A Pictorial Review of Changes in the BI-RADS Fifth Edition

Initially developed in 1993, the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon serves to standardize breast imaging reports, improve communication with referring physicians, and provide a quality assurance tool. The long-awaited BI-RADS fifth edition consolidates, improves, and expands the lexicon for mammography, breast ultrasonography (US), and breast magnetic resonance (MR) imaging. The new edition has increased the number of imaging examples to nearly 600. The breast MR imaging lexicon is significantly expanded since it first appeared in the fourth edition. New terms have been added to the US lexicon to reflect technologic advances. Minor but important changes have been made to the mammography section. Calcification descriptors in the lexicon are now consolidated into two categories: benign and suspicious. The controversial “intermediate concern” grouping has been eliminated, and a table in the lexicon summarizes the literature supporting the recommendation to biopsy such calcifications. New descriptors such as “developing asymmetry” are illustrated, and abstracts are provided to reference their significance. A generous guidance section is included after the lexicon description for each modality. Useful frequently asked questions are succinctly answered, and the literature to support each answer is included in the reference section for each modality. This review article illustrates and highlights changes to the BI-RADS lexicon and provides readers with a general overview to familiarize them with the fifth edition.

^©RSNA, 2016