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Background: Response to neoadjuvant chemotherapy (NACT) for breast cancer in patients with LABC is considered to be an important prognostic factor; but there are limited studies to evaluate preoperative response assessment in patients with locally advanced breast cancer (LABC) after NACT. We estimated the accuracy of ultrasound (US) to predict pathologic response after NACT using common response criteria and pCR definitions Methods: A total of 185 patients presenting with locally advanced breast cancer were subjected to pre-operative ultrasound of axilla after completion of NACT. Histo-pathologic assessment of Axillary Lymph Node dissection specimen was considered as gold standard and used to assess the sensitivity, specificity and accuracy of axillary ultrasound. Results On axillary ultrasound examination of 185 post NACT patients, 131 were found to have demonstrable LN in the axilla, of these, only 108 harboured metastasis. USG could successfully detect 108/121 histologically positive lymph nodes. USG showed 89.25% sensitivity and 63.49% specificity for overall nodal status. For N1 disease, USG could correctly classify 73/86 as N1. Its sensitivity was 84.88a%, which much higher than that of clinical examination only. The specificity for USG was 63.49%. The sensitivity and specificity of USG for N2 disease was 71.42% and 100% respectively, similar to that for clinical examination alone offering no added advantage in N2 disease. Conclusions: Pre-operative axillary ultrasound examination is a good tool for assessment of response and tailoring of further therapy after NACT. This accuracy increases for higher N stages. Combining this with guided FNAC may further improve the accuracy in assessing response. [ABSTRACT FROM AUTHOR]