Background: Breast mass is a common surgical problem. Such masses pose a potential threat to women especially in the era of increased cases of breast cancer worldwide. Early detection is required to decrease breast cancer related deaths. The role of ultrasound imaging is differentiating malignant and benign breast masses with intention of guiding patient management. The effective diagnosis and management of breast mass involves multidisciplinary approach to their assessment. Ultrasonography is an excellent modality, especially in patients with dense breasts. The precision of the final diagnosis can be greatly increased by ultrasound imaging and pathological diagnosis which is gold standard in confirming the diagnosis. Accurate radiologic and histopathology diagnosis is crucial in deciding the type of management a patient should undergo and to ensure a good prognosis. Objective: To assess consistency of sonographic patterns and pathologic results in the diagnosis of breast mass and the associated factors among adult female patients in Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia, 2022 G.C Methods and materials: Institutional based prospective cross sectional study was conducted on 250 patients with clinical breast mass and who had ultrasound evaluation from MAR /2022 to AUG/2022, at Tibebe Ghion specialized Hospital, Bahir Dar, Ethiopia. Systematic random sampling technique was used to select to select the study participants. Structured questionnaires and check lists were used to record the sociodemographic information, the clinical information, ultrasound findings and pathologic findings. Data were entered using EpiData software and analyzed using SPSS version 26. The association between the dependent and independent variables was assessed using bivariate and multivariate logistic regression analysis. In bivariate logistic regression variables with p-value less than 0.25 were selected for multivariable analysis and in multivariate logistic regression analysis variables with P-Value less than 0.05 were considered as statistically significant. Results: Out of 250 patients, 232(92.4%) patients had consistent breast ultrasound and FNAC result; and only 18(7.6%) had inconsistent result. The sensitivity, specificity and accuracy of ultrasound in diagnosing breast cancer were 90.1%, 94.7% and 93.2% respectively. We found a PPV of 89% and a NPV of 95.2%. Strong level of agreement was found between USG and FNAC diagnosis with kappa value0.845 (95%CI). On the multivariate logistic regression analysis, patients with young age (<35 years) [AOR=4.298, (95%CI: 1.711-10.796)] and ultrasounds done by radiologists [AOR =2.674, (95%CI: 1.041 -6.867)] were significantly associated with consistency of breast ultrasound and FNAC results. Conclusion and recommendation: Ultrasound has high sensitivity and high consistent value with FNAC results in diagnosing breast mass; so it can be considered as the first line investigation for the evaluation of breast lump especially in young women with dense breast. Key Words: Breast mass, ultrasound, FNAC, sensitivity, specificity