontal views of treated patients. Our results demonstrate that observer concensus with either scale is rarely attained, particularly for patients with T1 or T2 tumors. Experienced observers could reach a concensus more often, although still infrequently. Moreover, the reliability of both scales is poor, since approximately one-third of observers evaluating one photograph twice during the same test session changed their answer. We conclude that while observer-based cosmesis scales demonstrate that current surgical and radiation therapy techniques can provide a "good" cosmetic result in 66-90% of patients with Stage I or II breast cancer, they lack the sensitivity and reliability to evaluate factors affecting cosmetic outcome since all forms of cosmetic change are lumped together into one assessment. Each type of cosmetic change should be evaluated separately by objective measures to determine factors related to its development.
我们评估了两种常用的基于观察者的量表在评估乳腺癌保乳治疗患者美容效果方面的相对效用。我们让44名志愿者观察者使用其中一种量表，对一系列14张经治疗患者正面观的投影彩色照片的美容效果进行评估。我们的结果表明，很少能在两种量表上达成观察者共识，尤其是对于T1或T2期肿瘤患者。经验丰富的观察者达成共识的频率更高，尽管仍然不常见。此外，两种量表的可靠性都很差，因为在同一次测试中，约三分之一对一张照片进行两次评估的观察者改变了他们的答案。我们得出结论，虽然基于观察者的美容量表表明，当前的手术和放射治疗技术能在66% - 90%的I期或II期乳腺癌患者中提供“良好”的美容效果，但它们缺乏评估影响美容效果因素的敏感性和可靠性，因为所有形式的美容变化都被归为一项评估。每种美容变化都应通过客观测量单独评估，以确定与其发生相关的因素。
