Stage IV: Distant metastases, spread beyond breast and ipsilateral nodes; TNM classification (M1)
De devo MBC = stage IV at initial presentation
Recurrent MBC = stages I, II, or III at initial presentation, with recurrence at distant sites
IMAGING
Radiographic Findings
Mammographic Findings
Ultrasonographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Image-Guided Biopsy
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
Pons-Tostivint E et al: Survival impact of locoregional treatment of the primary tumor in de novo metastatic breast cancers in a large multicentric cohort study: A propensity score-matched analysis. Ann Surg Oncol. 26(2):356-365, 2019
Gogate A et al: An updated systematic review of the cost-effectiveness of therapies for metastatic breast cancer. Breast Cancer Res Treat. ePub, 2019
Bai XM et al: Long-term outcomes and prognostic analysis of percutaneous radiofrequency ablation in liver metastasis from breast cancer. Int J Hyperthermia. 35(1):183-93, 2019
New Global Cancer Data: GLOBOCAN 2018. https://www.uicc.org/new-global-cancer-data-globocan-2018. Accessed January 11, 2019
Begg CB et al: Contralateral breast cancers: Independent cancers or metastases? Int J Cancer. 142(2):347-356, 2018
Begg CB et al: Contralateral breast cancers: Independent cancers or metastases? Int J Cancer. 142(2):347-356, 2018
Caswell-Jin JL et al: Change in Survival in Metastatic Breast Cancer with Treatment Advances: Meta-Analysis and Systematic Review. JNCI Cancer Spectr. 2(4):pky062, 2018
Caswell-Jin JL et al: Change in Survival in Metastatic Breast Cancer with Treatment Advances: Meta-Analysis and Systematic Review. JNCI Cancer Spectr. 2(4):pky062, 2018
Szekely B et al: Immunological differences between primary and metastatic breast cancer. Ann Oncol. ePub, 2018
Szekely B et al: Immunological differences between primary and metastatic breast cancer. Ann Oncol. ePub, 2018
Xiao W et al: Primary tumor resection in stage IV breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol. ePub, 2018
Xiao W et al: Primary tumor resection in stage IV breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol. ePub, 2018
Yararbas U et al: The value of 18F-FDG PET/CT imaging in breast cancer staging. Bosn J Basic Med Sci. 18(1):72-79, 2018
Yararbas U et al: The value of 18F-FDG PET/CT imaging in breast cancer staging. Bosn J Basic Med Sci. 18(1):72-79, 2018
Lower EE et al: Discordance of the estrogen receptor and HER-2/neu in breast cancer from primary lesion to first and second metastatic site. Breast Cancer (Dove Med Press). 9:515-520, 2017
Lower EE et al: Discordance of the estrogen receptor and HER-2/neu in breast cancer from primary lesion to first and second metastatic site. Breast Cancer (Dove Med Press). 9:515-520, 2017
Mariotto AB et al: Estimation of the Number of Women Living with Metastatic Breast Cancer in the United States. Cancer Epidemiol Biomarkers Prev. 26(6):809-815, 2017
Mariotto AB et al: Estimation of the Number of Women Living with Metastatic Breast Cancer in the United States. Cancer Epidemiol Biomarkers Prev. 26(6):809-815, 2017
Sugihara T et al: Bone metastases from breast cancer: associations between morphologic CT patterns and glycolytic activity on PET and bone scintigraphy as well as explorative search for influential factors. Ann Nucl Med. 31(10):719-725, 2017
Sugihara T et al: Bone metastases from breast cancer: associations between morphologic CT patterns and glycolytic activity on PET and bone scintigraphy as well as explorative search for influential factors. Ann Nucl Med. 31(10):719-725, 2017
Groheux D et al: ¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer. J Nucl Med. 57 Suppl 1:17S-26S, 2016
Groheux D et al: ¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer. J Nucl Med. 57 Suppl 1:17S-26S, 2016
Taghipour M et al: FDG Avidity and Tumor Burden: Survival Outcomes for Patients With Recurrent Breast Cancer. AJR Am J Roentgenol. 206(4):846-55, 2016
Taghipour M et al: FDG Avidity and Tumor Burden: Survival Outcomes for Patients With Recurrent Breast Cancer. AJR Am J Roentgenol. 206(4):846-55, 2016
