Aim/Objectives: This study aimed to evaluate the diagnostic accuracy of full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) in detecting and characterizing the lesions. Also, we compared both modalities in detecting breast lesions.Methods: A prospective study was conducted from January 2021 to June 2022 on 76 patients. All of them underwent FFDM, DBT, and ultrasonography (USG), and the features of breast lesions were characterized based on the BIRADS followed by histopathological confirmation.Results: This study found that DBT (97.3%) was more accurate than FFDM (88.4%) in detecting breast lesions and is superior to FFDM when used alone or as an adjunctive tool for FFDM. The sensitivity of DBT vs FFDM (100% vs 92%) and DBT +FFDM vs FFDM (100% vs 92%) was relatively higher. Also, the specificity of DBT vs FFDM was 91.4% vs 76.7% and FFDM+DBT vs FFDM was 89.8% vs 76.7%.The individual characteristics of breast lesions with the highest sensitivity were spiculations, lobulations, and architectural distortion being 100% for all on DBT and 90.9%, 88%, and 80.8% on FFDM respectively. They also showed high specificity of 96% for spiculations and architectural distortion, 90% for lobulations on DBT and 90% for spiculations, 50% for lobulations, and 84.3% for architectural distortion on FFDM. Calcifications showed high sensitivity of 95.2% on DBT. The features favoring malignancy on DBT and FFDM were spiculated margins, architectural distortion, microlobulations, microcalcifications, irregularly shaped lesions with irregular margins, and also, >2cm size of the lesion. With the addition of DBT to FFDM, 14 out of 76 lesions had shown up gradation on BIRADS.
Conclusion:The performance of DBT was significantly higher for the detection and characterization of breast lesions. Evaluation of the features of breast lesions on DBT can help to identify the malignant and benign potential of the lesions. The addition of DBT as a screening tool can decrease false positives and recall rates as well.