Objective To investigate the diagnostic value of the Breast Imaging Reporting and Data System (BI-RADS) classification ultrasound in distinguishing benign from malignant breast nodules. Methods A total of 68 patients with breast nodules admitted to Zhengzhou People""s Hospital from September 2021 to March 2024 were included in the study. Using puncture biopsy results as the gold standard, the detection efficacy and diagnostic value of BI-RADS classification for benign and malignant breast nodules were analyzed. Results Among the 68 patients with breast nodules, puncture biopsy detected 41 benign cases (60.29%) and 27 malignant cases (39.71%). BI-RADS classification detected 48 benign cases and 20 malignant cases. With the gold standard of puncture biopsy results, BI-RADS ultrasound findings showed high consistency with puncture biopsy, with a Kappa value of 0.647. There were significant differences in ultrasound signs between the benign and malignant nodule groups (All P＜0.05). Conclusion BI-RADS ultrasound has a certain diagnostic value for benign and malignant breast nodules in female patients. By analyzing multiple indicators of breast nodules, it can effectively assess the benign or malignant nature of nodules and improve diagnostic sensitivity and accuracy.