Estimation of the potential GDP by a new robust filter method.

The first purpose of this paper is to propose a theoretically new robust filter method to estimate non-observable macroeconomic indicators. The second purpose is to apply the proposed method to estimate the Hungarian potential GDP in 2000-2021. The novelty of the proposed filter method is that - unlike papers published so far - it does not require the stability of the dynamic model, only a partial stability condition must be satisfied. Moreover, such time-dependent uncertainties and nonlinearities can arise in the model that satisfy a general quadratic constraint. An important advantage of the proposed robust filter method over the traditional Kalman filter is that no stochastic assumptions is needed that may not be valid for the problem at hand. The proposed filter method has never been applied to estimate the potential GDP. To estimate the Hungarian potential GDP, the proposed method is applied using uni-, bi- and trivariate models. Estimations up to 2021 has not been published yet for the Hungarian economy. The examined period includes both the financial world crisis and the Covid-19 crisis. The results of the different models are consistent. It turned out that the economic policy was very procyclical after 2012, and the GDP gap was still positive during and also after the Covid-19 crisis.

Early experiences with stentgrafts in the treatment of atherothrombotic diseases of the infrarenal aorta / Kezdeti tapasztalataink az infrarenalis aorta atherothromboticus obliteratív megbetegedéseinek sztentgraftokkal történo kezelésében

Introduction: Endovascular interventions have become the first-line treatment for peripheral arterial diseases. Athero-thrombotic disorders in the infrarenal aorta are also treated with open surgery, especially if it causes critical stenosis or embolization. The use of traditional stents leads to much more complications in such lesions; however, stentgrafts can provide excellent results.Objectives: We retrospectively analyzed our patients undergoing stengraft implantation due to atherothrombotic diseases in the infrarenal aorta and our early experiences.Methods: We included patients undergoing stentgraft implantation at our department due to symptomatic infrarenal aortic atherothrombotic diseases. We established the suitability for endovascular reconstruction with CT-angiogra-phy. Control CT-angiography was performed 6 weeks after the intervention.Results: 6 patients underwent successful stentgraft implantation between 25 February 2021 and 15 September 2021 at our department due to infrarenal aorta atherothrombotic diseases. 2 patients had critical limb ischaemia and 4 had claudication. Early postoperative complications did not occur. During the follow-up, the patients reported significant walking improvement. Control CT-angiography showed good stentgraft position without stenosis in all patients. Only 1 late postoperative complication (right iliac stent occlusion) occurred. Peripheral thrombolysis was performed for 24 hours; the stent opened and there was no need to perform further interventions.Conclusions: Both our early experiences and international studies have showed that this method is suitable for the treatment of atherothrombotic diseases in the infrarenal aorta. The use of stentgrafts in the treatment of peripheral atherosclerotic diseases is hindered by the high costs of the device, so at present it is subject to individual funding in Hungary.

Changes in the care of peripheral vascular disease at the University of Szeged / A perifériás érbetegség ellátásának változásai a Szegedi Tudományegyetemen

Introduction and aims. In recent decades health care changes have accelerated enormously. Previously, by learning an effective procedure, the doctor could guarantee his patients the highest level of care for many years. Nowadays, due to the dynamics of development, the renewal cycles of the methods have been shortened, without continuous learning and training, it is already inconceivable to provide the up-to-date care required by patients. Patients and methods. Instead of vascular replacements with prosthetic grafts, which played an important role in vascular reconstructions, the primacy of endovascular techniques has become decisive. It can be significant for aortic aneurysms that can be operated with high invasiveness. The learning of catheter techniques by vascular surgeons made it possible to treat more successfully those limb-threatening cases, which are often associated with extensive vascular involvement, through the so-called hybrid operations. In addition to the increasing prevalence of diabetes worldwide, the higher proportion of critical limb ischemia and the highlighted pathogenic role of multi-resistant bacteria in the disease caused the marginaliation of the use of previously preferred prosthetic grafts. The effectiveness of the treatment of graft infections, which thus become less frequent, is improved by the use of homografts and negative pressure therapy. An effective method of preventing stroke is carotid endarterectomy, the morbidity of which is reduced by the introduction of locoregional anaesthesia allowing direct neuromonitoring. Results/conclusions. Although the acquisition and implementation of new methods has posed a continuous challenge for our specialists and doctors over the past 10 years, our achievements have made our department one of the leading vascular surgery centres in the country.

