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The 25th European Congress of Radiology week was a busy one for the European Society of Breast Imaging (EUSOBI) filled with exciting discussions, presentations of new developments and idea sharing.

A warm and sunny Vienna welcomed, already starting on Monday, EUSOBI Mammography & beyond course speakers and delegates. The course was a full immersion – theoretical and hands-on.

Multiple workshops spanning from basic to advanced were offered covering mammography, tomosynthesis and contrast enhanced mammography. In addition, delegates got a short but insightful gaze into the future of breast imaging with breast CT and phase-contrast mammography. The interactive meeting was a huge success and received very positive feedbacks from participants.

A particularly hot topic that raised lots of discussion and questions was the usefulness of tomosynthesis is screening setting. Presented studies showed significant improvements in detection rates with both one and two views and using digital or synthetic mammography [1–3]. However, these results do not seem to translate into a significant reduction in interval cancers [4], showing that more evidence is needed before the formal introduction of tomosynthesis as the modality of choice in a screening program. Nevertheless, interim results from Italian randomized controlled trial [5], showed a reduction in interval cancers in women below 50 years old, indicating tomosynthesis as a possible first line modality in women between 40 and 50 years old.
While tomosynthesis is already in routine clinical other techniques are under investigation. The Zurich group [6] presented a breast CT with a photon counting detector with very high spatial resolution and low dose yielding promising results. Although there is still some way to go, before the introduction of breast CT in clinical practice, in one of the course workshops the delegates had the possibilities to directly experience breast CT reading.
On the other hand, contrast enhanced mammography has already made its way into clinical practice, thanks to the low costs, simplicity of examination acquisition interpretation and high diagnostic accuracy which is comparable to MRI [7]. The panelists underlined that there is still work to do in terms of technique standardization and optimization, but the technique will for sure get its place in breast imaging.

This year’s ECR was all about artificial intelligence (AI).
There is agreement that AI- machine learning, deep learning- will become a part of our clinical practice and could help the radiologists in the interpretation of screening mammography, reduce reading times and improve cancer detection and characterization [8].
With AI assisting in our daily tasks and reducing our work load, in a time of workforce shortage, breast radiologist would have more time to develop and practice their role as clinicians as guiding the breast units, and developing and testing a personalized screening program.

Having all these new developing tools in breast imaging, which role does MRI play?
Is MRI still needed as screening and assessment modality? And the answer seems to be: definitely yes!
Authors of the Dutch DENSE trial presented their eagerly awaited results on the role of contrast enhanced MRI as screening modality in women with very dense breast. The results confirmed the very high sensitivity of MRI in dense breasts, with an expected significant increase in cancer detection rate. This increase in detection rate was also associated with a reduction in interval cancers, thus raising again the question on whether MRI should not have a more extensive role in screening.
New, impressive data were also presented on the topic of MRI as staging modality. The multicentric, international MIPA trial proved that rather than MRI leading to an increase of mastectomy numbers, patients scheduled to undergo mastectomy are more likely to receive a pre-surgery MRI those intended to undergo BCT. Data indicate that contrast enhanced MRI is currently the best tool at our disposal to correctly plan surgery in breast cancer patients.

The EUSOBI Young Club members were also busy in an intense interactive case discussion, during the 2nd EYC Symposium at ECR. This year, a large group of breast radiologists engaged in an interesting and constructive discussion on the different approaches and possibilities for breast screening and diagnosis. Availability of tomosynthesis, MRI, stereotactic and MRI guided biopsy, are highly variable between and within countries, leading to very different diagnostic approaches to similar cases. It became clear, that one of the challenges for future breast radiologists and radiological societies will be to strive to ensure overall the best standard of care possible, improve education and increase the awareness not only in women, but also in law-makers.
It was such an intense and productive week, a week that showed us all the million possibilities and challenges ahead and the need to carry on with enthusiasm and passion in our research in order to being able to offer the best clinical practice.

Looking forward to ECR 2020!

Authors:
Paola Clauser, Elisabetta Giannotti, Maria Adele Marino, Ritse Mann, Katja Pinker, Julia Camps Herrero

References:
1. Skaane P, Bandos AI, Gullien R, et al (2013) Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology 267:47–56. https://doi.org/10.1148/radiol.12121373
2. Caumo F, Zorzi M, Brunelli S, et al (2017) Digital Breast Tomosynthesis with Synthesized Two-Dimensional Images versus Full-Field Digital Mammography for Population Screening: Outcomes from the Verona Screening Program. Radiology 170745. https://doi.org/10.1148/radiol.2017170745
3. Zackrisson S, Lång K, Rosso A, et al (2018) One-view breast tomosynthesis versus two-view mammography in the Malmö Breast Tomosynthesis Screening Trial (MBTST): a prospective, population-based, diagnostic accuracy study. Lancet Oncol 19:1493–1503. https://doi.org/10.1016/S1470-2045(18)30521-7
4. Houssami N, Bernardi D, Caumo F, et al (2018) Interval breast cancers in the “screening with tomosynthesis or standard mammography” (STORM) population-based trial. Breast Edinb Scotl 38:150–153. https://doi.org/10.1016/j.breast.2018.01.002
5. Pattacini P, Nitrosi A, Giorgi Rossi P, et al (2018) Digital Mammography versus Digital Mammography Plus Tomosynthesis for Breast Cancer Screening: The Reggio Emilia Tomosynthesis Randomized Trial. Radiology 288:375–385. https://doi.org/10.1148/radiol.2018172119
6. Berger N, Marcon M, Saltybaeva N, et al (2019) Dedicated Breast Computed Tomography With a Photon-Counting Detector: Initial Results of Clinical In Vivo Imaging. Invest Radiol. https://doi.org/10.1097/RLI.0000000000000552
7. Patel BK, Lobbes MBI, Lewin J (2018) Contrast Enhanced Spectral Mammography: A Review. Semin Ultrasound CT MR 39:70–79. https://doi.org/10.1053/j.sult.2017.08.005
8. Rodriguez-Ruiz A, Lång K, Gubern-Merida A, et al (2019) Stand-Alone Artificial Intelligence for Breast Cancer Detection in Mammography: Comparison With 101 Radiologists. J Natl Cancer Inst. https://doi.org/10.1093/jnci/djy222