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. 2017 Jul;164(2):421-427.
doi: 10.1007/s10549-017-4255-z. Epub 2017 May 2.

Objective breast symmetry analysis with the breast analyzing tool (BAT): improved tool for clinical trials

Wilfried Krois  1 , Alexander Ken Romar  2 , Thomas Wild  2 , Peter Dubsky  3 , Ruth Exner  2   4 , Peter Panhofer  2 , Raimund Jakesz  2 , Michael Gnant  2   4 , Florian Fitzal  2   4
Affiliations

Objective breast symmetry analysis with the breast analyzing tool (BAT): improved tool for clinical trials

Wilfried Krois et al. Breast Cancer Res Treat. 2017 Jul.

Abstract

Purpose: Objective cosmetic analysis is important to evaluate the cosmetic outcome after breast surgery or breast radiotherapy. For this purpose, we aimed to improve our recently developed objective scoring software, the Breast Analyzing Tool (BAT®).

Methods: A questionnaire about important factors for breast symmetry was handed out to ten experts (surgeons) and eight non-experts (students). Using these factors, the first-generation BAT® software formula has been modified and the breast symmetry index (BSI) from 129 women after breast surgery has been calculated by the first author with this new BAT® formula. The resulting BSI values of these 129 breast cancer patients were then correlated with subjective symmetry scores from the 18 observers using the Harris scale. The BSI of ten images was also calculated from five observers different from the first author to calculate inter-rater reliability. In a second phase, the new BAT® formula was validated and correlated with subjective scores of additional 50 women after breast surgery.

Results: The inter-rater reliability analysis of the objective evaluation by the BAT® from five individuals showed an ICC of 0.992 with almost no difference between different observers. All subjective scores of 50 patients correlated with the modified BSI score with a high Pearson correlation coefficient of 0.909 (p < .001) which was better compared to the old software (r = 0.769; p < .001).

Conclusions: The modified BAT® software improves the correlation between subjective and objective BSI values, and may be a new standard for trials evaluating breast symmetry.

Keywords: Breast analyzing tool; Breast cosmetics; Breast symmetry; Objective breast analysis.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Disclosure

The authors have nothing to disclose. The BAT® software can be used for free for research purpose via the website www.breastanalyzing.com. Please contact florian.fitzal@meduniwien.ac.at for permission and free access login.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Screenshot of the BAT software; the analysis shows a BSI of 3
Fig. 2
Fig. 2
Calculations done by BAT. a direct mammillary position, b horizontal mammillary position, c vertical mammillary position, d breast area, e breast border and f clockwise calculation of mammillary position regarding the breast border
Fig. 3
Fig. 3
The scatter diagram shows the correlation between the mean subjective and the objective BSI scoring in phase I of the study in 129 patients
Fig. 4
Fig. 4
Boxplot shows BSI ranges from 50 patients subjectively and objectively evaluated by one expert and the improved BAT® in phase II of the study
See this image and copyright information in PMC

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