Paradigm shift in the vascular surgery of the lower extremity at the Department of Vascular Surgery, University of Szeged, Hungary / Szemléletváltozás az alsó végtagi érrekonstrukciók gyakorlatában a Szegedi Tudományegyetem Érsebészeti Osztályán.

Összefoglaló. Bevezetés: Az endovascularis intervenciókat kezdetben radiológusok alkalmazták, manapság, megfelelo képzést követoen, jó eredménnyel végeznek ilyen beavatkozásokat érsebészek is. Ezt a világszerte uralkodóvá váló szemléletet kívántuk meghonosítani a Szegedi Tudományegyetemen, melynek bevezetése nélkül elorevetítheto az érsebészet muködésének átalakulása az érrekonstrukciós beavatkozások csökkenésével. Célkituzés: Egyetemünkön radiológus- és érsebész-munkacsoport végez perifériás érintervenciókat. Célunk a két intézet alsó végtagi endovascularis tevékenységének összehasonlítása volt. Módszer: Vizsgálatunkba a Szegedi Tudományegyetemen 2012. 01. 01. és 2019. 12. 31. között alsó végtagi endovascularis beavatkozásokon átesett betegeket válogattuk be. A betegeket a rizikófaktoraik, a kezelt anatómiai régiók, a hospitalizációs ido és a szövodmények tekintetében hasonlítottuk össze. Egyéves utánkövetés során vizsgáltuk a 'redo' mutétek , az amputációk és a halálozások gyakoriságát. Eredmények: A beavatkozásokat 653 esetben radiológus, 573 esetben érsebész végezte. Az érmutoben infrainguinalis (63,2%), a radiológián suprainguinalis érintervenciók (68,6%) történtek nagyobb arányban. A percutan végzett beavatkozásokat vizsgálva a hospitalizációs idoben (2,5 ± 4,4 nap vs. 2,4 ± 2,5 nap, p = 0,78), valamint a minimálisan invazív módon végzett beavatkozások utáni szövodmények gyakoriságában (30/653 - 4,6% és 11/257 - 4,3%, p = 0,837) nem volt különbség a két betegcsoport között. 'Redo' mutétek (73/485 - 15,1% és 33/562 - 5,9%, p<0,001) és amputációk (31/485 - 6,4% és 12/562 - 2,1%, p<0,001) gyakrabban fordultak elo az érmutoben kezelt betegek körében, ebben a csoportban azonban a kritikus végtagischaemia elofordulása is gyakoribb volt (45,4% és 38,6%, p = 0,016). A mortalitásban nem volt szignifikáns különbség (5,8% és 3,9%, p = 0,16). Következtetés: A szoliter érelváltozások kezelését mindkét intézet hasonló hatásfokkal végezte. A több anatómiai régiót érinto betegség miatt érmutoben végzett beavatkozások utáni szövodmények elofordulása kissé magasabbnak bizonyult. Orv Hetil. 2021; 162(24): 943-951. INTRODUCTION: Endovascular interventions were initially performed by radiologists. Nowadays properly trained vascular surgeons also effectively perform these interventions. We wished to apply this widespread practice at our university because without this advancement the number of reconstructive surgeries was expected to decrease significantly. OBJECTIVE: Both radiologists and vascular surgeons perform endovascular interventions at our university. We compared the outcomes of lower extremity endovascular interventions between the two institutes. METHOD: We included patients who underwent lower extremity endovascular interventions between 01. 01. 2012 and 31. 12. 2019. We compared the risk factors, treated anatomical regions, hospitalization time and complication rate. During the one-year follow-up, we examined the occurrence of redo surgeries, amputations and mortality. RESULTS: 653 interventions were performed by radiologists and 573 by vascular surgeons. Vascular surgeons carried out more interventions in the infrainguinal region (63.2%), while radiologists in the suprainguinal region (68.6%). The hospitalization time after percutaneous interventions (2.5 ± 4.4 days vs. 2.4 ± 2.5 days, p = 0.78), and the rate of complications after minimally invasive interventions did not show significant difference (30/653 - 4.6% vs. 11/257 - 4.3%, p = 0.837). Redo surgeries (73/485 - 15.1% vs. 33/562 - 5.9%, p<0.001) and amputations (31/485 - 6.4% vs. 12/562 - 2.1%, p<0.001) occurred more frequently in the surgical group. However, the incidence of chronic limb ischaemia was also higher (45.4% vs. 38.6%, p = 0.016). There was no significant difference in the mortality (5.8% vs. 3.9%, p = 0.16). CONCLUSION: Both institutes had similar efficacy in performing peripheral interventions on solitary vascular lesions. Complications occurred more frequently in the surgical group, but the majority of these patients had extended atherosclerotic diseases. Orv Hetil. 2021; 162(24): 943-951.

