To assess the value of ultrasound examination to predict breast axillary lymph node metastasis. Methods In 336 patients with primary breast cancer, preoperative clinical and ultrasound examination of axillary lymph nodes and postoperative routine pathological examination were performed, and the accuracy of preoperative clinical and ultrasound was verified by postoperative pathological examination results. Results The sensitivity and specificity of physical examination were 76.2% and 47.6%, respectively; the sensitivity and specificity of ultrasound examination were 86.1% and 74.3%, respectively; the sensitivity and specificity of ultrasound physicians in the senior group were 95.6% and 82.7%, respectively; while those in the junior group were 84.7% and 59.o%, with significant differences. Conclusion Ultrasound is superior to physical examination in determining the status of axillary lymph node metastasis in breast cancer, and the experience of the ultrasonographer affects the diagnostic results.