Can A Preoperative Ultra Sound Avoid Axillary lymph node Dissection in Early Breast Cancer.

background: Axillary lymph node (ALN) status is a critical prognostic factor in early breast cancer. Sentinel lymph node biopsy (SLNB) is the current standard for axillary staging but is invasive and related to morbidity, in this study we aim to assess the diagnostic accuracy of preoperative axillary US in identifying ALN metastasis in early breast cancer patient.Methods: This prospective single-center cohort study was conducted on 50 cases had early breast cancer undergoing surgical management at Menoufia University Hospital (January 2024 to September 2025). Inclusion criteria were age ≥18 years, early-stage breast cancer (Tis, T1, T2a), and surgical eligibility. Patients with prior axillary surgery, biopsy, radiation, locally advanced cancer patient or metastatic Breast Cancer were excluded. Preoperative clinical, laboratory, imaging, and histopathological evaluations were performed. Ultrasound US findings have been compared with postoperative histopathology as the gold standard.Results: US detected ALN involvement in 32% of patients, while histopathology confirmed 38%. Agreement between US and histopathology was excellent (κ=0.87, p3 mm had the lowest predictive value (PPV 60%).Conclusion: Preoperative axillary US is a reliable, accurate, and highly specific tool for nodal staging in early breast cancer. Incorporating morphologic features can reduce unnecessary SLNB and guide surgical decision-making.