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Background: Women's breast cancer is considered a serious public health issue. throughout the world. For asymptomatic women, digital mammography is the primary imaging modality used for breast cancer screening. It also has been shown to reduce breast cancer mortality. Digital breast tomosynthesis provides better detection of the abnormalities especially in females with dense breasts. Aim: to evaluate the impact of digital breast tomosynthesis (DBT) in comparison to digital mammography (DM) in improving the detection and characterization of breast cancer across the dense and non-dense breasts (according to BI-RADS Atlas) in correlation with ultrasound and histopathology. Material & Method: This study included 100 female patients according to our inclusion criteria. All patients performed fullfield digital mammography (FFDM) and digital breast tomosynthesis (DBT) were classified according to breast density. To establish a correlation between mammographic findings and cancer diagnosis, high-resolution ultrasound (HHUS) and DBT were used following FFDM as the primary imaging modality. The cancer diagnosis was subsequently confirmed by histopathology. Results: The current study was based on histopathology as a reference standard, This was correlated with the final diagnosis; the diagnostic indices of mammography at the whole group were a sensitivity of 73.9%, a specificity of 74.3%, a positive predictive value (PPV) 84.2%, a negative predictive value (NPV) of 60.5%, and a diagnostic accuracy of 74%. Diagnostic indices of DBT were a sensitivity of 100%, a specificity of 88.6%, a PPV of 94.2%, an NPV of 100%, and a diagnostic accuracy of 96%. In patients with dense breasts Radiology ACR (c and d), 78% of cases had changed their BI-RADS scoring with the addition of tomosynthesis. However, in 54% of individuals with non-dense breast ACR (a and b), the addition of DBT to FFDM changed the BIRADS score. Our results showed that 100% of lesions detected by tomosynthesis were malignant tumors. [ABSTRACT FROM AUTHOR]