Abstract

Objective: To compare the diagnostic performance of digital breast tomosynthesis (DBT) with digital mammography (DM) and to evaluate the clinical benefit of DBT in breast cancer diagnosis among women with dense breasts. Methods: A cross-sectional study included 110 breast lesions in 98 women (aged 25 - 73 years) with BI-RADS C/D breast density. All patients underwent DM and DBT on the same day at Thien Nhan Medical Center, Da Nang, between April 2024 and August 2025. Histopathological results obtained from core needle biopsy and/or surgical specimens served as the reference standard. All lesions were classified according to BI-RADS. Diagnostic indices and Cohen’s Kappa were calculated, and McNemar’s test, with p < 0.05, was used for comparison. Result: DBT outperformed DM across all diagnostic parameters, including sensitivity (95.6% vs. 82.2%), specificity (60.0% vs. 52.3%), accuracy (74.5% vs. 64.5%), and AUC (0.78 vs. 0.67). The agreement between DBT and DM was moderate, with a kappa value of 0.516. DBT correctly downgraded 11 of 65 benign lesions and upgraded 11 of 45 malignant lesions, resulting in a 16.9% reduction in unnecessary biopsies. Conclusion: In women with dense breasts, DBT significantly improves diagnostic performance and reduces unnecessary biopsies compared with DM.