Abstract: Objective To explore the value of multimodality ultrasound in the diagnosis of benign and malignant BI-RADS 4 lesions. Methods One hundred and eighteen patients with BI-RADS 4 breast lesions in department of ultrasound, Chinese PLA General Hospital from March 2016 to May 2017 were included in our study. All the lesions were confirmed by pathology via surgery or vacuum-assisted biopsy. ROC curve was used to analyze the value of conventional ultrasound (US), contrast-enhanced ultrasound(CEUS), shear wave elastic imaging (SWE) and multimodal ultrasound in diagnosis of BI-RADS 4 lesions. Results Among the 118 BI-RADS 4 lesions, the pathological results of 74 lesions (62.7%) were benign and 44 lesions (37.3%) were malignant. The sensitivity of conventional ultrasonic diagnosis was 88.6%, the specificity was 75.7%, PPV was 0.68 and NPV was 0.92. The sensitivity, specificity, PPV and NPV of the combined diagnosis by US and CEUS were 86.4%, 94.6%, 0.90, and 0.92 respectively, and they were 88.6%, 90.5%, 0.85 and 0.93, respectively, by combined diagnosis of US and SWE. The sensitivity, specificity, PPV and NPV of combined diagnosis of US, CEUS and SWE were 97.7%, 86.5%, 0.81 and 0.98, respectively. The sensitivity and negative predictive values of combination of three methods were higher than those of single application. Taking 4a as the biopsy threshold, the puncture rate could decrease from 100% to 40.6% after the combined diagnosis of multimodality ultrasound. Conclusion The combined application of US, CEUS and SWE can significantly improve the accuracy of the diagnosis of BI-RADS 4 lesions and reduce the biopsy rate, which is of important clinical significance.