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

Area of Science:

• Radiology
• Medical Imaging
• Oncology

Background:

• The American College of Radiology updated the Breast Imaging Reporting and Data System (BI-RADS) to its 6th edition in December 2025.
• Previous editions, including the 5th edition from 2013, established standards for breast imaging interpretation and reporting.

Purpose of the Study:

• To summarize key changes in the BI-RADS Atlas 2025 mammography guidelines for radiologists.
• To facilitate adaptation to updated breast density classification, terminology, and reporting criteria.

Main Methods:

• Comparative analysis of the BI-RADS Atlas 2025 mammography section against the 5th edition (2013).
• Review of the 'What's New' summary and terminology lexicon for significant updates.
• Assessment of changes in descriptors, reporting structure, and integration of new technologies.

Main Results:

• Digital breast tomosynthesis (DBT) is now fully integrated into the mammography framework.
• Terminology updates include reintroducing 'lobulated' shape, removing 'microlobulated' margins, consolidating 'popcorn' and 'dystrophic' calcifications into 'coarse,' and retiring 'developing asymmetry.'
• Lymph-node reporting is unified, and 'Associated Features' are redefined as 'Secondary Findings.'

Conclusions:

• BI-RADS Atlas 2025 reflects advancements in DBT and regulatory changes, such as FDA breast density notification requirements.
• Radiologists must familiarize themselves with these updates for accurate communication and standardized breast imaging interpretation and reporting.