Abstract
Twenty-four experts from 13 different countries were asked to evaluate photographs taken of 60 women following conservative breast cancer treatment. The esthetic result of each case was classified as poor, fair, good or excellent. Agreement was evaluated using the kappa (k) and weighted kappa (wk) statistics, for all observers, mate and female participants, those younger and older than 50 years, those seeing more than 250 cases a year, and those with previous publications in this area. Consensus was obtained by way of a modified Delphi approach, when more than 50% of participants provided the same classification. In a second round, consensual cases were disclosed and a revised opinion was asked in non-consensual ones. Agreement between all participants was fair (k = 0.24, wk = 0.37) and remained within the same range (k = 0.20-0.31, wk = 0.31-0.45) in the subgroups analyzed. First round consensus was obtained in 46 out of 60 cases (77%) and in the second round in 59 out of 60 cases (98%). Evaluation of the esthetic results of conservative treatment for breast cancer is only fairly reproducible when performed by experts working in different geographical areas. Consensus is obtainable if a relatively low threshold of agreement is considered acceptable.

Abstract
During the Turning Subjective Into Objective seminar held in Lisbon in May 2011, experts in the topic gathered to discuss the unsolved problems of aesthetic evaluation of breast-conserving treatment (BCT). The purpose of this study is to review the main methodological issues related to the aesthetic evaluation of BCT, to discuss currently used methods of evaluation and the lack of a gold standard, and to write a set of recommendations that can be used as guidance for the aesthetic evaluation of BCT.

Abstract
The breast cancer conservative treatment. cosmetic results (BCCT. core) is a new software tool created for the automatic and objective evaluation of the aesthetic result of BCCT. It makes use of a face-only photographic view of each patient and might thus have been considered insufficient for an accurate evaluation, as others have used multiple views of each patient. The purpose of this work is to compare the performance of the BCCT. core (using face-only views) with a subjective expert analysis using both the face-only and four-view assessment. Photographs in four-views of 150 patients, were evaluated by a panel of experts and a consensus classification was obtained. The agreement between the consensus and the BCCT. core (face-only view) was calculated using the kappa (k) and weighted kappa (wk) statistics. Face-only views, of the same 150 patients, were subsequently sorted out in a different order and sent for individual evaluation by three specialists from the previous panel of experts. The individual agreement between the face-only view and the four-view evaluation by each of the three experts and the consensus was calculated using the same methods. Obtained results were compared to the BCCT. core performance. The software obtained a moderate agreement with the consensus (k = 0.57; wk = 0.68). The highest value of agreement, from the three experts, between the four-view evaluation and the consensus was identical to the software agreement (k = 0.55; wk = 0.67). In the face-only view experiment, the highest value of agreement between the experts and the consensus was only fair (k = 0.37; wk = 0.54). Performance of the software was thus considered equal to that obtained by experts using a four-view evaluation.

Abstract
Breast cancer conservative treatment (BCCT), due to its proven oncological safety, is considered, when feasible, the gold standard of breast cancer treatment. However, aesthetic results are heterogeneous and difficult to evaluate in a standardized way, due to the lack of reproducibility of the subjective methods usually applied. The objective assessment methods, considered in the past as being less capable of evaluating all aspects of BCCT, are nowadays being preferred to overcome the drawbacks of the subjective evaluation. A computer-aided medical system was recently developed to objectively and automatically evaluate the aesthetic result of BCCT. In this system, the detection of the breast contour on the patient's digital photograph is a necessary step to extract the features subsequently used in the evaluation process. In this paper an algorithm based on the shortest path oil a graph is proposed to detect automatically the breast contour. The proposed method extends an existing semi-automatic algorithm for the same purpose. A comprehensive comparison with manually-drawn contours reveals the strength of the proposed method.

Abstract
Cosmetic assessment of breast cancer conservative treatment (BCCT) plays a major role in the evaluation of this form of treatment. Objective assessment methods are being preferred to overcome the drawbacks of subjective evaluation. A recent computer-aided medical system was developed to objectively and automatically perform the aesthetic evaluation of the result of BCCT. In order to extract relevant features from the image, the detection of the breast contour is necessary. In this paper an algorithm based on the shortest path on a graph is proposed to detect the breast contour. The proposed method was applied to 300 breast images with an accuracy of 98%. © 2007 Springer-Verlag Berlin Heidelberg.

Abstract
Breast cancer conservative treatment (BCCT), due to its proven oncological safety, is considered, when feasible, the gold standard of breast cancer treatment. However, aesthetic results are heterogeneous and difficult to evaluate in a standardized way, due to the lack of reproducibility of the subjective methods usually applied. The objective assessment methods, considered in the past as being less capable of evaluating all aspects of BCCT, are nowadays being preferred to overcome the drawbacks of the subjective evaluation. A recent computer-aided medical system was developed to objectively and automatically evaluate the aesthetic result of BCCT. In this system, the detection of the breast contour on the digital photograph of the patient is a necessary step to extract the features Subsequently used in the evaluation process. In this paper an algorithm based on the shortest path on a graph is proposed to detect automatically the breast contour. The proposed method extends an existing semi-automatic algorithm for the same purpose. A comprehensive comparison with manually-drawn contours reveals the strength of the proposed method.