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Han CY, Lu KH, Corrigan G, Perez A, Kohring SD, Celestino J, Bedi D, Bedia E, Bevers T, Boruta D, Carlson M, Holman L, Leeds L, Mathews C, McCann G, Moore RG, Schlumbrecht M, Slomovitz B, Tobias D, Williams-Brown Y, Bevers MW, Liu J, Gornet TG, Handy BC, Lu Z, Bedia JS, Skates SJ, Bast RC. Normal Risk Ovarian Screening Study: 21-Year Update. J Clin Oncol 2024; 42:JCO2300141. [PMID: 38194613 DOI: 10.1200/jco.23.00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 09/08/2023] [Accepted: 11/03/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE The Normal Risk Ovarian Screening Study (NROSS) tested a two-stage screening strategy in postmenopausal women at conventional hereditary risk where significantly rising cancer antigen (CA)-125 prompted transvaginal sonography (TVS) and abnormal TVS prompted surgery to detect ovarian cancer. METHODS A total of 7,856 healthy postmenopausal women were screened annually for a total of 50,596 woman-years in a single-arm study (ClinicalTrials.gov identifier: NCT00539162). Serum CA125 was analyzed with the Risk of Ovarian Cancer Algorithm (ROCA) each year. If risk was unchanged and <1:2,000, women returned in a year. If risk increased above 1:500, TVS was undertaken immediately, and if risk was intermediate, CA125 was repeated in 3 months with a further increase in risk above 1:500 prompting referral for TVS. An average of 2% of participants were referred to TVS annually. RESULTS Thirty-four patients were referred for operations detecting 15 ovarian cancers and two borderline tumors with 12 in early stage (I-II). In addition, seven endometrial cancers were detected with six in stage I. As four ovarian cancers and two borderline tumors were diagnosed with a normal ROCA, the sensitivity for detecting ovarian and borderline cancer was 74% (17 of 23), and 70% of ROCA-detected cases (12 of 17) were in stage I-II. NROSS screening reduced late-stage (III-IV) disease by 34% compared with UKCTOCS controls and by 30% compared with US SEER values. The positive predictive value (PPV) was 50% (17 of 34) for detecting ovarian cancer and 74% (25 of 34) for any cancer, far exceeding the minimum acceptable study end point of 10% PPV. CONCLUSION While the NROSS trial was not powered to detect reduced mortality, the high specificity, PPV, and marked stage shift support further development of this strategy.
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Affiliation(s)
- Chae Young Han
- Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gwen Corrigan
- Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alexandra Perez
- Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sharlene D Kohring
- Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph Celestino
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Deepak Bedi
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Enrique Bedia
- Unity Point Health, John Stoddard Cancer Center, Des Moines, IA
| | - Therese Bevers
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, TX
| | - David Boruta
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew Carlson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School, Dallas, TX
| | - Laura Holman
- Department of Obstetrics and Gynecology, University of Oklahoma Medical School, Oklahoma City, OK
| | | | | | - Georgia McCann
- Department of Obstetrics and Gynecology, University of Texas San Antonio School of Medicine, San Antonio, TX
| | - Richard G Moore
- Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Brian Slomovitz
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
- Carol G. Simon Cancer Center, Atlantic Health, Morristown, NJ
| | - Dan Tobias
- Carol G. Simon Cancer Center, Atlantic Health, Morristown, NJ
| | - Yvette Williams-Brown
- Department of Obstetrics and Gynecology, Dell School of Medicine, University of Texas, Austin, TX
| | - Michael W Bevers
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jinsong Liu
- Department of Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Terrie G Gornet
- Department of Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Beverly C Handy
- Department of Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zhen Lu
- Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jacob S Bedia
- MGH Biostatistics, Massachusetts General Hospital, Boston, MA
| | - Steven J Skates
