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

The American College of Radiology BI-RADS v2025 Manual, representing the first major BI-RADS update since the 5th edition from 2013, incorporates advances in breast imaging technology, clinical practice, and regulatory requirements. This AJR Expert Panel Narrative Review describes the manual's most clinically significant updates for each modality, highlighting implications for interpretation, reporting, and patient management in everyday practice. Significant revisions were introduced across the mammography, ultrasound, MRI, contrast-enhanced mammography (CEM), and auditing sections to improve standardization and reporting consistency. Key mammography updates include alignment of breast density terminology with Mammography Quality Standards Act regulations, expanded digital breast tomosynthesis guidance, and removal of the standalone descriptor "developing asymmetry." Ultrasound updates include incorporation of nonmass lesions, elasticity descriptors, and automated breast ultrasound terminology. MRI updates include revisions to the terminology for enhancing lesions and expanded implant descriptors. BI-RADS v2025 also formally incorporates CEM as a dedicated modality section. Lexicon terminology and reporting principles have been harmonized across modalities. Additional revisions to auditing and outcomes monitoring emphasize modality-specific performance metrics and quality assurance. The BI-RADS v2025 updates are expected to enhance communication, reporting reproducibility, and quality assessment in current breast imaging practice while providing a flexible framework for future modifications and enhancements.