Objective: To compare the ultrasound & mammography results to histopathology reports of breast cancer cases presented in King Khalid hospital, Najran, Saudi Arabia, 2016.  Methods:This retrospective cross-sectional analytic study was performed on 105 patients with breast lumps, who were referred to breast clinic King Khalid hospital Najran, during 2016. The patients' information was recorded using a checklist, which included name, code, age, ultrasonography, and mammography results and pathology reports. The results of ultrasonography and mammography were compared with histopathology. The results were analyzed on SPSS (version 16). Results: The mean age of the patients was 42.3 (±5) years. Our results showed that in histopathology reports, in (30/105) patients i.e. 28.6% were malignant, 26 patients (24.8%) biopsy revealed benign disease. Examination with mammogram revealed that, 33/105 i.e. (31.4%) were malignant and 40 cases (38.1%) had benign disease. On ultrasound examination, 21/105 (20%) were malignant and 43(40.1%) had benign disease.The mammography sensitivity was 76.6% and ultrasound sensitivity was 60%. Breast Imaging-Reporting and Data System (BIRADS) by mammogram revealed the categories as follows; category 0 in 21.9%, 2in 11.4%, 3 in 31.4, 4 in 5.7%), 4a in 6.7%, 4b in 4.8%, 4c in1.9%, 5 in 8.6% in 6 in 4.8% and unclear in 2.9% of cases.Retro areolar area was involved in 24.8%, Upper Outer Quadrant in 45.7%, Upper Inner Quadrant in 3.8%, Lower Outer Quadrant in 4.8%, Lower Inner Quadrant in 8.6%, Diffuse involvement in 9.5% and unable to pick in 2.9%. By mammogram, the calcification found revealed 15.2% of examined patients had malignant lesions. Findings of lymph nodes examination by mammogram revealed 5.7% of the examined patients had malignant lesions. Significant difference (P<0.05) regarding the age group was found in pathology and mammogram results. Conclusion: This study showed that mammography is the preferred diagnostic tool in screening early breast cancer patients aged above than 40 years with a higher sensitivity; the results are near to open biopsy. For the younger age group the use of ultrasonography in cases with high breast density is promising.