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Background: Axillary lymphnode dissection as traditionally both staging method and also contributed to improved patient survival. Hoever morbidity is significant, ith lymphoedema in 5 to 39 percent of patients. Cytology or core biopsy of suspicious nodes, elastography and sentinel lymphnode biopsy can improve preoperative diagnosis. Our aim is to correlate clinical and radiological axillary nodal assessment ith pathological findings in omen ith carcinoma breast. Methods: Prospective data for a consecutive series of breast carcinoma patients having upfront surgery as analyzed. Routine mammography ith ultrasonography as performed as part of triple assessment, to evaluate both breast lesions and axilla. Ultrasonographic characteristics of metastatic nodes ere increased size, rounded shape, cortical thickening and loss of hilar character. Clinical and radiological evaluation before surgery as correlated ith pathological evaluation of nodal status after surgery. Results: In the study period 94 52 percent of 179 patients ho had upfront surgery had pathologically positive lymph nodes. Clinically, 44 24.5 percent patients ere correctly diagnosed ith positive and 62 34.6 percent ith negative axillary lymph nodes. There ere 50 27.9 percent false negative and 23 12.8 percent false positive clinical evaluations. Sensitivity and specificity of clinical evaluation as 46 percent and 73 percent respectively. By ultrasonography, 56 31.28 percent patients ere correctly diagnosed as positive and 70 39.1 percent as negative axillary lymph nodes. There ere 38 21.22 percent false negative and 15 8.37 percent false positive results. Sensitivity and specificity of ultrasonography ere 60 percent and 82 percent respectively. Combined clinical and radiological evaluation, ith both modalities suggesting metastases, had a Positive Predictive Value of 84 percent. Hoever the Negative Predictive Value as much loer at 57 percent, giving an Accuracy of 64 percent only. Conclusions: Even taken together, clinical and radiological assessment of axillary lymph nodes remains inaccurate, resulting in many patients having unnecessary axillary lymph node dissection. Wider application of Sentinel Node techniques in resource-poor countries is required to avoid the burden of complications.,J Clin Oncol 34, 2016 suppl; abstr e18147 ,Publication Only Health Services Research and Quality of Care