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Telemark Breast Score showed high agreement rates between surgeons evaluating surgery outcomes

The Telemark Breast Score for the assessment of breast-conserving and deep inferior epigastric perforator flap surgery outcomes showed a high degree of consistent agreement between breast surgeons and plastic surgeons, according to study results published in Plastic and Reconstructive Surgery.

The two groups being reviewed included 346 patients undergoing breast-conserving surgery and 31 undergoing microsurgical reconstruction using a deep inferior epigastric perforator (DIEP) flap between 2001 and 2004. Patients in the breast-conservation group were photographed in three standard planes — one frontal and two 45-degree oblique views — which were taken at least 12 months postoperation and/or 6 months after completed radiotherapy. Patients in the DIEP group were photographed 1 year postoperation.

Three study panels comprising two breast surgeons, two plastic surgeons, and two nurses evaluated the photographs using the Telemark Breast Score. They reviewed five items — size, upper pole, ptosis, overall aesthetic proportions, and symmetry — on a scale of 1 to 5 for each item.

Results of intraobserver reliability showed the breast surgeons had a high percentage agreement of evaluated items (range, 63% to 73%) for the breast-conservation group. The plastic surgeons range was 40% to 83% and the nurses ranged between 27% and 53%. Comparison between first evaluation test and a retest showed overall high consistency among the three panels: 97% to 100% for breast surgeons, 83% to 100% for plastic surgeons and 80% to 97% for nurses.

Interobserver reliability for the breast-conservation group was more varied depending on the item and profession of the panel with relatively lower agreement among the panels.

Results of the intraobserver reliability in the DIEP flap group was high for the breast surgeons (61% to 87%) and plastic surgeons (87% to 100%), but more inconsistent for the nurses (26% to 84%). Similar to the interobserver results of the breast-conservation group, agreement varied. Retest agreement, however, was similarly high for breast surgeons (84% to 100%) and plastic surgeons (81% to 97%), and moderate for the nurses (68% to 97%).

“The Telemark Breast Score showed a high degree of agreement within each panel, whereas differences in assessment were seen between the panels. The plastic surgeons and breast surgeons were more consisted in their judgements than were the nurses,” the authors wrote. They recommend providing clear instructions and performing consensus assessments when implementing the score in clinical practice. – by Talitha Bennett

Disclosure : This study was funded in part by an unrestricted grant from the Telemark Hospital Trust. The researchers report no relevant financial disclosures.