How Does ACR BI-RADS^® v2025 Change the Radiologist's Approach? A Practical Guide Across Mammography, Ultrasound, and...

Area of Science:

• Radiology
• Medical Imaging
• Breast Cancer Screening

Background:

• The American College of Radiology released the Breast Imaging Reporting and Data System (BI-RADS) v2025, the first major update since 2013.
• This new edition incorporates substantial revisions across mammography, ultrasonography, MRI, and introduces a dedicated section for contrast-enhanced mammography (CEM).

Purpose of the Study:

• To compare the key changes between BI-RADS v2013 and BI-RADS v2025.
• To evaluate the evidence supporting the diagnostic performance and reader agreement of the revised BI-RADS descriptors and principles.

Main Methods:

• Comparative analysis of BI-RADS v2013 and v2025 editions.
• Review of existing literature on diagnostic performance and reader agreement for imaging descriptors and assessment categories.

Main Results:

• BI-RADS v2025 includes new descriptors (e.g., 'lobulated' shape, 'non-mass lesion' in ultrasound), modified terminology (e.g., calcification shifts, MRI phase renaming), and revised Category 6 assessment.
• The update emphasizes a multimodality framework, separating assessment from management and incorporating new technologies like digital breast tomosynthesis and automated whole-breast ultrasonography.
• Evidence supporting improved reproducibility for newer descriptors is limited, and concerns remain regarding potential increases in false positives and overdiagnosis.

Conclusions:

• BI-RADS v2025 represents a significant evolution towards a comprehensive multimodality framework for breast imaging reporting.
• Further research is needed to validate the impact of v2025 revisions on diagnostic accuracy and inter-reader reliability.
• Equitable implementation of advanced tools, including artificial intelligence, is crucial for addressing reproducibility gaps and managing healthcare costs.