(1) The assessment is incomplete. Grade 0: Further evaluation with other imaging studies (e.g., mammography or MRI) is required. In most cases, ultrasound will provide a complete evaluation of the breast. When ultrasound is used as the initial examination, further additional examinations are required in the following cases: in one case, there is an obvious lesion in the breast on ultrasound examination and its ultrasound features are not sufficient to make an evaluation, in which case mammography or MRI is necessary; in another case, there are positive clinical signs, such as palpable lump, plasma overflow or nipple overflow, post-operative breast cancer and post-radiotherapy scars that need to be clarified for recurrence. Ultrasonography without abnormal findings must also be evaluated with the help of mammography or MRI of the breast. (2) The evaluation is complete – final grading. Grade 1: Negative. There are no positive clinical signs and no abnormalities on ultrasound images, e.g., no masses, no structural distortions, no skin thickening and no microcalcifications. To make the negative conclusion more credible, the ultrasound examination site should correspond as much as possible to the area of breast tissue of interest on the combined mammogram. Grade 2: Benign lesions. Basically, malignant lesions can be excluded. It can be followed up for 6 to 12 months depending on age and clinical presentation. For example, simple cysts, breast prostheses, lipomas, intramammary lymph nodes (which can also be classified as grade 1), postoperative changes in benign lesions with no change in images on multiple reexaminations, and nodules with documented little change in images after multiple examinations may be fibroadenomas. Grade 3: Possible benign lesions. Short-term review (3 to 6 months) and other further investigations are recommended. Based on clinical experience with mammography, a lesion with clear typical benign ultrasound features (solid oval, well-defined, non-full mass) is most likely to be a fibroadenoma, and its risk of malignancy should be less than 2%, preferably corroborated by both clinical, mammographic or MRI findings. Data from multicenter studies confirm that short-term follow-up with ultrasonography is safe, in addition to biopsy based on ultrasonographic findings, and that short-term follow-up is a current management strategy. Newly detected fibroadenomas, cystic adenopathy, verrucous hyperplastic nodules (in the indeterminate category), unsuspected multiple complex cysts or cluster cysts, pathologically definite inflammatory breast disease, and early postoperative follow-up of malignant lesions can be classified in this grade. Grade 4: Suspicious malignant lesions. Biopsy is recommended. The risk of malignancy for this grade of lesion ranges from 3% to 94%. Evaluation of grade 4 means that histopathology is recommended: fine needle aspiration cytology, hollow core needle aspiration biopsy, and surgical biopsy to provide a cytologic or histopathologic diagnosis. Ultrasonographic presentations that do not fully correspond to benign lesions or have malignant features are classified at this level. At present, they can be divided into 4A, 4B and 4C. 4A grade is more inclined to benign possibility, fibroadenoma that cannot be confirmed, intraductal lesions with nipple overflow or blood overflow, and inflammation of the breast that cannot be defined can be classified in this grade, and the malignancy rate of this grade is 3%-30%; 4B grade is inclined to malignancy, and the malignancy rate of this grade is 31%-60%; 4C grade suggests a higher possibility of malignancy, and the malignancy rate of this grade is 61%-94%. conforming to 61%~94%. Grade 5: highly likely to be malignant, appropriate diagnosis and treatment should be actively taken. Lesions with obvious malignant features on ultrasound sonograms are classified at this level, with a risk of malignancy greater than 95%, and aggressive treatment should be initiated with percutaneous biopsy (usually image-guided hollow-core needle aspiration biopsy) or surgery. Grade 6: Has been biopsy-proven malignant. This grade is used on imaging reviews where the biopsy has confirmed malignancy but treatment has not yet been performed. The main purpose is to evaluate imaging changes after prior biopsy or to monitor imaging changes before and after surgery and before and after neoadjuvant chemotherapy.