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AIM: The aim of this study is to compare the diagnostic accuracy in detecting axillary node metastases between preoperative ultrasound with percutaneous core biopsy or fine needle aspiration cytology, in patients with breast cancer. MATERIAL AND METHODS: All cases with newly diagnosed ipsilateral primary breast cancer that underwent axillary ultrasound guided biopsies in a 2 year period were reviewed and the biopsy outcome was compared to the final histopathology from sentinel lymph node biopsy or axillary node dissection. Comparison was also attempted in a subgroup including only patients who underwent one method and in a second subgroup of patients who had both techniques performed. RESULTS: Within the total population results are in favor of core biopsy which correlates statistically significantly with the final histology after excluding neoadjuvant related false negatives. Within the single modality subgroup results are again in favor of core biopsy which again correlates statistically significantly with the final histology. Within the combined modality subgroup results demonstrate equal diagnostics but neither method demonstrates statistically significant diagnostic success. DISCUSSION: The results of the study are generally in favour of core biopsy which tends currently to override fine needle aspiration cytology. Only few studies have directly compared the two methods and a great variability exists in the results of the different studies. CONCLUSIONS: A case-match cohort study is advised to accurately compare the diagnostic value of the two methods. Until then the decision will be based on the radiologist’s experience.