Preoperative Breast MRI for Surgical Planning: A Framework Incorporating BI-RADS v2025

A practical review synthesizes how preoperative breast MRI—detecting additional ipsilateral disease in ~20% of newly diagnosed breast cancers—should guide surgical planning under BI-RADS v2025, including new 'Additional Close Findings' category and key oncoplastic thresholds.

• Narrative/review design; no original patient cohort — provides a surgically-oriented interpretive framework rather than primary diagnostic-accuracy data.
• BI-RADS v2025 introduces 'Additional Close Findings' to streamline management of suspicious lesions within 2.0 cm of the index cancer; tumor-nipple distance >1.0 cm and MRI-to-skin distance ≤5 mm are highlighted as reported thresholds for nipple/margin involvement in mastectomy planning, though these derive from prior studies under specific conditions.
• Key limitation: thresholds cited are from heterogeneous prior literature, not a single validated dataset; generalizability across MRI platforms and institutional protocols is unconfirmed.

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