European association of nuclear medicine (EANM) focus meeting 6 consensus on molecular imaging in breast cancer (endorsed by EUSOBI, ESSO, ESTRO, EuropaDonna)

Background: Despite significant advancements in imaging and treatment of breast cancer, clinical practice remains heterogeneous across institutions and disciplines. Molecular imaging has a pivotal role in breast cancer care, from diagnosis to recurrence assessment. To address these discrepancies and define the future direction of imaging in breast cancer, the European Association of Nuclear Medicine (EANM) convened Focus Meeting 6 on molecular imaging in breast cancer. Methods: A three-phase consensus process was performed: 1) systematic literature review, 2) modified two-round online Delphi survey, 3) in-person consensus conference. Twenty-seven multidisciplinary experts participated in the online Delphi (nuclear medicine, radiology, medical oncology, surgery, pathology, and radiation oncology); 121 in the in-person consensus conference; patient advocacy was incorporated in the last two stages. Results: A total of 92 statements across six thematic tracks were evaluated. Consensus was achieved on 84 statements (91 %), including areas of agreement, disagreement, and uncertainty. Key findings supported the utility of [18F]FDG PET/CT at baseline staging, therapy response assessment, and recurrence evaluation, particularly in specific breast cancer subtypes. A shared call for standardising imaging interpretation, harmonising clinical and imaging guidelines, and promoting prospective multicentric studies with patient involvement emerged. Conclusions: This EANM Focus Meeting represents the first multidisciplinary consensus on molecular imaging in breast cancer. It establishes expert-endorsed recommendations, identifies research gaps, and emphasises the need for integrated imaging and clinical strategies to improve patient outcomes and care standardisation globally.