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Background Digital Breast Tomosythesis is a new technology of digital mammography that enables the acquisition of three dimensional volume of thin section data, and thus reduces or eliminates tissue overlap especially in dense breast, such ability allow visualization of cancers not apparent by digital mammography and differentiate between benign and malignant lesion. Objectives to compare the efficacy of digital breast Tomosynthesis (BDT) to digital Mammography (DM) in diagnosis of different breast lesions in dense breast. Patients and Method in this prospective study 30 patients with breast density ACR/C and ACR/D were assessed by Digital Mammography and Digital Breast Tomsynthesis. Each lesion was assigned a blinded category in an individual performance for each modality. The resultant BI-RADS categories were correlated with report of the pathology specimens or outcome follow up. Results Both modalities were compared regarding characterization, using Chi Square test (p value:0.035).The sensitivity, specificity and accuracy of digital mammography was 62.5%, 68.75% and 66% have significantly increase with tomosynthesis to be 100%,91% and 97% respectively. Conclusion Digital breast tomosythesis significantly enhanced characterization of breast lesions than digital mammography in dense breast parenchyma (ACR/C and ACR/D).