Early experience with self-expanding flexible stent for the treatment of atherosclerotic diseases in the popliteal artery / [Kezdeti tapasztalataink öntáguló flexibilis sztenttel az arteria poplitea atheroscleroticus betegségeinek kezelésében]

Introduction: The incidence of peripheral arterial diseases and the rate of chronic limb-threatening ischaemia are increasing year by year. Minimally invasive peripheral interventions have gradually replaced traditional operations. Earlier steno-occlusion of the popliteal artery was an indication for femoropopliteal bypass below the knee. Nowadays, endovascular procedures are also used, but the indication of the stent placement into the popliteal artery is controversial. Aim: We have been using Jaguar stent for the treatment of popliteal artery steno-occlusion since January 2016. The aim of our study was to evaluate the efficacy of this treatment. Method: We included patients who underwent popliteal artery angioplasty with Jaguar stent placement between 1 January 2016 and 31 December 2017 in our department. During the one-year follow-up, we examined the popliteal stent patency, amputation-free survival and risk factors that influence stent patency. Statistical analysis: For the comparison of mean values, two-sided t-tests were used. Categorical data were analyzed by using chi-square test. Results: 33 patients underwent popliteal or femoropopliteal endovascular intervention with Jaguar stent placement into the popliteal artery. Postoperative complications that required surgical treatment occurred in 2 patients. At the end of the follow-up, the primary patency of the popliteal stents was 58.1%, the secondary patency was 74.2% and amputation-free survival was 96.8%. Conclusion: Compared with international data, the primary patency of the Jaguar stents in our study is relatively lower, but amputation-free survival is much better, and in most cases there is less operative strain compared with traditional operations. Orv Hetil. 2020; 161(15): 588­593.

Dynamic output feedback H∞ design in finite-frequency domain for constrained linear systems.

This paper deals with the design problem of H∞ control for linear systems in finite-frequency (FF) domain. Accordingly, the H∞ norm from the exogenous disturbance to the controlled output is reduced in a given frequency range with utilizing the generalized Kalman-Yakubovic-Popov (gKYP) lemma. As some of the states are hard or impossible to measure in many applications, a dynamic output feedback controller is proposed. In order to meet practical requirements that express the limitations of the physical system and the actuator, these time-domain hard constraints are taken into account in the controller design. An algorithm terminating in finitely many steps is given to determine the dynamic output feedback with suboptimal FF H∞ norm bound. The algorithm consists of solving a series of linear matrix inequalities (LMIs). Finally, two case studies are given to demonstrate the effectiveness and advantageous of the proposed method.

Dual-Stained Cervical Cytology and Histology with Claudin-1 and Ki67.

Several biomarkers are in use to improve the sensitivity and specificity of cervical cancer screening. Previously, increased expression of tight junction protein claudin-1 (CLDN1) was detected in premalignant and malignant cervical lesions and applied for cytology screening. To improve the specificity, a double immunoreaction with CLDN1/Ki67 was developed in the recent study. Parallel p16/Ki67 (CINtec® PLUS) and CLDN1/Ki67 dual-stained cytology and histology were performed and compared. p16/Ki67 immunoreaction showed positivity in 317 out of 1596 smears with negativity in 1072 and unacceptable reactions in 207 samples. CLDN1/Ki67 dual staining was positive in 200 of 1358 samples, negative in 962, whereas 196 smears could not be evaluated due to technical reasons. Considering the high-grade squamous intraepithelial lesion cytology as gold standard, sensitivity of CLDN1/Ki67 reaction was 76%, specificity was 85.67%, while for p16/Ki67 sensitivity was 74% and specificity was 81.38%. Comparison of CLDN1/Ki67 and p16/Ki67 dual stainings showed the results of the two tests not to be significantly different. Analysing histological slides from 63 cases, the results of the two tests agreed perfectly. As conclusion the sensitivity and specificity proved to be similar using p16/Ki67 and CLDN1/Ki67 double immunoreactions both on LBC samples and on histological slides.

