Breast Imaging Reporting and Data System v2025: Key Updates in Mammography

In December 2025, the American College of Radiology released the 6th edition of the Breast Imaging Reporting and Data System (BI-RADS^® v2025). This review aimed to help radiologists adapt to the updated guidelines by summarizing major changes in mammography, including descriptions of breast-density classification, terminology updates, and revised interpretation/reporting criteria. The mammography section of the BI-RADS^® v2025 manual was comparatively analyzed against the 5th edition (2013), with an additional review of the 'What's New' summary and the terminology lexicon to identify key updates in descriptors and reporting structure. Aligning with the 2024 U.S. Food and Drug Administration (FDA) breast-density notification requirements, singular wording has been permitted for unilateral examinations. Digital breast tomosynthesis (DBT) has been fully integrated into the mammography framework, allowing mass definition even on a single-projection image. Regarding terminology, the 'lobulated' shape descriptor has been reintroduced, while the 'microlobulated' margin descriptor has been removed. Regarding calcification descriptors, 'popcorn' and 'dystrophic' have been consolidated under 'coarse,' and the term 'developing asymmetry' has been retired. Lymph-node reporting has been unified into a single category; several subsections previously included under 'Associated Features' have been renamed as 'Secondary Findings' and have been conceptually redefined. In conclusion, BI-RADS^® v2025 incorporates advances in DBT technology and evolving regulatory requirements. Radiologists should become familiar with these updated terms and structural changes to ensure accurate communication and standardized interpretation and reporting.