Background: Accurate preoperative characterization of breast lesions relies on imaging; however, the diagnostic yield of individual modalities varies. This study evaluated ultrasonography (USG), mammography (MMG), and their combination against histopathology. Methods: In a cross-sectional study of women with imaging-suspicious breast lesions (n=53), both USG and MMG were reported using BI-RADS, and all indicated cases underwent tru-cut/core biopsy (reference standard). Diagnostic performance (sensitivity, accuracy) was calculated for USG, MMG, and combined USG+MMG. Results: Age distribution was 18–20 (3.8%), 21–30 (30.2%), 31–40 (26.4%), 41–50 (24.5%), 51–60 (9.4%), and 61–70 years (5.7%). BI-RADS categories were: 3 (58.5%), 4 (7.5%), 5 (30.2%), and 6 (3.8%). Final histopathology (HPE) showed invasive ductal carcinoma (IDC) 33.9% (18/53), fibroadenoma 30.2% (16/53), fibrocystic disease 15.1% (8/53), phyllodes 11.3% (6/53), intraductal papilloma 7.5% (4/53), and acute inflammatory lesion 1.9% (1/53). USG demonstrated sensitivity 88.9% and accuracy 90.57%; MMG showed sensitivity 83.3% and accuracy 84.91%. The combined USG+MMG approach yielded the highest performance with sensitivity 94.4% and accuracy 95.62%. Conclusion: In this cohort, combined USG and mammography outperformed either modality alone for detecting biopsy-proven breast pathology, achieving the highest sensitivity and accuracy. These findings support a complementary, dual-modality approach for symptomatic or high-risk patients in routine practice.