- MGH Biostatistics, Massachusetts General Hospital, Boston, MA
| | - Robert C Bast
- Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
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Zhao M, Nie H, Wang H, Fang J, Wang F, Wang H, Yu H, Bai X, Zhang Y, Xiong Q, Cai H, Zhao Q. Novel oviduct endoscope combining optical coherence tomography with intratubal ultrasonography for fallopian tube exploration: An in vivo rabbit pilot study. Photodiagnosis Photodyn Ther 2023; 43:103650. [PMID: 37302641 DOI: 10.1016/j.pdpdt.2023.103650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND STUDY AIM Currently, several limitations exist in the examination of the oviduct. In this study, the usefulness and feasibility of a novel ultrafine dual-modality oviduct endoscopy device for in vivo assessment of the oviduct were evaluated. METHODS Five Japanese white rabbits were selected to undergo oviduct probing using a combination of optical coherence tomography (OCT) and intratubal ultrasonography. The feasibility of the procedure was evaluated through 152 pairs of clear, clinically interpretable images obtained using spiral scanning via the pull-back method. OCT images were compared with the oviduct histopathology sections. RESULTS Visualization of the oviduct using both OCT and ultrasound revealed a differentiated three-layer tissue; however, ultrasound showed a poorer clarity than OCT. By comparing OCT images with the histological morphology of the oviduct, the inner low-reflective layer of the oviduct corresponds to the mucosal layer, the middle high-reflective layer corresponds to the fibrous muscle layer, and the outer low-reflective layer corresponds to the connective tissue layer. Postoperatively, the general condition of the animals was good. CONCLUSION This study demonstrated the feasibility and potential clinical value of the novel ultrafine dual-modality oviduct endoscope. Dual-modality imaging of OCT and intratubal ultrasonography can provide clearer microstructure of the oviduct wall.
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Affiliation(s)
- Mengya Zhao
- Department of Gynecologic Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Haihang Nie
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Hongling Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Jun Fang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Fan Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Haizhou Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Hualiang Yu
- InnerMedical Co. Ltd, Shenzhen 518000, China
| | | | - Yafei Zhang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | | | - Hongbing Cai
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Qiu Zhao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China.
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Sadowski EA, Rockall A, Thomassin-Naggara I, Barroilhet LM, Wallace SK, Jha P, Gupta A, Shinagare AB, Guo Y, Reinhold C. Adnexal Lesion Imaging: Past, Present, and Future. Radiology 2023; 307:e223281. [PMID: 37158725 DOI: 10.1148/radiol.223281] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Currently, imaging is part of the standard of care for patients with adnexal lesions prior to definitive management. Imaging can identify a physiologic finding or classic benign lesion that can be followed up conservatively. When one of these entities is not present, imaging is used to determine the probability of ovarian cancer prior to surgical consultation. Since the inclusion of imaging in the evaluation of adnexal lesions in the 1970s, the rate of surgery for benign lesions has decreased. More recently, data-driven Ovarian-Adnexal Reporting and Data System (O-RADS) scoring systems for US and MRI with standardized lexicons have been developed to allow for assignment of a cancer risk score, with the goal of further decreasing unnecessary interventions while expediting the care of patients with ovarian cancer. US is used as the initial modality for the assessment of adnexal lesions, while MRI is used when there is a clinical need for increased specificity and positive predictive value for the diagnosis of cancer. This article will review how the treatment of adnexal lesions has changed due to imaging over the decades; the current data supporting the use of US, CT, and MRI to determine the likelihood of cancer; and future directions of adnexal imaging for the early detection of ovarian cancer.
