ACR BI-RADS 2025: What Changed and Why It Matters

ACR BI-RADS v2025 — the first year-versioned edition — drops 'focus' and 'developing asymmetry,' adds ultrasound 'non-mass,' standardizes Category 4 subdivisions across modalities, and reframes mammographic density around masking risk rather than volume.

• Major structural changes include expanded integration of digital breast tomosynthesis (DBT), contrast-enhanced mammography (CEM), and multiparametric MRI; the revised lexicon is harmonized across modalities to improve consistency in reporting.
• Mammographic density definitions are updated to emphasize masking risk over volumetric measurement — a clinically meaningful shift that may affect supplemental screening recommendations.
• This is a review/summary article, not a primary outcomes study; evidence base for individual lexicon changes is not quantified in the source, and real-world impact on inter-reader agreement awaits prospective evaluation.

RadPigeon summaries are original and for information only. They are not clinical advice.