Alkner S et al: Contralateral breast cancer can represent a metastatic spread of the first primary tumor: determination of clonal relationship between contralateral breast cancers using next-generation whole genome sequencing. Breast Cancer Res. 17:102, 2015
Alkner S et al: Contralateral breast cancer can represent a metastatic spread of the first primary tumor: determination of clonal relationship between contralateral breast cancers using next-generation whole genome sequencing. Breast Cancer Res. 17:102, 2015
Chikarmane SA et al: Metastatic patterns of breast cancer subtypes: what radiologists should know in the era of personalized cancer medicine. Clin Radiol. 70(1):1-10, 2015
Chikarmane SA et al: Metastatic patterns of breast cancer subtypes: what radiologists should know in the era of personalized cancer medicine. Clin Radiol. 70(1):1-10, 2015
Son SH et al: Whole-Body Metabolic Tumor Volume, as Determined by (18)F-FDG PET/CT, as a Prognostic Factor of Outcome for Patients With Breast Cancer Who Have Distant Metastasis. AJR Am J Roentgenol. 205(4):878-85, 2015
Son SH et al: Whole-Body Metabolic Tumor Volume, as Determined by (18)F-FDG PET/CT, as a Prognostic Factor of Outcome for Patients With Breast Cancer Who Have Distant Metastasis. AJR Am J Roentgenol. 205(4):878-85, 2015
Gold LS et al: Imaging Techniques for Treatment Evaluation for Metastatic Breast Cancer. Rockville (MD): Agency for Healthcare Research and Quality (US). Report No.: 14-EHC044-EF, 2014
Gold LS et al: Imaging Techniques for Treatment Evaluation for Metastatic Breast Cancer. Rockville (MD): Agency for Healthcare Research and Quality (US). Report No.: 14-EHC044-EF, 2014
Rong J et al: Comparison of (18)FDG PET-CT and bone scintigraphy for detection of bone metastases in breast cancer patients. A meta-analysis. Surg Oncol. 22(2):86-91, 2013
Rong J et al: Comparison of (18)FDG PET-CT and bone scintigraphy for detection of bone metastases in breast cancer patients. A meta-analysis. Surg Oncol. 22(2):86-91, 2013
Niikura N et al: FDG-PET/CT compared with conventional imaging in the detection of distant metastases of primary breast cancer. Oncologist. 16(8):1111-9, 2011
Niikura N et al: FDG-PET/CT compared with conventional imaging in the detection of distant metastases of primary breast cancer. Oncologist. 16(8):1111-9, 2011
Edge SB et al: Cancer Staging Handbook From the AJCC Cancer Staging Manual. 7th ed. Chicago: Springer. 417-60, 2010
Edge SB et al: Cancer Staging Handbook From the AJCC Cancer Staging Manual. 7th ed. Chicago: Springer. 417-60, 2010
Dawood S et al: Survival differences among women with de novo stage IV and relapsed breast cancer. Ann Oncol. 21(11):2169-74, 2010
Dawood S et al: Survival differences among women with de novo stage IV and relapsed breast cancer. Ann Oncol. 21(11):2169-74, 2010
Carlson RW et al: Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 7(2):122-92, 2009
Carlson RW et al: Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 7(2):122-92, 2009
NCCN. NCCN Clinical practice guidelines in oncology. In Winn R: Jenkintown, PA: National Comprehensive Cancer Network; 2008
NCCN. NCCN Clinical practice guidelines in oncology. In Winn R: Jenkintown, PA: National Comprehensive Cancer Network; 2008
Harris L et al: American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 25(33):5287-312, 2007
Harris L et al: American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 25(33):5287-312, 2007
Buyse M et al: Validation and clinical utility of a 70-gene prognostic signature for women with node-negative breast cancer. J Natl Cancer Inst. 98(17):1183-92, 2006
Buyse M et al: Validation and clinical utility of a 70-gene prognostic signature for women with node-negative breast cancer. J Natl Cancer Inst. 98(17):1183-92, 2006
Braun S et al: A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med. 353(8):793-802, 2005
Braun S et al: A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med. 353(8):793-802, 2005
Buzdar AU et al: Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol. 23(16):3676-85, 2005
Buzdar AU et al: Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol. 23(16):3676-85, 2005
