With a breast imaging grade of 4b, the tumor is malignant in nature and may be cured by surgery and adjuvant radiotherapy or chemotherapy. Grade 4b is the level of breast imaging that has a higher probability of malignancy and requires clinical intervention by a physician. If it is determined to be malignant after biopsy, it can be treated by surgical excision. If the results of the biopsy show a higher degree of malignancy, surgery can be combined with radiation or chemotherapy with the possibility of a cure. In addition to surgery and adjuvant radiotherapy and chemotherapy, if the patient’s tumor is poorly staged, the lesion can be reduced in size by means of neoadjuvant chemotherapy, with a view to obtaining an indication for surgery or achieving a better surgical outcome. Treatment options such as endocrine therapy and targeted therapy can also be chosen depending on the molecular type of the patient’s tumor. If the imaging grade is determined to be 4b by ultrasound, CT or MRI, and the diagnosis of malignancy is confirmed after pathological biopsy, timely treatment is required, and appropriate treatment is selected under the guidance of the doctor according to the typing of the tumor.