Neoadjuvant chemotherapy (NAC) is the standard treatment for high-risk breast cancer, but less than 30% of patients achieve a complete response, so there is a need for better pre-selection and monitoring. In this context, ultrasound is one of the standard clinical diagnostic modalities, but as implemented, it falls far short of its capabilities. Super-resolution ultrasound imaging (in particular motion model ultrasound localisation microscopy, mULM) is a technique that could change this. mULM was first presented conceptually by us in 20111 and clinically tested in breast cancer patients in 20182 . New clinical results underline the high potential of the method for tumour characterisation and show that it can be used to predict chemotherapy response in breast cancer. Functional vascular characterisation using contrast-enhanced ultrasound imaging can be combined with molecular ultrasound using targeted microbubbles3 . We have shown that VEGFR2-specific microbubbles, which are currently in clinical trials, behave similarly to untargeted microbubbles in tumours in the early accumulation phase, but provide molecular information about VEGFR2 in the late phase. In preclinical studies, however, molecular information has been shown to be more sensitive for assessing anti-angiogenic therapeutic effects. In this talk, I will summarise our research on superresolution and molecular ultrasound imaging of breast cancer, the transition from preclinical research to the clinic, and share my view on the future clinical implementation of these technologies.

Fabian Kiessling studied Medicine in Heidelberg. Until 2008, he worked in the Departments of Radiology and Medical Physics in Radiology of the German Cancer Research Center. In parallel, he did his clinical training at the University of Heidelberg and received the board certification as Radiologist. Since 2008 he is leading the Institute for Experimental Molecular Imaging at the RWTH Aachen University. Aim of his research is the development of novel diagnostic probes and imaging tools for a disease specific diagnosis and therapy monitoring. He authored over 500 publications and book chapters, edited four books, and received multiple research awards and honours. Furthermore, he was program chair of the WMIC in 2016, is a fellow of the WMIS and served as president of the European Society for Molecular Imaging from 2023-2023. Since 2019 he has been on the list of Clarivate’s Highly Cited Researchers (Web of Science).