Moon YW et al: Neoadjuvant chemotherapy with infusional 5-fluorouracil, adriamycin and cyclophosphamide (iFAC) in locally advanced breast cancer: an early response predicts good prognosis. Ann Oncol. 16(11):1778-85, 2005
Moon YW et al: Neoadjuvant chemotherapy with infusional 5-fluorouracil, adriamycin and cyclophosphamide (iFAC) in locally advanced breast cancer: an early response predicts good prognosis. Ann Oncol. 16(11):1778-85, 2005
van't Veer LJ et al: Gene expression profiling of breast cancer: a new tumor marker. J Clin Oncol. 23(8):1631-5, 2005
van't Veer LJ et al: Gene expression profiling of breast cancer: a new tumor marker. J Clin Oncol. 23(8):1631-5, 2005
Cristofanilli M et al: Circulating tumor cells, disease progression, and survival in metastatic breast cancer. N Engl J Med. 351(8):781-91, 2004
Cristofanilli M et al: Circulating tumor cells, disease progression, and survival in metastatic breast cancer. N Engl J Med. 351(8):781-91, 2004
Paik S et al: A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 351(27):2817-26, 2004
Paik S et al: A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 351(27):2817-26, 2004
Thor A: A revised staging system for breast cancer. Breast J. 10 Suppl 1:S15-8, 2004
Thor A: A revised staging system for breast cancer. Breast J. 10 Suppl 1:S15-8, 2004
Zangheri B et al: PET/CT and breast cancer. Eur J Nucl Med Mol Imaging. 31 Suppl 1:S135-42, 2004
Zangheri B et al: PET/CT and breast cancer. Eur J Nucl Med Mol Imaging. 31 Suppl 1:S135-42, 2004
Systemic treatment of early breast cancer by hormonal et al: 133 randomised trials involving 31,000 recurrences and 24,000 deaths among 75,000 women. Early Breast Cancer Trialists' Collaborative Group. Lancet. 339(8785):71-85, 1992
Systemic treatment of early breast cancer by hormonal et al: 133 randomised trials involving 31,000 recurrences and 24,000 deaths among 75,000 women. Early Breast Cancer Trialists' Collaborative Group. Lancet. 339(8785):71-85, 1992
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Abbreviations
Metastatic breast cancer (MBC)
Definitions
Stage IV: Distant metastases, spread beyond breast and ipsilateral nodes; TNM classification (M1)
De devo MBC = stage IV at initial presentation
Recurrent MBC = stages I, II, or III at initial presentation, with recurrence at distant sites
IMAGING
Radiographic Findings
Mammographic Findings
Ultrasonographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Image-Guided Biopsy
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
Pons-Tostivint E et al: Survival impact of locoregional treatment of the primary tumor in de novo metastatic breast cancers in a large multicentric cohort study: A propensity score-matched analysis. Ann Surg Oncol. 26(2):356-365, 2019
Gogate A et al: An updated systematic review of the cost-effectiveness of therapies for metastatic breast cancer. Breast Cancer Res Treat. ePub, 2019
Bai XM et al: Long-term outcomes and prognostic analysis of percutaneous radiofrequency ablation in liver metastasis from breast cancer. Int J Hyperthermia. 35(1):183-93, 2019
New Global Cancer Data: GLOBOCAN 2018. https://www.uicc.org/new-global-cancer-data-globocan-2018. Accessed January 11, 2019
Begg CB et al: Contralateral breast cancers: Independent cancers or metastases? Int J Cancer. 142(2):347-356, 2018
Begg CB et al: Contralateral breast cancers: Independent cancers or metastases? Int J Cancer. 142(2):347-356, 2018
Caswell-Jin JL et al: Change in Survival in Metastatic Breast Cancer with Treatment Advances: Meta-Analysis and Systematic Review. JNCI Cancer Spectr. 2(4):pky062, 2018
Caswell-Jin JL et al: Change in Survival in Metastatic Breast Cancer with Treatment Advances: Meta-Analysis and Systematic Review. JNCI Cancer Spectr. 2(4):pky062, 2018
Szekely B et al: Immunological differences between primary and metastatic breast cancer. Ann Oncol. ePub, 2018
Szekely B et al: Immunological differences between primary and metastatic breast cancer. Ann Oncol. ePub, 2018
Xiao W et al: Primary tumor resection in stage IV breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol. ePub, 2018
