Background: Benign lesions in the past were thought to be hyperechogenic lesions on ultrasonography. Recently, this conception has been changed where various malignant breast lesions were hyperechogenic on ultrasound and hyperechogenic lesions turned out to be malignant on histopathologic examination.Aim: The present retrospective clinical study was conducted to assess the clinical presentation, frequency, and related imaging finding of hyperechoic malignant breast lesions in cases with core needle biopsies guided ultrasonographically, and also, to assess ultrasonographic features that help in the prediction of the hyperechoic lesion to be malignant.Methods: In a total of 2255 subjects, an ultrasonographically guided core needle biopsy was done for 2168 subjects. The hyperechoic carcinomas were identified among all the assessed cases diagnosed by ultrasonography-guided core needle biopsy was calculated. For malignant lesions, imaging malignancy predictors were identified using 6 ultrasonography images comparison in malignant and high-risk cases. The sonographic findings assessed were orientation, vascularity, shape, posterior acoustic features, margins, and echogenicity. The results were formulated after the statistical evaluation.Results: A total of 2255 ultrasonographically guided core needle biopsy was done for 2168 subjects where 52.01% (n=1173) lesions were benign, 40.97% (n=924) were malignant, and 7% (n=158) were high risk. The study results have shown that in total 2255 lesions assessed, 0.57% (n=13) lesions were hyperechoic in 13 females after analyzing the image. In 924 malignant lesions 0.97% (n=9) lesions were hyperechoic. Circumscribed margins were seen in 62.5% (n=5) and non-circumscribed by 37,5% (n=3) study subjects with benign lesions, and by 100% (n=5) subjects with malignant lesions (p=0.007). For the shape of the lesions, more malignant lesions had irregular and lobular margins 100 (n=5) lesions, whereas, in benign lesions, 87.5 (n=7) had irregular/lobular margins (p=0.002). Conclusion: The present study concludes that hyperechoic breast lesions on ultrasonography have less prevalence of 0.57% (n=13) lesions in the present study. Hence, hyperechoic breast lesions are less encountered on sonography. However, whenever these hyperechoic lesions are seen, the probability of malignancy should not be excluded.