Objective To investigate the predictive value of clinicopathological and ultrasonic features for axillary lymph node metastasis in patients with invasive breast cancer and construct a nomogram to provide reference for individual diagnosis and treatment. Method The clinicopathologic and ultrasonic features of female patients with pathologically confirmed invasive breast cancer from June 2022 to October 2023 in Zhejiang Cancer Hospital were retrospectively analyzed, and randomly divided into the training set and the validation set at a ratio of 7:3. Univariate and multivariate logistic regression analysis was performed on the training set data to build a prediction model for axillary lymph node metastasis of invasive breast cancer and draw a nomogram. In the verification set, the differentiation and calibration degree of the model are evaluated. Result A total of 258 patients were included in the training set, of whom 116 (45%) had axillary lymph node metastasis. A total of 111 patients were included in the validation set, of whom 61 (55%) had axillary lymph node metastasis. Based on training set data analysis, high echo halo (OR, 15.783; P< 0.00 1), maximum diameter of primary focus (OR, 1.039; P= 0.011), tumor histological grade (OR, 12.469; P=0.012), the lesion was located in the inner lower breast quadrant (OR, 0.046; P<0.001) was an independent predictor of axillary lymph node metastasis. In the verification set, the area under the ROC curve of the model was: 0.823, the differentiation was good, the calibration curve was highly consistent with the ideal curve, and the calibration was good. Conclusion The nomogram based on ultrasonic characteristics (halo, maximum diameter and location of primary lesion) and pathological characteristics (tumor histological grade) can effectively predict the risk of axillary lymph node metastasis, and provide reference for accurate diagnosis and treatment.