Elvira L. Vos

Benefits of preoperative MRI in breast cancer surgery studied in a large population-based cancer registry

Although evidence for the benefits of preoperative MRI in breast cancer is lacking, use of MRI is increasing and characterized by large interhospital variation. The aim of the study was to evaluate MRI use and surgical outcomes retrospectively.

Preoperative prediction of cosmetic results in breast conserving surgery

Preoperative objective predictions of cosmetic result after breast conserving surgery (BCS) has the potential to aid in surgical treatment decision making. Our aim was to investigate the predictive value of tumor volume in relation to breast volume (TV/BV ratio) for cosmetic result.

Breast and Tumour Volume Measurements in Breast Cancer Patients Using 3-D Automated Breast Volume Scanner Images

BackgroundThe resection volume in relation to the breast volume is known to influence cosmetic outcome following breast-conserving therapy. It was hypothesised that three-dimensional ultrasonography (3-D US) could be used to preoperatively assess breast and tumour volume and show high association with histopathological measurements.MethodsBreast volume by the 3D-US was compared to the water displacement method (WDM), mastectomy specimen weight, 3-D MRI and three different calculations for breast volume on mammography. Tumour volume by the 3-D US was compared to the histopathological tumour volume and 3-D MRI. Relatedness was based on the intraclass correlation coefficient (ICC) with corresponding 95% confidence interval (95% CI). Bland–Altman plots were used to graphically display the agreement for the different assessment techniques. All measurements were performed by one observer.ResultsA total of 36 patients were included, 20 and 23 for the evaluation of breast and tumour volume (ductal invasive carcinomas), respectively. 3-D US breast volume showed ‘excellent’ association with WDM, ICC 0.92 [95% CI (0.80–0.97)]. 3-D US tumour volume showed a ‘excellent’ association with histopathological tumour volume, ICC 0.78 [95% CI (0.55–0.91)]. Bland–Altman plots showed an increased overestimation in lager tumour volumes measured by 3-D MRI compared to histopathological volume.Conclusions3-D US showed a high association with gold standard WDM for the preoperative assessment of breast volume and the histopathological measurement of tumour volume. 3-D US is an patient-friendly preoperative available technique to calculate both breast volume and tumour volume. Volume measurements are promising in outcome prediction of intended breast-conserving treatment.

Evaluation of cosmetic outcome following breast-conserving therapy in trials: panel versus digitalized analysis and the role of PROMs

Cosmetic outcome is an important quality of life‐related end point following breast‐conserving therapy (BCT). To advise on a gold standard, we compare cosmetic outcome evaluated by panel and an objective evaluation (BCCT.core software). Second, patient‐reported outcome measures (PROMs) are compared to cosmetic outcome evaluation by panel and BCCT.core. Sixty‐eight breast cancer patients were included following BCT between 2007 and 2012. Two independent 6‐member panels and two observers using the BCCT.core evaluated cosmetic outcome. First, reproducibility, repeatability, and relatedness of panel and BCCT.core were analyzed using the interclass correlation coefficient (ICC). Second, the association between panel/BCCT.core with PROMs (EORTC‐QLQ‐C30/BR23, EQ‐5D‐5L, and BREAST‐Q) was analyzed with a linear regression and the goodness of fit by the R2. Both panel and BCCT.core evaluations showed “excellent” intraobserver agreement (ICC 0.93 [95% CI: 0.83; 0.97] and 0.93 [95% CI: 0.84; 0.97]) for respectively panel 1 and BCCT.core 1 and “excellent” interobserver agreement (ICC 0.94 [95% CI: 0.90; 0.96] and 0.85 [95% CI: 0.77; 0.91]) respectively for panel and BCCT.core. Association between panel and BCCT.core varied, ICC 0.59‐0.69. Only the PROM BREAST‐Q showed a significant association with both panel evaluations and BCCT.core observers (panel 1 and BCCT.core 1; R2 of .157 [P = .002] and .178 [P = .001]). Both panel and BCCT.core showed comparable “excellent” intraobserver and interobserver agreement. For future trials evaluating cosmetic outcome following BCT, one of those can be chosen. Solely, the PROM BREAST‐Q showed a significant association with panel and/or BCCT.core evaluation. To enable standardized cosmetic outcome evaluation and corresponding patient satisfaction in future trials, at least the BREAST‐Q should be combined with a panel or BCCT.core evaluation.

