Background: Digital breast tomosynthesis (DBT) now become one of the available diagnostic imaging modalities of the breast, and the present study was done to evaluate its diagnostic value versus that of breast ultrasound (US) in the evaluation of breast asymmetries. This study included 51 patients with 57 mammography identified breast asymmetries; their ages were ranged from 26 to 72 years (mean age 50.05 ± 8.1 SD). For all patients, both digital breast tomosynthesis and ultrasound were done, and their results were compared. Results: Tomosynthesis in this study showed better diagnostic performance compared to mammography; the sensitivity of tomosynthesis was 83.33%, the specificity was 89.74%, the positive predictive value was 78.95%, the negative predictive value was 92.11%, and the accuracy was 87.71% while the sensitivity of mammography was 72.22%, the specificity was 71.79%, the positive predictive value was 54.17%, the negative predictive value was 84.85 %, and the accuracy was 71.92 %. Breast ultrasound showed the highest sensitivity in this study with the sensitivity of ultrasound being 100.00 %, the specificity being 92.31%, the positive predictive value being 85.71%, the negative predictive value being 100.00%, and the accuracy being 94.73%. Conclusion: Tomosynthesis enables better depiction of asymmetries. It can be useful in the screening setting where better lesion detection and accurate description of lesions is desired. Therefore, it can detect more cancers and can reduce the number of biopsies. Breast ultrasound should be coupled with breast mammography and 3D tomosynthesis in the evaluation of the breast asymmetries as it reduces false-negative results, detects solid and cystic lesions, and assesses solid lesion nature.
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