Purpose: To compare tumor size by mammography and sonography and align with pathological results inprimary breast cancer cases. Materials and Methods: We retrospectively reviewed 95 primary breast cancerpatients who underwent mammography and sonography from January 2011 to June 2012. The largest tumordiameter was chosen as sizing reference for each imaging modality. The measurements of mammography andsonography were considered concordant if they were within the measurement of pathological results±0.5cm.Pearson’s correlation coefficient was calculated for imaging results. Results: The range of the maximum diameterwas 0.6cm-10.5cm and mean value was 3.81±2.04 cm by pathological results, 0.7cm-12.4 cm and 3.99±2.19 cmby mammography, and 0.9cm-11.0cm and 3.63±2.01 cm by sonography, respectively. Sonography (R: 0.754),underestimated tumor size, but had a better correlation with pathological tumor size compared to mammography(R: 0.676), which overestimated tumor size. Conclusions: Sonography is superior to mammography in assessmentof primary breast cancer.