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by Mirjam Wielema, MD and Thiemo van Nijnatten, MD , PhD

This year’s European Society of Breast Imaging (EUSOBI) Annual Scientific Meeting held in Budapest started with the EUSOBI Young Club (EYC) Symposium on October 3rd, Thursday morning. This was an interactive workshop dedicated to young breast radiologists, focused on communication, leadership and career planning. European experts and leaders in the field, including Prof. Michael Fuchsjäger (ESR 1st Vice-President), Dr. Julia Camps-Herrero (EUSOBI President) and Prof. Christiane Kuhl, shared their experience on communication, leadership and research. The fruitful discussion with the experts provided us with leads and suggestions to read (1) in order to achieve our goals and balance clinical tasks, research and private life. The attendees participated actively and shared their thoughts, hopes and fears with the panel of experts, not hesitant to tell their stories and experiences. The youngest generation had the opportunity to get precious tips on how to succeed in the complex job of being a breast radiologist. The EYC Committee announced the launch of a series of monthly webinars focused on “Tricks and Treats of Breast MRI” starting November 2019. More information on dates and time-schedules will be forthcoming on the EUSOBI website.

The EUSOBI Annual Scientific Meeting continued that afternoon with updates on digital breast tomosynthesis (DBT) and a focus on synthetic mammography. Despite the initial enthusiasm around DBT, we are still lacking the evidence to include DBT in screening programs as there seems to be little effect on the frequency of interval cancers, as presented by Dr. Alfonso Frigerio. Dr. Alexandra Athanasiou explained that despite the improvement in image quality of synthetic mammograms, they should be considered as an addition to DBT, and should be interpreted in combination, rather than as a real stand-alone examination.
The last session of the first day focused on breast MRI, in particular on abbreviated and ultrafast MRI protocols and diffusion weighted imaging (DWI). Progress is made in shortening DCE-T1 protocols, reducing the number of scans after contrast and making use of ultrafast sequences: “post contrast high temporal resolution” (2). Despite the exciting advances in the last year on both abbreviated MRI protocols and DWI, the speakers underlined the need for further, large scale and multi-institutional studies to confirm their value in clinical practice.

One of the highlights of the congress was the session on risk evaluation, which included a talk on the eagerly awaited DENSE trial by providing an overview of the first-round screening results and the effect on interval cancers (3). The promising results show a significant increase in cancer detection rate with MRI in dense breasts and a significant decrease in the frequency of interval cancers. Second and third round screening results from this study may provide insight into the long-term benefit of additional breast MRI in screening. Furthermore, Dr. Allison Rose and Prof. Bruce Mann from Melbourne presented the PROSPECT trial whereby patients with unifocal Luminal cancers confirmed by MRI are spared radiation therapy, a great step towards de-escalation of treatment.

Artificial intelligence (AI) in breast imaging was a hot topic. Multiple lectures and workshops were dedicated to the (near) future implementation of AI in daily clinical practice. This included the key note lecture by one of the pioneers of AI in medical image analysis, Prof. Bram van Ginneken. New developments and results, including the promising potential role of reducing workload in breast cancer screening (4) were presented throughout the conference. In addition, new insights in both nodal and distant staging of breast cancer revealed the potential role of promising techniques, such as mammi-PET, PET/MRI and whole body (diffusion weighted) MRI in daily practice.

During a particularly interesting and moving session, this year’s EUSOBI Gold Medal was awarded to Prof. Thomas H. Helbich, in honor of his commitment and work for the EUSOBI and his cutting-edge research. Prof. Helbich gave an inspiring lecture on the novel developments and achievements in breast imaging. His contributions to the field of breast imaging will continue to inspire the next generation of imagers.
On Saturday, SBI President, Margarita L. Zuley, MD, FACR, FSBI, gave an excellent lecture on contrast enhanced mammography. She presented on the potential role of this emerging technique in clinical practice including the possible reduction in biopsy rates of lesions with low probability of malignancy.

The congress was closed by an encouraging evening symposium on the role of AI in radiology in the High Note SkyBar, organized by the EYC. With Budapest’s rooftops as an impressive background for this gathering, the youngest generation shared their thoughts on AI in breast imaging with experts on the field, whilst enjoying food and drinks. Seeds for possible new collaborations were planted. We concluded that AI will help us radiologists in the future, but much work still needs to be done including addressing the importance of ethical and legal aspects of AI.

In summary, EUSOBI 2019 was a great success with many new impressive lectures and inspiring discussions on research in order to improve breast radiology with the goal of offering the best clinical care to our patients. We are already looking forward to welcoming you to the next EYC event planned at the European Congress of Radiology in Vienna, March 2020.

References
1. A.R. Magulis. The Road to Succes. A career manual. Elsevier 2007. ISBN: 978-0-12-370587-7. https://doi.org/10.1016/B978-0-12-370587-7.X5000-2
2. Mann, R.M., van Zelst, J.C.M., Vreemann, S. et al. Curr Breast Cancer Rep (2019) 11: 9. https://doi.org/10.1007/s12609-019-0300-8
3. Emaus MJ, Bakker MF, Peeter PH, et al. MR imaging as an additional screening modality for the detection of breast cancer in women aged 50-75 years with extremely dense breasts: the DENSE trial study design. Radiology. 2015 Nov;277(2):527-37.
4. Rodriguez-Ruiz A, Lång K, Gubern-Merida A, et al. Can we reduce the workload of mammographic screening by automatic identification of normal exams with artificial intelligence? A feasibility study. Eur Radiology. 2019 Sep;29(9):4825-4832.