Background: The aim of this study was to analyze the clinical value of the combined application of color Doppler ultrasound (CDUS), ultrasound elastography (UE) and real-time three-dimensional ultrasound (3D-US) in the early diagnosis of breast cancer. Methods: A retrospective analysis was conducted on 202 female patients with solitary breast nodules who were admitted to the Affiliated Wuxi People’s Hospital of Nanjing Medical University between March 2022 and October 2024. All patients underwent examinations using CDUS, UE, and 3D-US. Results: Pathological findings identified 98 malignant and 104 benign lesions among the 202 solitary breast nodules. Ultrasonographic findings revealed that the malignant group exhibited a significantly higher prevalence of irregular tumor shape, ill-defined margins, posterior acoustic attenuation, a taller-than-wide orientation (aspect ratio ≥1), penetrating arterial blood supply, a resistance index (RI) >0.7, a UE score ≥4 compared to the benign group (p < 0.05). Diagnostic performance of the individual modalities was as follows: 3D-US diagnosed 97 malignant and 105 benign nodules, demonstrating 78.57% sensitivity, 80.77% specificity, 79.38% positive predictive value (PPV), 80.00% negative predictive value (NPV), 79.70% accuracy, and moderate agreement with pathology (Kappa = 0.594, p < 0.001). CDUS identified 101 malignant and 101 benign nodules, with 83.67%sensitivity, 81.73% specificity, 81.19% PPV, 84.16% NPV, 82.67% accuracy, and good agreement (Kappa = 0.654, p < 0.001). UE detected 98 malignant and 104 benign nodules, achieving 81.63% sensitivity, 82.69% specificity, 81.63% PPV, 82.69% NPV, 82.18% accuracy, and good agreement (Kappa = 0.643, p < 0.001). The combined diagnostic approach yielded superior performance, with sensitivity 90.82%, specificity 80.77%, PPV 81.65%, NPV 90.32%, accuracy 85.64%, and strong agreement with pathology (Kappa = 0.716, p < 0.001). Conclusions: CDUS, UE, and 3D-US each demonstrate diagnostic value in the early detection breast cancer, while their combined application significantly enhances overall diagnostic efficacy.