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Affiliation(s)
- Elizabeth A Sadowski
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Andrea Rockall
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Isabelle Thomassin-Naggara
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Lisa M Barroilhet
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Sumer K Wallace
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Priyanka Jha
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Akshya Gupta
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Atul B Shinagare
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Yang Guo
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Caroline Reinhold
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
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Tamash Y, Hammer N, Varga I, Supilnikov A, Iukhimetc S. Arterial Blood Supply of the Mesosalpinx Appears Segmentally Organized in Absence of Uterine Tubes Arteries. Physiol Res 2022. [DOI: 10.33549/physiolres.935015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Arterial branches to the uterus and ovaries that pass through the mesosalpinx contribute significantly to the maintenance of the ovarian reserve. Especially arterial supply of the uterine tube is provided by a number of anastomoses between both the uterine and ovarian vessels. Knowledge on the morphologic peculiarities will allow to identify main contributors especially blood flow ultrasound examination for the purpose of ovary preserving surgery. This study aimed at identifying landmarks especially for so-called low-flow tubal vessels. Arteries of 17 female Thiel-embalmed bodies were studied along three preselected paramedian segments and measurements taken. A section was made through the center of the ovary perpendicular to uterine tube, then the mesosalpinx tissue distance was divided into 3 equivalent zones: upper, middle and lower thirds. The surface area of the mesosalpinx averaged 1088 ± 62 mm2. 47.7 ± 7.1 % of the mesosalpinx zones included macroscopically visible vessels. The lower third segment of mesosalpinx was the thickest averaging 2.4 ± 1.5 mm. One to three tubal branches were identified in the middle third of the mesosalpinx. Arterial anastomoses were found in the upper segment of the mesosalpinx, but no presence of a marginal vessel supplying the fallopian tube could be found. Statistically significant moderate positive correlations were established between the diameters of the mesosalpingeal arteries between the three zones. The mesosalpinx, uterine tube and the ovary form areas of segmental blood supply. Variants of tubal vessels appear to be a sparse source of blood supply.
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TAMASH Y, HAMMER N, VARGA I, SUPILNIKOV A, IUKHIMETC S. Arterial Blood Supply of the Mesosalpinx Appears Segmentally Organized in Absence of Uterine Tubes Arteries. Physiol Res 2022; 71:S107-S113. [PMID: 36592446 PMCID: PMC9853995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Arterial branches to the uterus and ovaries that pass through the mesosalpinx contribute significantly to the maintenance of the ovarian reserve. Especially arterial supply of the uterine tube is provided by a number of anastomoses between both the uterine and ovarian vessels. Knowledge on the morphologic peculiarities will allow to identify main contributors especially blood flow ultrasound examination for the purpose of ovary preserving surgery. This study aimed at identifying landmarks especially for so-called low-flow tubal vessels. Arteries of 17 female Thiel-embalmed bodies were studied along three preselected paramedian segments and measurements taken. A section was made through the center of the ovary perpendicular to uterine tube, then the mesosalpinx tissue distance was divided into 3 equivalent zones: upper, middle and lower thirds. The surface area of the mesosalpinx averaged 1088 ± 62 mm2. 47.7 ± 7.1 % of the mesosalpinx zones included macroscopically visible vessels. The lower third segment of mesosalpinx was the thickest averaging 2.4 ± 1.5 mm. One to three tubal branches were identified in the middle third of the mesosalpinx. Arterial anastomoses were found in the upper segment of the mesosalpinx, but no presence of a marginal vessel supplying the fallopian tube could be found. Statistically significant moderate positive correlations were established between the diameters of the mesosalpingeal arteries between the three zones. The mesosalpinx, uterine tube and the ovary form areas of segmental blood supply. Variants of tubal vessels appear to be a sparse source of blood supply.
