The BI-RADS v2025 Manual: Key Updates for Everyday Practice-AJR Expert Panel Narrative Review

Area of Science:

• Radiology
• Breast Imaging
• Medical Informatics

Background:

• The Breast Imaging Reporting and Data System (BI-RADS) is crucial for standardizing breast imaging interpretation and communication.
• The previous BI-RADS edition was published in 2013, necessitating an update to reflect advancements in technology and clinical practice.

Purpose of the Study:

• To review and highlight the most clinically significant updates in the American College of Radiology BI-RADS v2025 Manual.
• To describe the implications of these revisions for interpretation, reporting, and patient management in breast imaging.

Main Methods:

• This is an Expert Panel Narrative Review of the BI-RADS v2025 Manual.
• The review focuses on significant revisions across mammography, ultrasound, MRI, contrast-enhanced mammography (CEM), and auditing sections.
• Key updates are analyzed for their impact on clinical practice.

Main Results:

• BI-RADS v2025 introduces harmonized lexicon terminology and reporting principles across modalities.
• Mammography updates include revised breast density terminology and expanded digital breast tomosynthesis guidance.
• Ultrasound, MRI, and CEM sections feature new descriptors and terminology, including dedicated guidance for CEM.
• Auditing and outcomes monitoring emphasize modality-specific metrics and quality assurance.

Conclusions:

• The BI-RADS v2025 updates aim to improve standardization, reporting consistency, and communication in breast imaging.
• These revisions are expected to enhance the quality assessment of breast imaging practices.
• The manual provides a flexible framework for future advancements in the field.