Xiao W et al: Primary tumor resection in stage IV breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol. ePub, 2018
Yararbas U et al: The value of 18F-FDG PET/CT imaging in breast cancer staging. Bosn J Basic Med Sci. 18(1):72-79, 2018
Yararbas U et al: The value of 18F-FDG PET/CT imaging in breast cancer staging. Bosn J Basic Med Sci. 18(1):72-79, 2018
Lower EE et al: Discordance of the estrogen receptor and HER-2/neu in breast cancer from primary lesion to first and second metastatic site. Breast Cancer (Dove Med Press). 9:515-520, 2017
Lower EE et al: Discordance of the estrogen receptor and HER-2/neu in breast cancer from primary lesion to first and second metastatic site. Breast Cancer (Dove Med Press). 9:515-520, 2017
Mariotto AB et al: Estimation of the Number of Women Living with Metastatic Breast Cancer in the United States. Cancer Epidemiol Biomarkers Prev. 26(6):809-815, 2017
Mariotto AB et al: Estimation of the Number of Women Living with Metastatic Breast Cancer in the United States. Cancer Epidemiol Biomarkers Prev. 26(6):809-815, 2017
Sugihara T et al: Bone metastases from breast cancer: associations between morphologic CT patterns and glycolytic activity on PET and bone scintigraphy as well as explorative search for influential factors. Ann Nucl Med. 31(10):719-725, 2017
Sugihara T et al: Bone metastases from breast cancer: associations between morphologic CT patterns and glycolytic activity on PET and bone scintigraphy as well as explorative search for influential factors. Ann Nucl Med. 31(10):719-725, 2017
Groheux D et al: ¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer. J Nucl Med. 57 Suppl 1:17S-26S, 2016
Groheux D et al: ¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer. J Nucl Med. 57 Suppl 1:17S-26S, 2016
Taghipour M et al: FDG Avidity and Tumor Burden: Survival Outcomes for Patients With Recurrent Breast Cancer. AJR Am J Roentgenol. 206(4):846-55, 2016
Taghipour M et al: FDG Avidity and Tumor Burden: Survival Outcomes for Patients With Recurrent Breast Cancer. AJR Am J Roentgenol. 206(4):846-55, 2016
Alkner S et al: Contralateral breast cancer can represent a metastatic spread of the first primary tumor: determination of clonal relationship between contralateral breast cancers using next-generation whole genome sequencing. Breast Cancer Res. 17:102, 2015
Alkner S et al: Contralateral breast cancer can represent a metastatic spread of the first primary tumor: determination of clonal relationship between contralateral breast cancers using next-generation whole genome sequencing. Breast Cancer Res. 17:102, 2015
Chikarmane SA et al: Metastatic patterns of breast cancer subtypes: what radiologists should know in the era of personalized cancer medicine. Clin Radiol. 70(1):1-10, 2015
Chikarmane SA et al: Metastatic patterns of breast cancer subtypes: what radiologists should know in the era of personalized cancer medicine. Clin Radiol. 70(1):1-10, 2015
Son SH et al: Whole-Body Metabolic Tumor Volume, as Determined by (18)F-FDG PET/CT, as a Prognostic Factor of Outcome for Patients With Breast Cancer Who Have Distant Metastasis. AJR Am J Roentgenol. 205(4):878-85, 2015
Son SH et al: Whole-Body Metabolic Tumor Volume, as Determined by (18)F-FDG PET/CT, as a Prognostic Factor of Outcome for Patients With Breast Cancer Who Have Distant Metastasis. AJR Am J Roentgenol. 205(4):878-85, 2015
Gold LS et al: Imaging Techniques for Treatment Evaluation for Metastatic Breast Cancer. Rockville (MD): Agency for Healthcare Research and Quality (US). Report No.: 14-EHC044-EF, 2014
Gold LS et al: Imaging Techniques for Treatment Evaluation for Metastatic Breast Cancer. Rockville (MD): Agency for Healthcare Research and Quality (US). Report No.: 14-EHC044-EF, 2014
Rong J et al: Comparison of (18)FDG PET-CT and bone scintigraphy for detection of bone metastases in breast cancer patients. A meta-analysis. Surg Oncol. 22(2):86-91, 2013
Rong J et al: Comparison of (18)FDG PET-CT and bone scintigraphy for detection of bone metastases in breast cancer patients. A meta-analysis. Surg Oncol. 22(2):86-91, 2013
