Objective To explore the application of digital breast tomosynthesis (DBT) combined with MR wave in the diagnosis of high-risk breast lesions. Methods A total of 100 patients with breast high-risk lesions diagnosed as BI-RADS 4 or above by mammography in our hospital from June 2020 to June 2021 were selected as the research objects. The selected patients were examined by MR spectrum and DBT. The signs of MR spectrum and the photographic characteristics of DBT breast lesions were analyzed. Based on the pathological results, the diagnostic efficacy of MR spectrum, DBT and their combination in the diagnosis of breast high-risk lesions was evaluated. Results The sensitivity, specificity, positive predictive value and negative predictive value of DBT were higher than those of MR spectrum; the missed diagnosis rate and misdiagnosis rate of DBT were lower than those of MR spectrum (P<0.05). There was no significant difference in the coincidence rate of MR spectrum and DBT in the pathological diagnosis of malignant lesions ≥ 2 cm (P>0.05). The coincidence rate of MR spectrum and DBT in the diagnosis of benign and malignant breast lesions<2 cm was higher than that of MR spectrum (P<0.05). Conclusions Selecting DBT in the diagnosis of breast high-risk lesions can make accurate analysis and judgment in the diagnosis of breast high-risk lesions. It has higher application value in the diagnosis of breast high-risk lesions and is worthy of clinical adoption.