الفهرس 
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Abstract
Breast cancer is one of the leading causes of death in women over the age of 40 years. Breast cancer screening is used to identify women with asymptomatic cancer with the goal of enabling women to undergo less invasive treatments that lead to better outcomes, ideally at earlier stages and before the cancer progresses. Breast imaging is currently undergoing a major change with the wide spread implementation of Full Field Digital Mammography equipment. Mammography is the best-studied breast cancer screening modality and the only recommended imaging tool for screening the general population of women. Dense fibroglandular tissue is the most important inherent limitation of mammography due to its masking effect. FFDM is accused of having a low sensitivity because the overlapping breast tissue may hide an abnormality and this increases the number of false negative results. On the other hand, it is accused of having a low specificity because the overlapping tissues may give the impression of a false abnormality which is responsible for a large number of false positive results. So, our study aimed at evaluating the role 3D Digital Tomosynthesis in screening and diagnosis of cancer breast in women with dense breast. Fifty females were included in this study; their ages ranged from 35 to 65 years. They were subjected to full history taking and were evaluated by 2D Mammography (cranio-caudal and mediolateral oblique views) and 3D Digital Breast Tomosynthesis individually. Each breast was assessed for its density and for presence of any lesions. Each lesion was assessed for its site, type (mass, focal asymmetry ± calcifications), and was assigned an independent BIRADS score for each modality. The results were studied and compared to each other and to the final outcome of the studied females according to the standard reference (histopathology, ultrasound or combination) that detected 25 females with no abnormal findings, 16 females with benign lesions, and 9 females with malignant lesions. 3D Digital Tomosynthesis resolved the problem of tissue overlap in FFDM. It enhanced the detection and diagnostic ability of FFDM. By 2D mammography, no abnormal findings were detected in 8 females (16%), and abnormal mammographic findings were detected in 44 females (88%). While by 3D tomosynthesis, no abnormal findings were detected in 10 females (20%), and abnormal finding were detected in 40 females (80%). According to BIRADS category, 2D mammography categorized lesions into BIRADS 0 in 25 females (50%), BIRADS I in 8 females (16%), BIRADS II in 3 females (6%), BIRADS III in 10 females (20%), BIRADS IV in 2 females (4%) and BIRADS V in 2 females (4%) with no significant correlation between breast density and 2D mammographic BIRADS, while 3D tomosynthesis detected 10 females with BIRADS I, 27 females with BIRADS II, 3 females with BIRADS III, 5 females with BIRADS IV and 5 females with BIRADS V with no significant correlation between breast density and 3D tomosynthesis. 3D Tomosynthesis in this study showed better screening performance compared to mammography with a sensitivity of tomosynthesis of 97.4%, a specificity of 90.9%, positive predictive value of 97.4%, negative predictive value of 90.9% and a diagnostic accuracy was 96% versus 2D mammography sensitivity of 64.1%, specificity of 54.5%, positive predictive value of 83.3%, negative predictive value of 30%, and diagnostic accuracy of 62%. from these results, we concluded: Tomosynthesis enables better depiction of masses and asymmetries. It can separate overlapping tissue in dense breast by acquisition of multiple images over limited angular range. Tomosynthesis is very useful in the screening setting due to better lesion detection and accurate description of its margins, shape and effects on surrounding structures, as well as the presence or absence of microcalcifications which can be of value in confirming or excluding the potential for malignancy of a certain lesion. Therefore, it can detect more cancers and can reduce the number of biopsies from a questionable finding seen on mammography. Tomosynthesis has higher sensitivity, specificity and diagnostic accuracy than mammography as it allows better detection of breast cancer, decreasing false positive recall rate and superior resolution for making an accurate diagnosis. So, we recommend using tomosynthesis as a routine investigation in the field of screening for breast cancer and also in evaluation of female patients with suspicious breast lesions for accurate diagnosis.