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Affiliation(s)
- Yana TAMASH
- Department of Morphology and Pathology, Medical University “Reaviz”, Samara, Russia
| | - Niels HAMMER
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria,Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany,Fraunhofer Institute for Machine Tools and Forming Technology (IWU), Medical Branch, Chemnitz, Germany
| | - Ivan VARGA
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Alexey SUPILNIKOV
- Department of Morphology and Pathology, Medical University “Reaviz”, Samara, Russia
| | - Sergei IUKHIMETC
- Department of Morphology and Pathology, Medical University “Reaviz”, Samara, Russia
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Chung EH, Petishnok LC, Conyers JM, Schimer DA, Vitek WS, Harris AL, Brown MA, Jolin JA, Karmon A, Styer AK. Virtual Compared With In-Clinic Transvaginal Ultrasonography for Ovarian Reserve Assessment. Obstet Gynecol 2022; 139:561-570. [PMID: 35271530 PMCID: PMC8936158 DOI: 10.1097/aog.0000000000004698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/23/2021] [Accepted: 12/03/2021] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To evaluate noninferiority of virtual transvaginal ultrasonography compared with in-clinic ultrasonography for ovarian reserve assessment. METHODS We conducted a single-site, head-to-head crossover trial. Participants performed self-administered virtual transvaginal ultrasonography at home, guided by a remote-certified ultrasound technologist, then underwent transvaginal ultrasonography in-clinic with another ultrasound technologist. Participants were women in the greater Boston area interested in evaluating ovarian reserve and recruited through social media, health care referrals, and professional networks. The uterus and ovaries were captured in sagittal and transverse views. These randomized recordings were reviewed by two or three independent, blinded reproductive endocrinologists. The primary outcome was noninferiority of the rate of clinical quality imaging produced at home compared with in clinic. Sample size was selected for greater than 90% power, given the 18% noninferiority margin. Secondary outcomes included antral follicle count equivalency and net promoter score superiority. RESULTS Fifty-six women were enrolled from December 2020 to May 2021. Participants varied in age (19-35 years), BMI (19.5-33.9), and occupation. Ninety-six percent of virtual and 98% of in-clinic images met "clinical quality." The difference of -2.4% (97.5% CI lower bound -5.5%) was within the noninferiority margin (18%). Antral follicle counts were equivalent across settings, with a difference in follicles (0.23, 95% CI -0.36 to 0.82) within the equivalence margin (2.65). Virtual examinations had superior net promoter scores (58.1 points, 97.5% CI of difference 37.3-79.0, P<.01), indicating greater satisfaction with the virtual experience. CONCLUSION Virtual transvaginal ultrasonography remotely guided by an ultrasonography technologist is noninferior to in-clinic transvaginal ultrasonography for producing clinical quality images and is equivalent for estimating antral follicle count. Virtual transvaginal ultrasonography had superior patient satisfaction and has potential to significantly expand patient access to fertility care. FUNDING SOURCE This study was sponsored by Turtle Health. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT04687189.
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Affiliation(s)
- Esther H. Chung
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Laura C. Petishnok
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Jesse M. Conyers
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - David A. Schimer
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Wendy S. Vitek
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Amy L. Harris
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Michelle A. Brown
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Julie A. Jolin
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Anatte Karmon
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
| | - Aaron K. Styer
- Duke University Medical Center, Durham, North Carolina; Boston Children's Hospital, Boston, Massachusetts; Emory University, Atlanta, Georgia; University of Rochester Medical Center, Rochester, New York; Wright State University, Wright-Patterson AFB, Ohio; Northwestern Medicine, Chicago, Illinois; Massachusetts General Hospital, Boston, Massachusetts; Hawaii Pacific Health, Honolulu, Hawaii; and CCRM Fertility, Boston, Massachusetts
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7
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Abstract
Bast et al. discuss the early detection of ovarian cancer in the context of the recent UKCTOCS screening trial. The authors suggest potential reasons why the trial failed to achieve a reduction in mortality and outline next steps in the development of biomarkers and imaging modalities to detect ovarian cancer.