Performance of a new HPV and biomarker assay in the management of hrHPV positive women: Subanalysis of the ongoing multicenter TRACE clinical trial (n > 6,000) to evaluate POU4F3 methylation as a potential biomarker of cervical precancer and cancer.

The ongoing Triage and Risk Assessment of Cervical Precancer by Epigenetic Biomarker (TRACE) prospective, multicenter study aimed to provide a clinical evaluation of the CONFIDENCE™ assay, which comprises a human papillomavirus (HPV) DNA and a human epigenetic biomarker test. Between 2013 and 2015 over 6,000 women aged 18 or older were recruited in Hungary. Liquid-based cytology (LBC), high-risk HPV (hrHPV) DNA detection and single target host gene methylation test of the promoter sequence of the POU4F3 gene by quantitative methylation-specific polymerase chain reaction (PCR) were performed from the same liquid-based cytology sample. The current analysis is focused on the baseline cross-sectional clinical results of 5,384 LBC samples collected from subjects aged 25 years or older. The performance of the CONFIDENCE HPV™ test was found to be comparable to the cobas® HPV test with good agreement. When applying the CONFIDENCE Marker™ test alone in hrHPV positives, it showed significantly higher sensitivity with matching specificity compared to LBC-based triage. For CIN3+ histological endpoint in the age group of 25-65 and 30-65, the methylation test of POU4F3 achieved relative sensitivities of 1.74 (95% CI: 1.25-2.33) and 1.64 (95% CI: 1.08-2.27), respectively, after verification bias adjustment. On the basis of our findings, POU4F3 methylation as a triage test of hrHPV positives appears to be a noteworthy method. We can reasonably assume that its quantitative nature offers the potential for a more objective and discriminative risk assessment tool in the prevention and diagnostics of high-grade cervical intraepithelial neoplasia (CIN) lesions and cervical cancer.

Radioguided occult lesion localisation versus wire-guided lumpectomy in the treatment of non-palpable breast lesions.

The purpose of this study was to compare the two methods-guidewire localisation and the radioguided occult lesion localisation-used in the localisation and surgical removal of non-palpable breast tumours. This retrospective study enrolled patients diagnosed with nonpalpable malignant breast tumours. In this study either guidewire localisation (GWL, n = 69) or radioguided occult lesion localisation (ROLL, n = 321) was used for the detection and removal of the tumours. The two methods were compared with regards to preoperative localisation time, operating time, removed specimen volume, the pathological tumour size, the presence of positive surgical margins and postoperative complications. Furthermore, we have also investigated other factors that could have an impact on the frequency of positive resection margins. The localisation time was significantly shorter in the ROLL group, both with ultrasound guidance (5.7 ± 1.44 min vs. 21.6 ± 2.37 min, p = 0.05) and with radiographic guidance (21.8 ± 3.1 min vs. 41.6 ± 3.75 min, p = 0.021) as well. No significant difference was observed between the two methods in terms of operating time, removed specimen volume and pathological tumour size, or the presence of positive resection margins, or the occurrence of postoperative wound infections. The size of the tumour (ROLL, GWL grps), the presence of a multifocal tumour (ROLL grp), the presence of an extensive in situ breast carcinoma around the invasive cancer (ROLL, GWL grps) and the volume of the removed breast specimen (GWL grp) significantly increased the frequency of positive resection margins. We recommend the use of the ROLL method for the removal of nonpalpable breast tumours as it has a much shorter localisation time, and it is a simpler surgical technique as well.

Multi-institutional comparison of non-sentinel lymph node predictive tools in breast cancer patients with high predicted risk of further axillary metastasis.

