Reliability of the BCCT.core software in evaluation of breast cosmesis - A systematic review

Breast cancer conservative treatment software (BCCT.core) has the potential to provide objective results using digital photographs, thus increasing the reliability, limiting the subjective interpretation and standardising the evaluation of breast cosmesis in patients. The aim of this systematic review was to summarise the empirical evidence regarding the agreement between the BCCT.core and other methods used by health professionals and patients to assess breast cosmesis. The Ovid MEDLINE, Embase, CINAHL, PsycINFO and Scopus databases were systematically searched for studies comparing the agreement between BCCT.core and other methods used to assess breast cosmesis. A total of 14 studies involving 2703 patients were included in the review. In studies where patients undertook self-assessment, the percentage agreement ranged from 69.2% to 74.8% and the kappa values ranged from slight (k = 0.12) to fair agreement. There was a low correlation between the BCCT.core and the Harvard scale when patients assessed cosmetic outcomes using photographs of their breasts (r = 0.165). A 75% and 42.8% agreement was reported in studies where clinicians assessed breast cosmesis by directly visualising the patients' breasts and photographs, respectively. Assessment of breast cosmesis by the expert panel using patient photographs reported a percentage agreement ranging from 25% to 83%. The results of this systematic review demonstrated an overall agreement of fair to moderate between the BCCT.core and the subjective scales used to assess breast cosmesis. However, clinician experience and patient values should be considered in clinical decision-making.

Epidermoid cyst removal with CO2 laser fenestration: A retrospective cohort study

BACKGROUND

Epidermoid cyst (EC) is a common and benign tumor, which can occur anywhere on the skin. Surgical excision is usually considered as the first-line treatment. However, linear scars arising after excision for EC remain a cosmetic problem.

OBJECTIVE

To evaluate the efficacy and safety of EC removal assisted with CO₂ laser fenestration.

METHODS

All patients diagnosed with EC and treated with CO₂ laser fenestration, content extrusion, and removal of the cyst wall between January 1, 2016, and December 31, 2018, were included in this study. After a follow-up period ranging from 6 to 27 months, scarring, recurrence, complications, and satisfaction were assessed and analyzed.

RESULTS

Forty-three of the 47 patients have been cured by a single operation. The recurrence rate was 8.5%, which was not significantly correlated with tumor sizes or locations. 46.8% of the patients had no obvious scar after treatment. No infections or complications were observed in any of these cases. 89.4% of the patients were satisfied with the effectiveness of the treatment, while 95.7% and 87.2% were satisfied with the comfort and the cosmetic results, respectively.

CONCLUSIONS

CO₂ laser fenestration-assisted removal procedure is effective for the treatment of ECs with good aesthetic outcome.

Oncoplastic surgery; volume displacement techniques for breast conserving surgery in patients with breast cancer

BACKGROUND

Surgical management of breast cancer has drastically changed. Breast-conserving surgery (BCS) has now become a commonly used method for its treatment. Oncoplastic techniques are widely applied with satisfactory aesthetic results. We evaluated the aesthetic and oncological outcomes of BCS with glandular tissue displacement techniques.

METHODS

Seventy-five patients with invasive breast cancer were surgically treated by oncoplastic techniques. Preoperative evaluations, including breast and tumor size, localizations and features, were performed by physical examination, imaging methods, and histopathological analysis. Appropriate volume displacement techniques were planned according to breast and tumor size and localization. Early and late aesthetic results were evaluated.

RESULTS

The mean age of the patients was 54 years, and mean tumor size was 25 mm. Tumors were located in the upper-outer quadrant in 44% of patients. Glandular flaps were used in 55 (73%) patients. Racquet mammoplasty was the most preferred method. Nipple areolar complex (NAC) recentralization was performed in 26 (47.3%) of 55 patients with glandular tissue displacement. Therapeutic reduction mammoplasty was performed in 20 patients. All patients underwent adjuvant radiotherapy. After an average follow-up of 24 months, neither locoregional recurrence nor distant metastases were observed. Aesthetic results of the oncoplastic BCS method were very good in 54 (72%) patients.

CONCLUSION

Breast remodeling by glandular flap displacement after a wide local excision should be the primary aim in patients with breast cancer for better aesthetic outcomes. NAC recentralization is the primary component that could be considered for achieving better results. BCS associated with oncoplastic techniques allows wide excision of larger tumors and provides good and satisfactory aesthetic results at long-term follow-up.