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Affiliation(s)
- Robert C Bast
- Department of Experimental Therapeutics, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Chae Young Han
- Department of Experimental Therapeutics, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Zhen Lu
- Department of Experimental Therapeutics, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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8
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Kalsi J, Gentry-Maharaj A, Ryan A, Singh N, Burnell M, Massingham S, Apostolidou S, Sharma A, Williamson K, Seif M, Mould T, Woolas R, Dobbs S, Leeson S, Fallowfield L, Skates SJ, Parmar M, Campbell S, Jacobs I, McGuire A, Menon U. Performance Characteristics of the Ultrasound Strategy during Incidence Screening in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Cancers (Basel) 2021; 13:cancers13040858. [PMID: 33670571 PMCID: PMC7922843 DOI: 10.3390/cancers13040858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
Randomised controlled trials of ovarian cancer (OC) screening have not yet demonstrated an impact on disease mortality. Meanwhile, the screening data from clinical trials represents a rich resource to understand the performance of modalities used. We report here on incidence screening in the ultrasound arm of UKCTOCS. 44,799 of the 50,639 women who were randomised to annual screening with transvaginal ultrasound attended annual incidence screening between 28 April 2002 and 31 December 2011. Transvaginal ultrasound was used both as the first and the second line test. Participants were followed up through electronic health record linkage and postal questionnaires. Out of 280,534 annual incidence screens, 960 women underwent screen-positive surgery. 113 had ovarian/tubal cancer (80 invasive epithelial). Of the screen-detected invasive epithelial cancers, 37.5% (95% CI: 26.9-49.0) were Stage I/II. An additional 52 (50 invasive epithelial) were diagnosed within one year of their last screen. Of the 50 interval epithelial cancers, 6.0% (95% CI: 1.3-16.5) were Stage I/II. For detection of all ovarian/tubal cancers diagnosed within one year of screen, the sensitivity, specificity, and positive predictive values were 68.5% (95% CI: 60.8-75.5), 99.7% (95% CI: 99.7-99.7), and 11.8% (95% CI: 9.8-14) respectively. When the analysis was restricted to invasive epithelial cancers, sensitivity, specificity and positive predictive values were 61.5% (95% CI: 52.6-69.9); 99.7% (95% CI: 99.7-99.7) and 8.3% (95% CI: 6.7-10.3), with 12 surgeries per screen positive. The low sensitivity coupled with the advanced stage of interval cancers suggests that ultrasound scanning as the first line test might not be suitable for population screening for ovarian cancer. Trial registration: ISRCTN22488978. Registered on 6 April 2000.
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Affiliation(s)
- Jatinderpal Kalsi
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London WC1E 6HU, UK; (J.K.); (I.J.)
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (S.M.); (S.A.); (M.P.)
| | - Andy Ryan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (S.M.); (S.A.); (M.P.)
| | - Naveena Singh
- Department of Pathology, Barts and the London, London E1 2ES, UK;
| | - Matthew Burnell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (S.M.); (S.A.); (M.P.)
| | - Susan Massingham
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (S.M.); (S.A.); (M.P.)
| | - Sophia Apostolidou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (S.M.); (S.A.); (M.P.)
| | - Aarti Sharma
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff CF14 4XW, UK;
| | - Karin Williamson
- Department of Gynaecological Oncology, Nottingham City Hospital, Nottingham NG5 1PB, UK;
| | - Mourad Seif
- Division of Gynaecology and of Cancer Services, St. Mary’s Hospital and University of Manchester, Manchester M13 9WL, UK;
| | - Tim Mould
- Department of Gynaecological Oncology, University College Hospital, London NW1 2BU, UK;
| | - Robert Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK;
| | - Stephen Dobbs
- Department of Gynaecological Oncology, Belfast City Hospital, Belfast BT9 7AB, UK;
| | - Simon Leeson
- Department of Obstetrics and Gynaecology, Ysbyty Gwynedd, Bangor, Gwynedd LL57 2PW, UK;
| | - Lesley Fallowfield
- Cancer Research UK Sussex Psychosocial Oncology Group at Brighton & Sussex Medical School, University of Sussex, Falmer BN1 9PX, UK;
| | - Steven J. Skates
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (S.M.); (S.A.); (M.P.)
| | | | - Ian Jacobs
- Department of Women’s Cancer, Institute for Women’s Health, University College London, London WC1E 6HU, UK; (J.K.); (I.J.)
- Department of Women’s Health, University of New South Wales, Australia, Sydney 2052, Australia
| | - Alistair McGuire
- London School of Economics and Political Science, London WC2A 2AE, UK;
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London WC1V 6LJ, UK; (A.G.-M.); (A.R.); (M.B.); (S.M.); (S.A.); (M.P.)
