PurposeObjective 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®).MethodsA 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.ResultsThe 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).ConclusionsThe modified BAT® software improves the correlation between subjective and objective BSI values, and may be a new standard for trials evaluating breast symmetry.

The different needles and methods used in the prick test give rise to disparate results. This has significance when carrying out multi-centre studies and when using the technique in the standardization of allergenic extracts. With test reliability as our objective, prick tests were carried out on 30 subjects: 10 patients sensitive to Dermatophagoides pteronyssinus received a glycerine extract of known allergenic potency, 10 healthy individuals 2.5% codeine phosphate in a glycerine solution, and another 10, histamine 1/1000. The total prick tests per individual was 27 with each of the needles employed (Allergy Pricker, the Morrow-Brown needle and Insulin needle in accordance with Pepy's procedure). The tests were carried out systematically by three different testers, and the total number of prick tests performed was 810. With the Allergy Pricker, no differences were observed among results obtained by the same tester, nor when the results of the three testers were compared. With the Morrow-Brown needle, the results varied in the same person and from one tester to another, and on many occasions the test was negative. With the Pepys method, no falsely negative results were obtained, but there was considerable variation in the size of the wheal. The variation coefficient is 41% with the Allergy Pricker, and 115% and 64% with the Morrow-Brown and Pepys method, respectively. In conclusion, the results obtained clearly indicate that the highest degree of reproducibility is obtained with the Allergy Pricker.