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Chiofalo B, Mazzon I, Di Angelo Antonio S, Amadore D, Vizza E, Laganà AS, Vocaturo G, Calagna G, Favilli A, Palmara V, Maranto M, Vitale SG, Cucinella G, Granese R, Ghezzi F, Sperduti I, Triolo O. Hysteroscopic Evaluation of Endometrial Changes in Breast Cancer Women with or without Hormone Therapies: Results from a Large Multicenter Cohort Study. J Minim Invasive Gynecol 2019; 27:832-839. [PMID: 31425735 DOI: 10.1016/j.jmig.2019.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/30/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE The primary aim of our study was to investigate the incidence of endometrial pathologies, especially endometrial cancer, in women with breast cancer treated with tamoxifen (TAM), aromatase inhibitors (AIs), or receiving no treatment (NT). The secondary aim was to identify, in this cohort, ultrasonographic findings that represent robust indications for hysteroscopy and endometrial biopsy, to avoid unnecessary second-level diagnostic procedures. DESIGN Multicenter retrospective cohort study (Clinical Trial ID: NCT03898947). SETTING Data were collected from different Italian centers: Regina Elena National Cancer Institute of Rome, Arbor Vitae Centre of Rome, Gaetano Martino University Hospital of Messina, and Villa Sofia-Cervello Hospital of Palermo. PATIENTS We selected and consecutively included patients with a history of breast cancer who had undergone hysteroscopy for ultrasonographic or clinical indications between January 2007 and December 2016. INTERVENTIONS Diagnostic hysteroscopy with endometrial biopsy or operative hysteroscopy, when clinically indicated. MEASUREMENTS AND MAIN RESULTS A higher percentage of patients in the TAM and AI groups had a normal endometrium compared with those in the NT group, whereas the incidence of endometrial polyps was higher in the NT group than in the others; no significant differences were observed among the 3 groups for other benign conditions or for premalignant and malignant uterine diseases, such as endometrial atypical hyperplasia and adenocarcinoma. CONCLUSION TAM treatment does not seem to be associated with a higher rate of endometrial cancer in women with breast cancer compared with women treated with AIs or NT.
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Affiliation(s)
- Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Ivano Mazzon
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Silvia Di Angelo Antonio
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Donatella Amadore
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Antonio Simone Laganà
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti).
| | - Giuseppe Vocaturo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Gloria Calagna
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Alessandro Favilli
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Vittorio Palmara
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Marianna Maranto
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Salvatore Giovanni Vitale
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Gaspare Cucinella
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Roberta Granese
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Fabio Ghezzi
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Isabella Sperduti
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
| | - Onofrio Triolo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Drs. Chiofalo, Vizza, and Vocaturo); Arbor Vitae Centre, Nuova Villa Claudia Clinic, Rome, Italy (Drs. Mazzon and Di Angelo Antonio); Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi," University of Messina, Messina, Italy (Drs. Amadore, Palmara, Granese, and Triolo); Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy (Drs. Laganà and Ghezzi); Gynecology and Obstetrics Unit, Villa Sofia-Cervello Hospital, University of Palermo, Palermo, Italy (Drs. Calagna, Maranto, and Cucinella); Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy (Dr. Favilli); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr.Vitale); Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy (Dr. Sperduti)
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