- Correspondence: ; Tel.: +44-7670-4909
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9
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Alsina JL, Khamvongsa P. Incidental Finding of Unilateral Ovarian and Fallopian Tube Agenesis During Cesarean Delivery in Patient With Recurrent Pregnancy Loss. Cureus 2021; 13:e12769. [PMID: 33614358 PMCID: PMC7888686 DOI: 10.7759/cureus.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Congenital unilateral agenesis of the ovary and fallopian tube is a rare condition that has been previously described in the literature. While this condition is benign, studies have proposed it could be associated with infertility. The purpose of this report is first to highlight a rare incidental finding of unilateral ovarian and fallopian tube agenesis. Secondly, we aim to discuss the various imaging modalities used for the detection of uterine, ovarian, and fallopian tube defects and their shortcomings. Our case describes a 37-year-old G4P0030 woman with an obstetric history of spontaneous abortion and ectopic pregnancy, presenting at 38 weeks gestational age with polyhydramnios. The patient received routine obstetric care with no abnormalities being reported on routine ultrasonography. Elective cesarean section was performed at which time the incidental condition discovery of unilateral agenesis of the right ovary and fallopian tube was made. This case is unique since the incidental diagnosis of unilateral right ovarian and right fallopian tube agenesis occurred during cesarean delivery instead of through imaging. It is important for patient counseling to understand the typical workup and deficiencies in pelvic imaging concerning congenital anomalies
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Affiliation(s)
- Jorge L Alsina
- Obstetrics and Gynecology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Peter Khamvongsa
- Obstetrics and Gynecology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
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10
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Bast RC, Lu Z, Han CY, Lu KH, Anderson KS, Drescher CW, Skates SJ. Biomarkers and Strategies for Early Detection of Ovarian Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:2504-2512. [PMID: 33051337 PMCID: PMC7710577 DOI: 10.1158/1055-9965.epi-20-1057] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/29/2020] [Accepted: 10/09/2020] [Indexed: 12/14/2022] Open
Abstract
Early detection of ovarian cancer remains an important unmet medical need. Effective screening could reduce mortality by 10%-30%. Used individually, neither serum CA125 nor transvaginal sonography (TVS) is sufficiently sensitive or specific. Two-stage strategies have proven more effective, where a significant rise above a woman's baseline CA125 prompts TVS and an abnormal sonogram prompts surgery. Two major screening trials have documented that this strategy has adequate specificity, but sensitivity for early-stage (I-II) disease must improve to have a greater impact on mortality. To improve the first stage, different panels of protein biomarkers have detected cases missed by CA125. Autoantibodies against TP53 have detected 20% of early-stage ovarian cancers 8 months before elevation of CA125 and 22 months before clinical diagnosis. Panels of autoantibodies and antigen-autoantibody complexes are being evaluated with the goal of detecting >90% of early-stage ovarian cancers, alone or in combination with CA125, while maintaining 98% specificity in control subjects. Other biomarkers, including micro-RNAs, ctDNA, methylated DNA, and combinations of ctDNA alterations, are being tested to provide an optimal first-stage test. New technologies are also being developed with greater sensitivity than TVS to image small volumes of tumor.See all articles in this CEBP Focus section, "NCI Early Detection Research Network: Making Cancer Detection Possible."
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Affiliation(s)
- Robert C Bast
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Zhen Lu
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chae Young Han
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Charles W Drescher
- Translational Research Program, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Steven J Skates
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
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11
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Improved Sonographic Detection of Epithelial Ovarian Cancer: New Concepts and Evolving Technology. Ultrasound Q 2020; 36:133-137. [PMID: 32511206 DOI: 10.1097/ruq.0000000000000502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Tubal Disease and Impersonators/Masqueraders. Clin Obstet Gynecol 2017; 60:46-57. [DOI: 10.1097/grf.0000000000000262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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