Post-contrast series at 60–120 seconds renamed from “initial” to “early” because newer ultrafast protocols may have initial timepoints before the early phase
Lexicon Changes
Change
Details
Focus removed
Most small dots of enhancement are benign; truly unique ≤5 mm findings should be characterized as small mass or focal NME
Lobulated shape reintroduced
Previously folded into oval; now separate category
”Irregular” margin → “Indistinct”
Avoids confusion with irregular shape descriptor; harmonizes across modalities
T2 signal intensity added
New mass descriptor; T2 hyperintense + oval + circumscribed + homogeneous/dark septations = ≤2% cancer
Thick rim enhancement renamed
Previously just “rim enhancement”; emphasizes difference from benign peri-cystic enhancement
Peritumoral edema added
New associated feature; T2 hyperintense signal surrounding tumor
Lymph nodes elevated
From sub-category of associated features to separate lexicon category with detailed descriptors
Reporting System Changes
Change
Details
Category 0 split
Two sub-types: “Need Additional Imaging” and “Need Prior Imaging for Comparison” (matches 2024 MQSA)
Category 3 in current cancer
Should be avoided; assign 4A instead for near-term tissue diagnosis
Category 4 subdivisions
Now optional for MRI (4A, 4B, 4C) — previously only mammography/US
Category 6 + ACFs
Structured criteria for additional close findings (within 2 cm, no >2 cm extent increase, no management change)
“Satellite” term
Discouraged — use “additional close finding (ACF)“
Structured indications
Three categories: Asymptomatic Screening, Diagnostic Work-Up, Diagnostic Current Breast Cancer
”Second-look” US
Term discouraged — use “targeted” or “MRI-directed” ultrasound