BI-RADS v2025 for breast ultrasound: key updates and Asian perspectives

Breast ultrasound plays an increasingly important role in breast cancer detection, diagnosis, and management, particularly in regions where mammographic sensitivity is reduced by dense breast tissue. Although the Breast Imaging Reporting and Data System (BI-RADS) lexicon, developed by the American College of Radiology, provides a standardized framework for ultrasound interpretation, its terminology and conceptual structure continue to evolve in response to advances in imaging technology, changes in screening paradigms, and ongoing refinement of diagnostic and therapeutic approaches. This review summarizes the key ultrasound-related updates in BI-RADS v2025, with particular emphasis on the glandular tissue component, non-mass lesions, and structured lymph node assessment, and discusses their clinical implications in settings where breast ultrasound plays a central role in screening and diagnostic pathways, especially in Asia.