OBJECTIVES: As part of the information needed for recommendations making, we aimed to compare the cost of systematic axillary lymph node dissection and sentinel lymph node biopsy –with axillary dissection only if the sentinel node contains metastases-, with or without intra-operative histological examination.  METHODS: Unit costs collected in a French national study were included in a model simulating the cost of 3 strategies: 1) axillary lymph node dissection; 2) sentinel lymph node biopsy followed by distant axillary lymph node dissection in case of positive sentinel lymph node; and and 3) sentinel lymph node biopsy with intra-operative histological examination and axillary lymph node dissection for positive cases. A multivariate probabilistic sensitivity analysis was conducted on identification rate, complication rates, sensitivity, specificity and length of hospital stay. RESULTS: The sentinel mph node biopsy is less costly than lyaxillary lymph node dissection in the early stages of breast cancer. Intra-operative histological examination of sentinel lymph node significantly reduces the cost of the procedure. Data on molecular intra-operative examination couldn’t be integrated in the present study as no French cost data were available. In a systematic review, no survival difference could be demonstrated between the three strategies in early stage of breast cancer and quality of life was found to be better with sentinel lymph node biopsy than with axillary lymph node dissection. Nevertheless, more data are needed to integrate these results in a cost-effectiveness analysis. CONCLUSIONS: The study confirms the interest of sentinel lymph node biopsy in early stage of breast cancer. The cost comparison helps to determine the choice of the intervention alongside other arguments as women’s preference, efficacy and safety.