Objective To explore the relationship among ultrasound breast imaging reporting and data system (BI-RADS) grading, sonographic manifestations and different pathological classification of breast cancer patients, in order to provide reference for clinical diagnosis and the treatment plan. Methods The clinical data of 100 patients with breast masses (100 masses) found during physical examination in Huhhot First Hospital from January 2019 to December 2021 were retrospectively analyzed, all patients were examined by doppler ultrasonography and BI-RADS grading was performed, the clinical data of the selected patients were complete and the breast masses nature were confirmed by puncture biopsy or postoperative pathological examination. The pathological examination results of breast masses were counted; the results of ultrasonic diagnosis and pathological diagnosis of breast mass were compared; the sonographic manifestations of benign and malignant breast masses were compared. Results The pathological examination results of 100 patients with breast masses showed that, 33 cases were benign lesions and 67 cases were malignant lesions; the BI-RADS grading results of 100 patients with breast masses showed that, 30, 27, 10, 9, and 24 cases were classified as grade 3, grade 4 a, grade 4 b, grade 4 c, and grade 5, respectively; the results of BI-RADS grading of 100 patients with breast masses showed that, the coincidence rate of ultrasonic diagnosis and pathological diagnosis for benign breast lesions was 90.91%, and the coincidence rate of ultrasonic diagnosis and pathological diagnosis for malignant breast lesions was 95.71%; the proportions of unclear boundary, diameter ≥2 cm, calcification, with Ⅱ or Ⅲ blood flow grade, aspect ratio ≥1 and backward echo attenuation in malignant masses were higher than those in benign masses (all P<0.05). Conclusion Clinical application of ultrasound BI-RADS classification combined with sonographic manifestations can improve the qualitative diagnosis of breast masses, analyze the nature of the malignant breast masses moreaccurately, which can provide certain reference for subsequent treatment scheme, reduce the subjective judgment of ultrasound doctors, increase objective basis of judgment, help to improve the diagnostic accuracy of breast cancer.