Background: On ultrasonography, benign tumors were believed to be hyperechogenic. This notion has recently been altered, since some malignant breast tumors were found to be hyperechogenic on ultrasonography, and upon histopathologic analysis, the hyperechogenic lesions were shown to be malignant. Aim: to evaluate hyperechoic malignant breast lesions for their clinical presentation, frequency, and associated imaging findings in cases involving core needle biopsies guided by ultrasonography. Methods: A core needle biopsy guided by ultrasonography was performed on 2168 out of 2255 participants. Out of all the evaluated instances, hyperechoic carcinomas were found using a core needle biopsy guided by ultrasonography.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:2168 individuals underwent 2255 ultrasonographically guided core needle biopsies; 52.01% (n=1173) of the lesions were benign, 40.97% (n=924) were malignant, and 7% (n=158) were high risk. Based on image analysis, the study's findings indicate that, out of the 2255 lesions evaluated, 13 females had 0.57% (n=13) hyperechoic lesions. 0.97% (n=9) of the 924 malignant lesions had hyperechoic lesions. Among study participants with benign lesions, circumscribed 62.5% (n=5), and non-circumscribed 37.5% (n=3) and 100% (n=5) of those with malignant lesions (p=0.007) were observed. Lesions with irregular and lobular margins were more common in malignant lesions (100; n = 5), while 87.5 (n = 7) of benign lesions had irregular and lobular margins (p=0.002). Conclusion: hyperechoic breast lesions on ultrasonography have less prevalence of 0.57% (n=13) which indicate that hyperechoic breast lesions are less encountered on sonography.However, whenever these hyperechoic lesions are seen, the probability of malignancy should not be excluded.