Background: For staging of the axilla, axillary ultrasound (AUS) has been researched as a non-invasive substitute for sentinel lymph node biopsy (SLNB). Objective: The aim of the present study was to compare between accuracy of AUS and SLNB in assessment of the axillary nodal status in early breast cancer. Patients and methods: A cross sectional study was conducted and included 60 female' patients with early breast cancer and carried out in General Surgery Department, Zagazig University Hospitals. All cases were arranged for accurate axillary ultrasound examination. Patients were postoperatively followed up for 6 months. Results: The most common quadrant to be affected is the upper outer quadrant (UOQ) seen in 32 patients of the studied group (53.3%). A total of 28 (46.7%) patients presented with T1 tumors and 32 patients presented with T2 tumors; with an overall incidence 53.3%. Only 4 patients underwent modified radical mastectomy with an overall incidence of 6.7%, and 44 patients underwent conservative breast surgery with overall incidence 73.3%. The number of excised lymph nodes (LNs) in study group ranged from 2 to 4. The level of excised LNs in study group ranged from level I and/or level II. Concerning the Validity of AUS finding; 73.3% of the studied women were negative SLN with Negative AUS LNs. Conclusion: The surgical procedure as sentinel LNs biopsy SLNB (by methylene blue MB) still has the upper hand as a diagnostic tool for axillary nodal status with more accuracy and sensitivity than radiological methods as axillary ultrasound AUS.