The Added Value of Digital Tomosynthesis in BI-RADS 4 and 5 Lesions: A Prospective Study with Histopathological Correlation

Background: Digital breast tomosynthesis (DBT) generates reconstructed three-dimensional mammographic images of the breast and is increasingly used for breast cancer (BC) diagnosis and screening. Objective: To evaluate the diagnostic benefit of adding DBT to digital mammography (DM) in assessment of BI-RADS 4 and 5 breast lesions, with correlation to histopathological outcomes. Patients and Methods: This prospective study was carried out between March 2023 and June 2025 and included 108 female patients presented with BI-RADS 4 or BI-RADS 5 breast lesions diagnosed by initial mammogram. Tomosynthesis examination was done prior to biopsy and the findings were correlated with the pathological results. Results: DBT provided significantly better visualization of tumor margins and more accurate BI-RADS classification than conventional mammography, especially in dense breast (P < 0.001). Conclusions: Integration of DBT into standard diagnostic pathways for patients with suspicious mammographic findings offers considerable added value. It improves lesion assessment, enhances alignment with pathological outcomes, and supports more confident clinical decisions particularly in dense breasts.