Niikura N et al: FDG-PET/CT compared with conventional imaging in the detection of distant metastases of primary breast cancer. Oncologist. 16(8):1111-9, 2011
Niikura N et al: FDG-PET/CT compared with conventional imaging in the detection of distant metastases of primary breast cancer. Oncologist. 16(8):1111-9, 2011
Edge SB et al: Cancer Staging Handbook From the AJCC Cancer Staging Manual. 7th ed. Chicago: Springer. 417-60, 2010
Edge SB et al: Cancer Staging Handbook From the AJCC Cancer Staging Manual. 7th ed. Chicago: Springer. 417-60, 2010
Dawood S et al: Survival differences among women with de novo stage IV and relapsed breast cancer. Ann Oncol. 21(11):2169-74, 2010
Dawood S et al: Survival differences among women with de novo stage IV and relapsed breast cancer. Ann Oncol. 21(11):2169-74, 2010
Carlson RW et al: Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 7(2):122-92, 2009
Carlson RW et al: Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 7(2):122-92, 2009
NCCN. NCCN Clinical practice guidelines in oncology. In Winn R: Jenkintown, PA: National Comprehensive Cancer Network; 2008
NCCN. NCCN Clinical practice guidelines in oncology. In Winn R: Jenkintown, PA: National Comprehensive Cancer Network; 2008
Harris L et al: American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 25(33):5287-312, 2007
Harris L et al: American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 25(33):5287-312, 2007
Buyse M et al: Validation and clinical utility of a 70-gene prognostic signature for women with node-negative breast cancer. J Natl Cancer Inst. 98(17):1183-92, 2006
Buyse M et al: Validation and clinical utility of a 70-gene prognostic signature for women with node-negative breast cancer. J Natl Cancer Inst. 98(17):1183-92, 2006
Braun S et al: A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med. 353(8):793-802, 2005
Braun S et al: A pooled analysis of bone marrow micrometastasis in breast cancer. N Engl J Med. 353(8):793-802, 2005
Buzdar AU et al: Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol. 23(16):3676-85, 2005
Buzdar AU et al: Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol. 23(16):3676-85, 2005
Moon YW et al: Neoadjuvant chemotherapy with infusional 5-fluorouracil, adriamycin and cyclophosphamide (iFAC) in locally advanced breast cancer: an early response predicts good prognosis. Ann Oncol. 16(11):1778-85, 2005
Moon YW et al: Neoadjuvant chemotherapy with infusional 5-fluorouracil, adriamycin and cyclophosphamide (iFAC) in locally advanced breast cancer: an early response predicts good prognosis. Ann Oncol. 16(11):1778-85, 2005
van't Veer LJ et al: Gene expression profiling of breast cancer: a new tumor marker. J Clin Oncol. 23(8):1631-5, 2005
van't Veer LJ et al: Gene expression profiling of breast cancer: a new tumor marker. J Clin Oncol. 23(8):1631-5, 2005
Cristofanilli M et al: Circulating tumor cells, disease progression, and survival in metastatic breast cancer. N Engl J Med. 351(8):781-91, 2004
Cristofanilli M et al: Circulating tumor cells, disease progression, and survival in metastatic breast cancer. N Engl J Med. 351(8):781-91, 2004
Paik S et al: A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 351(27):2817-26, 2004
Paik S et al: A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. N Engl J Med. 351(27):2817-26, 2004
Thor A: A revised staging system for breast cancer. Breast J. 10 Suppl 1:S15-8, 2004
Thor A: A revised staging system for breast cancer. Breast J. 10 Suppl 1:S15-8, 2004
Zangheri B et al: PET/CT and breast cancer. Eur J Nucl Med Mol Imaging. 31 Suppl 1:S135-42, 2004
Zangheri B et al: PET/CT and breast cancer. Eur J Nucl Med Mol Imaging. 31 Suppl 1:S135-42, 2004
Systemic treatment of early breast cancer by hormonal et al: 133 randomised trials involving 31,000 recurrences and 24,000 deaths among 75,000 women. Early Breast Cancer Trialists' Collaborative Group. Lancet. 339(8785):71-85, 1992
Systemic treatment of early breast cancer by hormonal et al: 133 randomised trials involving 31,000 recurrences and 24,000 deaths among 75,000 women. Early Breast Cancer Trialists' Collaborative Group. Lancet. 339(8785):71-85, 1992
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