Background: The preoperative ultrasound (USG) guided fine needle aspiration cytology (FNAC) of axillary metastasis may avoid unnecessary axillary dissections and time consuming and costly sentinel lymph node biopsy. This study was aimed to evaluate the accuracy of USG guided FNAC in preoperative assessment of clinically node negative breast cancer patients.Methods: An observational study was done in patients who fall within the inclusion criteria. USG guided FNAC of suspicious nodes was done. All the selected patients were taken up for modified radical mastectomy. The resected specimens were sent for detailed histopathological (HPR) evaluation, which was taken as the gold standard for the comparison with the pre-operative FNAC report.Results: Among a total of 33 patients with early breast cancer subjected to USG guided FNAC and compared with the HPR results. The sensitivity, specificity, positive predictive value and negative predictive value of FNAC were 44.44%, 100%, 100% and 28.57% respectively.Conclusions: The sensitivity of USG guided FNAC of suspicious axillary lymph nodes was low, whereas the specificity and positive predictive values were high. Moreover, the negative predictive value is very less. Hence, the results suggested that USG guided FNAC has not proved to be sufficiently accurate for routine preoperative assessment in patients with early breast cancer.