Unmasking Malignancy in Dense Breast Tissue (American College of Radiology Types C and D): A Biopsy-Proven…

Cohort studyDiagnostics (Basel, Switzerland)· Jul 2026

Unmasking Malignancy in Dense Breast Tissue (American College of Radiology Types C and D): A Biopsy-Proven Analysis of Digital Breast Tomosynthesis Performance, Clinical Decision Dynamics, and Correlation with Histological Grade and Molecular Subtypes.

Abdulkadir Eren, Emrah Karatay, Ferhat Ozden

Breast ImagingCohort studyQ2IF 4.4

Adding tomosynthesis to mammography sharply raised cancer detection sensitivity in dense breasts.

Unmasking Malignancy in Dense Breast Tissue (American College of Radiology Types C and D): A Biopsy-Proven Analysis of Digital Breast Tomosynthesis Performance, Clinical Decision Dynamics, and Correlation with Histological Grade and Molecular Subtypes.

Abdulkadir Eren … Ferhat Ozden

Diagnostics (Basel, Switzerland) · Jul 2026 · Q2 in General Medicine

Purpose

This study aimed to evaluate the diagnostic performance and clinical decision-making impact of adding digital breast tomosynthesis (digital breast tomosynthesis) to two-dimensional digital mammography (2D DM) in a 100% biopsy-proven cohort of women with dense breast parenchyma (ACR types C and D), focusing on the relationship between tumor biology and radiologic conspicuity.

Methods

This retrospective study analyzed 123 women (mean age 46.7 ± 9.9 years) with ACR type C (n = 67) or D (n = 56) breast density who underwent sequential 2D DM and digital breast tomosynthesis imaging, all with definitive histopathology (malignant, n = 78; high-risk, n = 8; benign, n = 37).

n = 123 women

Results

Digital breast tomosynthesis combo caught far more cancers than 2D mammography alone in dense breasts

2D DM + DBT sensitivit

97.4%

2D DM alone sensitivit

69.2%

More results

Mean lesion visibility increased from 2.94 ± 1.19 to 4.52 ± 0.78 ( p < 0.0001), with the largest gains for architectural distortion (100% sensitivity) and, notably, for Grade 1 tumors (delta +1.90), which reached the highest digital breast tomosynthesis visibility of any grade.

Major BI-RADS upgrades occurred in 27 cases (22.0%; upgrade PPV 88.9%).

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Conclusion · 1 of 3

In this biopsy-enriched ACR C/D cohort, adding digital breast tomosynthesis to 2D DM was diagnostically superior across all metrics.

Conclusion · 2 of 3

The disproportionate visibility gain for Grade 1 tumors is a hypothesis-generating finding relevant to the overdiagnosis debate, not proof that digital breast tomosynthesis reduces overdiagnosis.

Conclusion · 3 of 3

These findings support digital breast tomosynthesis as a valuable adjunct to 2D DM in dense breasts, pending prospective, multi-reader validation in unselected populations.

Unmasking Malignancy in Dense Breast Tissue (American College of Radiology Types C and D): A Biopsy-Proven Analysis of Digital Breast Tomosynthesis Performance, Clinical Decision Dynamics, and Correlation with Histological Grade and Molecular Subtypes.

Unmasking Malignancy in Dense Breast Tissue (American College of Radiology Types C and D): A Biopsy-Proven Analysis of Digital Breast Tomosynthesis Performance, Clinical Decision Dynamics, and Correlation with Histological Grade and Molecular Subtypes.

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