Recent advances in breast imaging reporting: a review of the BI-RADS® sixth edition

Abstract

The breast imaging reporting and data system (BI-RADS), developed by the American College of Radiology, serves as the cornerstone for standardized breast imaging interpretation and reporting. The Sixth Edition, released as the BI-RADS® v2025 Manual, represents a substantial evolution of the framework in response to advances in imaging technology, expanding clinical applications, and accumulated evidence highlighting limitations of earlier editions. This narrative review summarizes the major updates introduced in BI-RADS v2025 across mammography, ultrasound, magnetic resonance imaging, and contrast-enhanced mammography. Key revisions include refinement of breast density communication, formal integration of digital breast tomosynthesis-based lesion characterization, expanded ultrasound lexicon including non-mass lesions, elimination of ambiguous magnetic resonance imaging (MRI) terminology, incorporation of additional MRI descriptors, recognition of abbreviated MRI protocols, and elevation of contrast-enhanced mammography to a core modality. Collectively, these updates aim to improve reproducibility, harmonize reporting across modalities, and strengthen audit and quality assurance processes. Understanding these changes is essential for accurate interpretation, effective multidisciplinary communication, and consistent application in contemporary breast imaging practice.