Objectives: To evaluate breast lesions with doppler ultrasound and calculated the diagnostic accuracy of resistive index as a predictor of malignancy, taking histopathology as gold standard. Study Design: Cross-sectional study. Setting: Radiology Department, CMH Multan. Period: December 2015 to May 2016. Material & Methods: 150 female patients, having age between 20 – 60 years, with palpable breast lumps were admitted in the study. Doppler ultrasound of the lesion was performed with emphasis on the vascularity and resistive index was formulated. Categorization as malignant or otherwise was declared as established by doppler ultrasound. Patients then underwent biopsy followed by histopathology. Correlation of doppler ultrasound and histopathological findings was done with calculation of diagnostic accuracy of doppler ultrasound, keeping histopathology as gold standard. Results: The mean of age was 40.23 ± 5.75 years. In 81 breast doppler ultrasound positive patients, 73 (True Positive) showed malignant lesions in breast while 08 (False Positive) did not have malignancy on biopsy. Among 69 Breast Doppler Ultrasound negative patients, 06 (False Negative) demonstrated malignancy on biopsy whereas 63 (True Negative) did not have any malignant lesion. Overall specificity was 88.77%, sensitivity 92.40%, negative predictive value 91.30%, positive predictive value 90.12% and diagnostic accuracy of Doppler Ultrasound came out 90.67%. Conclusion: Angiogenesis in malignant lesions lead to formation of structurally abnormal and tortuous vessels with increased resistive index. Doppler ultrasound is a safe and effective modality which shows acceptable diagnostic accuracy for noninvasive characterization of malignant breast lesions. Therefore, it can be employed as an alternative to histopathology in patients who present with breast lesions.