Objective:

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

Approach:

• Consensus Development: A modified Delphi process was used to reach consensus on pre-operative imaging methods, involving multiple rounds of discussion and voting among experts from various European societies.
• Evidence Review: A comprehensive review of existing literature and imaging techniques was conducted to support the consensus process.
• Expert Input: Contributions from multidisciplinary experts, including radiologists, surgeons, and oncologists, were incorporated to ensure a well-rounded perspective on imaging practices.

Key Findings:

• 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.

Interpretation:

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

Limitations:

• 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.

Conclusion:

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

Sources:

• EUSOBI Guidelines