Background: Preoperative evaluation of the axilla using fine-needle aspiration biopsy (FNAB) and/or intraoperative evaluation of the sentinel lymph nodes (SLNs) may significantly decrease the number of operative procedures required for staging or local control of the axilla in breast cancer patients. The purpose of this study was to examine and determine the number of operative procedures that could be excluded using both approaches. Methods: A retrospective review of data was performed on 168 patients presenting with invasive clinical stage 1 to 3 breast cancer from March 2004 to March 2007. Results: Of the 168 patients, 57 (34%) underwent ultrasound-guided FNAB for suspicious-appearing nodes. Of these 57 patients, 40 (70%) had a positive FNAB, and 16 (28%) had a negative FNAB. The FNAB was suspicious in 1 (2%) patient. One hundred twenty patients (71%) with a normal axillary ultrasound or with a negative or suspicious FNAB underwent SLN mapping, of which 29 (24%) had an intraoperative diagnosis of metastatic tumor. Conclusions: Preoperative evaluation of the axilla using ultrasound-guided fine-needle aspiration biopsy spared 24% of patients the cost and morbidity of undergoing SLN biopsy. SLN mapping, along with intraoperative evaluation of nodes, spared an additional 17% of patients from having to undergo a second operative procedure. © 2007 Excerpta Medica Inc. All rights reserved.