Breast nodule grade 4a is a relatively serious condition. Breast nodule grade 4 is an indication that the nodule may be malignant and can be treated conservatively or surgically depending on the doctor’s recommendation. Breast nodules belong to a type of breast hyperplasia, which is a chronic inflammation of necrotic epithelioid granuloma. The ultrasound grading of breast nodules, there are 0 to 6 grades, a total of 7 grades, the larger the value, the greater the possibility of malignancy. Grade 4 is divided into three subgrades: 4a, 4b, and 4c. 4a has a 2% to 10% likelihood of malignancy, and the patient can have the nodule punctured for histopathologic analysis to further define the nature of the nodule. If the pathologic diagnosis shows benign, it can be managed by conservative treatment such as medication. If the pathological diagnosis shows malignancy, surgical treatment, chemotherapy, radiation therapy and other ways of treatment need to be chosen according to the degree of the disease. Patients with grade IVa breast nodules are advised to go to regular hospitals for a comprehensive examination in time and actively cooperate with doctors for treatment.