Objective: To investigate the diagnostic value of color Doppler ultrasound in uterine sarcoma. Methods: A total of 40 patients with uterine sarcoma confirmed pathologically in the Department of Obstetrics and Gynecology of the Second Affiliated Hospital of Army Military Medical University from January 2016 to August 2022 were selected, and 50 patients with uterine fibroids confirmed pathologically during the same period were randomly selected as controls. The ultrasonographic characteristics and related clinical data were retrospectively analyzed. Results: ① The onset age and CA125 of patients with uterine sarcoma were higher than those with uterine fibroids, and the difference was statistically significant. Uterine sarcoma patients with postmenopausal vaginal bleeding, lower abdominal swelling discomfort and other symptoms. ② There were statistical differences in the number, size, boundary, shape, internal echo and site distribution between the two groups of uterine sarcoma and uterine fibroids (P < 0.05). Uterine sarcoma was mostly single, large in volume, unclear boundary, irregular in shape, and internal echo presented uneven hypoecho, solid chaotic echo, mixed cyst solid or honeycomb echo. There were statistically significant differences in blood flow distribution and blood flow richness between the two groups (P<0.001). There was abundant blood flow inside the multiple lesions of uterine sarcoma, while regular point strip blood flow was distributed around the multiple lesions of fibroids. ③ Among 40 patients with uterine sarcoma, preoperative ultrasonographic diagnosis was made in 23 cases of uterine tumor (probable malignancy), 1 case of uterine sarcoma, 4 cases of endometrial cancer, 1 case of cervical cancer, 9 cases of uterine fibroids (2 cases with probable degeneration), 1 case of vascular leiomyoma, and 1 case of vascular leiomyoma. Postoperative pathology confirmed uterine leiomyosarcoma in 11 cases, endometrial stromal sarcoma in 20 cases, carcinosarcoma in 8 cases, and extraosseous Ewing sarcoma in 1 case. Conclusion：Color Doppler ultrasound has high clinical application value in uterine sarcoma, fully understanding the ultrasonographic characteristics of uterine sarcoma, combined with clinical data comprehensive analysis, is conducive to improve the diagnostic accuracy.