{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T05:11:40Z","timestamp":1783746700800,"version":"3.55.0"},"reference-count":35,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Twelve years after the 2013 fifth edition, the American College of Radiology has released BI-RADS\u00ae v2025, with substantial revisions across mammography, ultrasonography, MRI, and the newly independent contrast-enhanced mammography (CEM) section. This review compares the two editions and reads the main changes against the available evidence on diagnostic performance and reader agreement, rather than only cataloguing them. Examples featuring digital breast tomosynthesis, synthetic mammography, and automated whole-breast ultrasonography now appear throughout the modality sections. \u201cLobulated\u201d has been added as a shape descriptor across all modalities, while \u201cmicrolobulated\u201d was dropped from the mammography margin list. Calcification terms shifted from etiology to morphology: \u201cmilk of calcium\u201d became \u201clayering,\u201d \u201cpunctate\u201d was folded into \u201cround,\u201d and \u201cdystrophic\u201d moved under \u201ccoarse.\u201d Ultrasonography gained two new entries, \u201cnon-mass lesion\u201d and \u201cechogenic rind,\u201d and on MRI, \u201cinitial phase\u201d was renamed \u201cearly phase.\u201d Category 6 was rewritten; therefore, surgical excision is recognized as one of several definitive local treatments, and an \u201cuncoupled\u201d principle now separates assessment from management. The auditing section folds Category 3 follow-up into basic auditing and adds a Method of Detection data field. Most supporting data, however, predate v2025, and reader agreement remains lower for newer descriptors such as non-mass enhancement; whether the revisions measurably improve reproducibility is still unproven. Integrating every high-sensitivity tool also brings more false positives, overdiagnosis, and cost; artificial intelligence and radiomics may help close the reproducibility gap, but resource-stratified, equitable implementation will be essential. With v2025, BI-RADS becomes a multimodality framework rather than a reporting lexicon alone.<\/jats:p>","DOI":"10.3390\/diagnostics16132135","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T15:40:09Z","timestamp":1783525209000},"page":"2135","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["How Does ACR BI-RADS\u00ae v2025 Change the Radiologist\u2019s Approach? A Practical Guide Across Mammography, Ultrasound, and MRI: A Narrative Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5039-9070","authenticated-orcid":false,"given":"Ela","family":"Kaplan","sequence":"first","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Adiyaman University, Adiyaman 02040, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6764-8483","authenticated-orcid":false,"given":"Ahmet Burak","family":"Aydemir","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, Adiyaman University, Adiyaman 02040, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/j.jacr.2009.07.023","article-title":"The ACR BI-RADS\u00ae Experience: Learning From History","volume":"6","author":"Burnside","year":"2009","journal-title":"J. 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