Objective To explore the differences in ultrasound breast imaging reporting and data system (BI-RADS) grading, virtual touch tissue imaging quantification (VTIQ) technical parameter and carbohydrate antigen 153 (CA153) in patients with breast cancer of different pathological characteristics. Methods The clinical data of 106 patients with breast cancer diagnosed by postoperative pathology in the hospital were retrospectively analyzed. Before surgery, all the patients received conventional ultrasonography for BI-RADS grading and underwent VTIQ technology to detect the maximum shear wave velocity (SWV_max) of lesions. CA153 was detected by immunosorbent assay, and the relationship between the above detection results and clinicopathological characteristics was analyzed. Results There were no statistical differences in the ultrasound BI-RADS grading distribution and CA153 level among different pathological types, histological grades, tumor sizes and pathological molecular types of breast cancer (P>0.05). The SWV_max of patients with invasive lobular carcinoma was higher than that of patients with ductal carcinoma in situ, invasive ductal carcinoma and other disease, and the SWV_max of patients with invasive ductal carcinoma and other disease was higher than that of patients with ductal carcinoma in situ (P<0.05). The SWV_max was higher in patients with histological grade 3 than grade 2 or 1, and was higher in patients with grade 2 than grade 1 (P<0.05). According to pathological molecular typing, Luminal B (HER2+) had the highest SWV_max, which was higher than that of Luminal A, Luminal B (HER2-), Luminal B (HER2+) and triple-negative type. The SWV_max wasthe lowest in Luminal A, which was lower than other molecular types (P<0.05). The distribution of BI-RADS grades 3-4a in breast cancer patients without lymph node metastasis was more than that in patients with metastasis, and the SWV_max and CA153 were higher than those in patients with metastasis (P<0.05). Conclusion Ultrasound BI-RADS grading and CA153 level are related to the status of lymph node metastasis in patients with breast cancer, and VTIQ technical parameter SWV_max is associated with pathological type, histological grade, tumor size, pathological molecular type and lymph node metastasis, which can provide effective reference information for the clinical diagnosis and disease evaluation of breast cancer.