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In the last decade the number of breast cancer patients presenting with early stage disease has increased.The results from multiple randomized breast cancer trials have shown that these patients represent a special subgroup, in which many treatment options should be considered before offering definitive surgical, cosmetic, hormonal and/or chemotherapy treatments.Furthermore, the recent development of reliable molecular prognostic markers now questions the value of extensive, costly and perhaps unnecessary surgical approaches to their axillae.We present our 10-year experience in designing a multidisciplinary, practical and cost effective algorithm for the preoperative staging of the axillae in this patient population (see figures 1 and 2), including the summaries of the research data explaining the rationale and methodology involved in its design and its potential applications in scenarios where sentinel node mapping is not available.Specifically this presentation addresses the following: a) The incidence of macro-metastatic disease after the detection ofmicrometástasis in a sentinel node; b) The significance of size of sentinel node metastatic disease in terms of further non-sentinel node involvement; c) A histologic-sonographic correlation of early metastases to axillary nodes; d) the advantages and limitations of ultrasound guided fine needle aspiration biopsy of sonographically suspicious non-palpable axillary nodes; e) the accuracy of axillary staging using sonographic surveys of the axilla +/-fine needle aspiration biopsy in selected patients; f) Extent of axillary dissections based on pre-operative studies and g) alternatives for sentinel node mapping.