A preliminary prediction model for potentially guiding patient choices between breast conserving surgery and mastectomy in early breast cancer patients; a Dutch experience

PurposeTo guide early stage breast cancer patients to choose between breast conserving surgery (BCS) and mastectomy (MST) considering the predicted cosmetic result and quality of life (QoL).MethodsA decision model was built to compare QoL after BCS and MST. Treatment could result in BCS with good cosmesis, BCS with poor cosmesis, MST only, and MST with breast reconstruction. QoL for these treatment outcomes were obtained from a previous study and the literature and translated into EuroQoL-5D derived utilities. Chance of good cosmesis after BCS was predicted based on tumor location and tumor/breast volume ratio. The decision model determined whether the expected QoL was superior after BCS or MST based on chance of good cosmesis.ResultsThe mean utility for the treatments such as BCS with good cosmesis, BCS with poor cosmesis, MST only, and MST with breast reconstruction were 0.908, 0.843, 0.859, and 0.876, respectively. BCS resulted in superior QoL compared to MST in patients with a chance of good cosmesis above 36%. This 36% threshold is reached in case the tumor is located in the upper lateral, lower lateral, upper medial, lower medial, and central quadrant of the breast with a tumor/breast volume ratio below 21.6, 4.1, 15.1, 3.2, and 14.7, respectively.ConclusionsBCS results in superior QoL in patients with tumors in the upper breast quadrants or centrally and a tumor/breast volume ratio below 15. MST results in superior QoL in patients with tumors in the lower breast quadrants and a tumor/breast volume ratio above 4.

Abstract P1-11-11: Evaluating cosmetic outcome following breast conserving surgery in trials; panel verus objective evaluation and the role of patient reported outcome measures (PROMs)

Objective Cosmetic outcome is an important quality of life related endpoint following breast conserving surgery (BCS). We aim to compare the cosmetic outcome evaluated by panel and objective evaluation (BCCT.core software). Second patient reported outcome measures (PROMs) are compared to cosmetic evaluation by panel and BCCT.core. Methods Sixty-eight breast cancer patients were included after breast conserving surgery between 2007-2012. Cosmetic outcome was evaluated by; two independent 6-member panels, the BCCT.core by two observers and PROMs (EORTC-QLQ-C30/BR23, EQ-5D-5L and BREAST-Q 9breast conserving module9). First, reproducibility, repeatability and overall agreement of panel and BCCT.core was analysed using the interclass correlation coefficient (ICC). Second, the correlation between panel/BCCT.core with PROMs was analysed using the Spearman9s rank correlation coefficient (spearman9s ρ). Sensitivity of all PROMs to differentiate between a 9good9 or 9bad9 cosmetic outcome was evaluated. Results Sixty-four patients (94.1%) completed the EORTC-QLQ-C30/B23, 58 (85.3%) the EQ-5D-5L and BREAST-Q. Repeatability between both panels and BCCT.core observers was respectively 0.93 and 0.86 (ICC). Reproducibility for panel 1 and BCCT.core 1 was respectively 0.93 and 0.96. Overall agreement between panel and BCCT.core ranged between 0.59 – 0.69. For PROMs the BREAST-Q showed the strongest correlation with panel and BCCT.core, 0.32-047 spearman9s ρ. The BREAST-Q significantly differentiated between a 9good9 or 9bad9 cosmetic outcome based on panel and BCCT.core (p Conclusion Comparable good reproducibility and repeatability was found for panel and BCCT. PROMs showed limited agreement but the PROM BREAST-Q was able to differentiate between a good or bad cosmetic evaluation. Combining PROMs with panel or BCCT.core in future trials evaluating cosmetic outcome following BCS could further improve and evaluate the use of PROMs. Citation Format: Lagendijk M, Vos EL, Corten EML, Verhoef C, Koppert LB. Evaluating cosmetic outcome following breast conserving surgery in trials; panel verus objective evaluation and the role of patient reported outcome measures (PROMs) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-11-11.