Although axillary lymph node dissection (ALND) has been the standard intervention in breast cancer patients with sentinel lymph node (SLN) metastasis, only a small proportion of patients benefit from this operation, because most do not harbor additional metastases in the axilla. Several predictive tools have been constructed to identify patients with low risk of non-SLN metastasis who could be candidates for the omission of ALND. In the present work, predictive nomograms were used to predict a high (>50 %) risk of non-SLN metastasis in order to identify patients who would most probably benefit from further axillary treatment. Data of 1000 breast cancer patients with SLN metastasis and completion ALND from 5 institutions were tested in 4 nomograms. A subset of 313 patients with micrometastatic SLNs were also tested in 3 different nomograms devised for the micrometastatic population (the high risk cut-off being 20 %). Patients with a high predicted risk of non-SLN metastasis had higher rates of metastasis in the non-SLNs than patients with low predicted risk. The positive predictive values of the nomograms ranged from 44 % to 64 % with relevant inter-institutional variability. The nomograms for micrometastatic SLNs performed much better in identifying patients with low risk of non-SLN involvement than in high-risk-patients; for the latter, the positive predictive values ranged from 13 % to 20 %. The nomograms show inter-institutional differences in their predictive values and behave differently in different settings. They are worse in identifying high risk patients than low-risk ones, creating a need for new predictive models to identify high-risk patients.

International multicenter tool to predict the risk of nonsentinel node metastases in breast cancer.

BACKGROUND: Axillary treatment of breast cancer patients is undergoing a paradigm shift, as completion axillary lymph node dissections (ALNDs) are being questioned in the treatment of patients with tumor-positive sentinel nodes. This study aims to develop a novel multi-institutional predictive tool to calculate patient-specific risk of residual axillary disease after tumor-positive sentinel node biopsy. METHODS: Breast cancer patients with a tumor-positive sentinel node and a completion ALND from five European centers formed the original patient series (N = 1000). Statistically significant variables predicting nonsentinel node involvement were identified in logistic regression analysis. A multivariable predictive model was developed and validated by area under the receiver operating characteristics curve (AUC), first internally in 500 additional patients and then externally in 1068 patients from other centers. All statistical tests were two-sided. RESULTS: Nine tumor- and sentinel node-specific variables were identified as statistically significant factors predicting nonsentinel node involvement in logistic regression analysis. A resulting predictive model applied to the internal validation series resulted in an AUC of 0.714 (95% confidence interval [CI] = 0.665 to 0.763). For the external validation series, the AUC was 0.719 (95% CI = 0.689 to 0.750). The model was well calibrated in the external validation series. CONCLUSIONS: We present a novel, international, multicenter, predictive tool to assess the risk of additional axillary metastases after tumor-positive sentinel node biopsy in breast cancer. The predictive model performed well in internal and external validation but needs to be further studied in each center before application to clinical use.

Thermal behavior of acousto-optic devices: effects of ultrasound absorption and transducer losses.

In the present paper we analyze the electric and acoustic losses in acousto-optic devices, especially in their ultrasonic transducers and the related thermal effects. We include electric and acoustic losses into the classical electric equivalent model of the transducer, to explain the characteristics of the measured electric and thermal behavior. Measured temperature distributions on the acousto-optic crystal faces serve visualization of the conversion efficiency of the radio-frequency input to bulk acoustic waves. We show that the pronounced acoustic frequency dependence of the temperature distribution is in correlation with the frequency dependent losses in the transducer and in the bulk. We also demonstrate experimentally the effectiveness of our active and passive heat removing and temperature stabilization methods.

Importance of sentinel lymph node biopsy in surgical therapy of in situ breast cancer.

The aim of this retrospective study was to determine the rate of sentinel lymph node (SLN) positivity in patients with a final diagnosis of ductal in situ cancer (DCIS) of the breast. Between October 2002 and January 2007, 57 patients with DCIS underwent wide excision after radio-guided lesion localization; 53 of them (53/57, 93%) had participated in simultaneous SLN mapping. SLNs were analysed by 250-micron step-sectioning with haematoxylin and eosin staining and immunohistochemical evaluation. The histologic investigation verified pure breast DCIS in 44 cases (44/57, 77.2%), DCIS with microinvasion in eight cases (8/57, 14%) and lobular in situ breast cancer in five cases (5/57, 8.8%). SLNs were identified in 49 cases (49/53, 92.5%) and removed in 48 cases (48/53, 90.6%), i.e. an average of 1.6 SLNs per patient. In four patients (4/53, 7.6%), the SLN biopsy was unsuccessful because of the failure of the radiocolloid substance to migrate. In these cases, axillary sampling was performed. In one case (1/53, 1.9%), only a parasternal SLN was detected; this was not removed. Histologic analysis of the SLNs and the axillary lymph nodes with haematoxylin and eosin or cytokeratin immunohistochemistry did not prove the presence of metastases. The international data and our present results suggest that routine SLN biopsy is not to be recommended in pure DCIS cases. If the final histology verifies an invasive or microinvasive tumour, or if mastectomy is to be performed, SLN mapping is suggested.

