European consensus on pre-operative imaging in breast cancer developed jointly by EUSOBI, ESSO, ESP and ESTRO

To establish a consensus on pre-operative imaging techniques for breast cancer among European scientific societies.

Bilateral mammography or digital breast tomosynthesis plus synthetic mammography should always be performed before surgery.
Consensus reached that ultrasound should be performed before surgery, targeting the entire affected breast.
Breast MRI is the most accurate imaging method for tumor extent, but its use varies geographically.
Contrast-enhanced mammography is a valuable adjunct when MRI is unavailable or contraindicated.

The guidelines aim to standardize pre-operative imaging practices across Europe, addressing the variability in current practices.

The consensus reflects expert opinion and may not encompass all clinical scenarios.
The evidence base for some recommendations may be limited due to historical reliance on MRI as an experimental modality.

These guidelines provide a practical toolbox for optimal breast cancer staging, integrating current evidence and expert consensus.