Background: Arm morbidity such as arm edema, pain, numbness, weakness and impaired shoulder mobility are negative side effects of axillary clearance. Less invasive ways to establish the axillary nodal status are therefore of interest. 
Patients and methods: One hundred and eighty eight patients with breast cancer (clinical stage T0-3, N0-1, M0) were 
operated upon by either modified radical mastectomy or breast conserving surgery, in whom the axilla was subjected to fivenode biopsy followed in the same session by full axillary dissection in order to evaluate the accuracy of the five-node biopsy compared with full axillary dissection. 
Results: The sensitivity of the five-node biopsy was 96.2% with a negative predictive value of 97.3% and negative likelihood ratio of 0.04. 
Conclusion: Five-node biopsy of the axilla has good accuracy for staging the axilla. It could be considered as an alternative to sentinel node biopsy in centers not having the facilities for this procedure.