Molecular beacon-based real-time PCR method for detection of 15 high-risk and 5 low-risk HPV types.

Detection of HPV infections requires a robust time-effective single-step method for efficient screening. A molecular beacon-based one-step multiplex real-time PCR system was developed to detect 15 high-risk (HPV types 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68) and 5 low-risk HPV types (HPV types 6, 11, 42, 43, 44). Molecular beacons detecting high-risk types are 5'-FAM-3'-DABCYL-labelled, molecular beacons for low-risk detection are 5'-TET-3'-DABCYL-labelled, while the internal control added before sample DNA extraction is detected by a 5'-FAM-TexasRed-3'-DABCYL wavelength-shifting molecular beacon. Accordingly, fluorescent data for HPV detection are collected at 530 nm for high-risk types, 560 nm in case of low-risk types and the reaction internal control is detected at 610 nm on a Roche LightCycler 2.0 instrument. The sensitivity for detected types varies between 22 and 700 copies/reaction. The clinical performance was tested on 161 clinical sample DNAs. The MB-RT PCR results were compared to the typing results obtained by the L1F/L1R PCR and hybridization-based system described previously, and the concordance rate between the two systems was 89.44%. The favorable characteristics shown by this multiplex single-step real-time HPV detection system make this promising approach worthy for further development and application for clinical screening.

Detection and typing of 46 genital human papillomaviruses by the L1F/L1R primer system based multiplex PCR and hybridization.

There are several genital HPV DNA detection systems described, however most of them present different disadvantages regarding the number of amplified and detected types, sensitivity, type specificity. A new PCR and hybridization based detection method was developed for sensitive and balanced amplification and specific typing of HPV DNA from clinical samples. The technique amplifies and detects 46 HPV types: 2a, 3, 6, 7, 10, 11, 13, 16, 18, 26, 27, 28, 29, 30, 31, 33, 34, 35, 39, 40, 42, 43, 44/55, 45, 51, 52, 53, 54, 56, 57, 58, 59, 61, 66, 67, 68, 70, 72, 73(MM9), 74, 82(MM4), 84(MM8), 89, 90, 91. Key elements of the L1F/L1R PCR and hybridization system are: the special selection of the amplified region, a novel and optimized amplification primer set, circumspectly designed general and type-specific oligonucleotide probes. Detection following a multiplex PCR is based on solid phase hybridization in microtiter plate format using general and type-specific probes at medium stringency, which makes the detection robust in case of small sequence variations. The assay is highly reproducible and suitable for automation. The method was compared to Hybrid Capture II test, and after clarifying conflicting results, the comparison showed an excellent agreement (96.2%).

[Importance of sentinel lymph node biopsy in surgical therapy of in situ breast cancer]. / Az orszem (sentinel) nyirokcsomó jelentôsége in situ emlocarcinoma sebészi kezelésében.

INTRODUCTION AND AIMS: The aim of this retrospective study was to determine the rate of sentinel lymph node (SLN) positivity in patients with a final diagnosis of ductal carcinoma in situ (DCIS). PATIENTS AND METHODS: Between October 2002 and January 2006, 47 patients with DCIS underwent wide excision after radio-guided lesion localisation; 44 of them (93.6%) had simultaneous SLN mapping. SLNs were analysed by 250 micron step-sectioning by H&E and immunohistochemical evaluation. RESULTS: The histological investigation verified pure breast DCIS in 36 cases (76.6%), DCIS with microinvasion in 7 cases (14.9%) and lobular in situ breast cancer in 4 cases (8.5%). SLNs were identified in 40 cases (91%) and removed in 39 cases: an average of 1.5 SLNs per patient. In 4 patients (9%) SLN biopsy was unsuccessful because of the lack of migration of radiocolloid substance. In these cases, axillary sampling was performed. In 1 case (2.3%), only a parasternal SLN was detected; this was not removed. Histological analysis of SLNs and axillary lymph nodes with haematoxylin and eosin or cytokeratin immunohistochemistry did not prove metastases. DISCUSSION AND CONCLUSION: On the basis of international data and our present results, routine SLN biopsy is not recommended in pure DCIS cases. If the final histology verifies an invasive or microinvasive tumour, or if mastectomy is to be performed, SLN mapping is suggested.