BI-RADS grade 4b refers to the suspicion of a nodule or malignant mass in the breast on ultrasound or mammogram. Breast BI-RADS is a commonly used clinical imaging modality for breast nodules or masses, mostly for ultrasound or mammograms. According to the BI-RADS grading criteria, it can be categorized into 0-6 grades, with grade 4 indicating a high degree of malignancy, in which the probability of malignancy for 4A is 3-8%, 4B is 9-49%, and the probability of malignancy for 4C is 50-94%. The presence of BI-RADS grade 4b, need to actively seek further treatment, the general treatment can be surgical excision treatment, including excision of the mass or mass puncture and frozen pathology, if malignant, radical surgical excision, postoperative endocrine or targeted therapy. Breast nodule grade 4 or above should be closely followed up, tracked and treated surgically, and confidence in the treatment should be built up.