BI-RADS® v2025: The Updates Transforming Breast Imaging Reporting
New Criteria for Mammography, Breast Ultrasound, and Breast MRI: Advancing Standardization and Diagnostic Accuracy
The American College of Radiology (ACR) has introduced BI-RADS® v2025, a major update to the internationally recognized classification and reporting system used in breast imaging. The new guidelines represent a significant evolution for mammography, breast ultrasound, and breast MRI while formally incorporating Contrast-Enhanced Mammography (CEM) into the framework for the first time.
The primary goal of this revision is to improve consistency among radiologists, enhance communication between healthcare professionals, and increase the reproducibility of clinical findings. At a time when breast cancer screening remains one of the most effective tools for early detection, standardizing diagnostic language is becoming increasingly important.
Thirteen takeaways include:
- Masses no longer require confirmation on two views
- Mass and calcification descriptors have been reorganized to reduce ambiguity
- A new approach for calcification descriptors
- Greater focus on the densest region of the breast rather than an overall fibroglandular percentage
- Greater clarity for the assessment of BI-RADS Category 0
- Improved guidelines for reporting lymph nodes
- More detailed descriptive criteria for the assessment of dilated ducts
- Addition of new descriptors for shape, echotexture, and elasticity of ultrasound findings
- The term “non-mass” has been added for ultrasound findings
- Expanded guidelines on lymph node and tissue composition
- Updated ultrasound terminology for calcifications and associated features
- Breast MRI reporting with terminology changes
- Revision of associated features
Among the changes introduced in BI-RADS v2025 is the reorganization of descriptors used in mammography reporting. Several long-standing terms have been eliminated or updated to reduce ambiguity. For example, the term “microlobulated” was removed as a margin descriptor, while “lobulated” has been introduced as a shape descriptor to support more consistent lesion characterization. In addition, calcification descriptors have been revised with greater emphasis on morphology and distribution, two essential factors for accurate risk stratification.
Another important development concerns breast density assessment. While the traditional four density categories remain unchanged, the new manual encourages radiologists to focus more closely on the densest regions of the breast rather than on overall fibroglandular density. This approach enables a more accurate evaluation of how breast density may obscure potentially malignant lesions.
Breast ultrasound has also undergone significant updates. BI-RADS v2025 introduces the concept of “non-mass lesion,” a category designed to describe tissue abnormalities that do not exhibit the typical characteristics of a defined mass. Additionally, the new descriptor “echogenic rind” has been added for thick echogenic bands around a mass or non-mass that carry a high positive predictive value for malignancy and should be included in lesion size measurement.
Eventually, one of the most significant aspects of the revision is its stronger focus on reporting standardization and its terminologies. The updated guidelines establish a more consistent structure across mammography, ultrasound, and MRI reports, facilitating comparison between examinations and improving long-term patient management.
The evolution of BI-RADS reflects a broader trend within breast imaging: the integration of technological innovation, diagnostic quality, and standardized clinical processes. While advanced imaging systems are essential, it is equally important that findings are interpreted and communicated in a clear and uniform manner so that diagnostic information can support timely, informed clinical decisions.