Metastatic spread of primary head & neck SCCa to lymph nodes
IMAGING
General Features
CT Findings
MR Findings
Ultrasonographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Sananmuang T et al: Pre- and post-radiotherapy radiologic nodal features and oropharyngeal cancer outcomes. Laryngoscope. 131(4):E1162-71, 2021
Stack BC Jr et al: FDG-PET/CT and Pathology in Newly Diagnosed Head and Neck Cancer: ACRIN 6685 Trial, FDG-PET/CT cN0. Otolaryngol Head Neck Surg. 164(6):1230-1239, 2021
Stadler TM et al: FDG-PET-CT/MRI in head and neck squamous cell carcinoma: Impact on pretherapeutic N classification, detection of distant metastases, and second primary tumors. Head Neck. 43(7):2058-2068, 2021
Driessen DAJJ et al: Novel Diagnostic Approaches for Assessment of the Clinically Negative Neck in Head and Neck Cancer Patients. Front Oncol. 10:637513, 2020
Elhalawani H et al: Data from a terminated study on iron oxide nanoparticle magnetic resonance imaging for head and neck tumors. Sci Data. 7(1):63, 2020
Faraji F et al: Computed tomography performance in predicting extranodal extension in HPV-positive oropharynx cancer. Laryngoscope. 130(6):1479-1486, 2020
Hiyama T et al: Extra-nodal extension in head and neck cancer: how radiologists can help staging and treatment planning. Jpn J Radiol. 38(6):489-506, 2020
Mahieu R et al: New Developments in Imaging for Sentinel Lymph Node Biopsy in Early-Stage Oral Cavity Squamous Cell Carcinoma. Cancers (Basel). 12(10), 2020
Yan F et al: Predictive value of computed tomography in identifying extranodal extension in human papillomavirus-positive versus human papillomavirus-negative head and neck cancer. Head Neck. ePub, 2020
de Veij Mestdagh PD et al: Mapping of sentinel lymph node drainage using SPECT/CT to tailor elective nodal irradiation in head and neck cancer patients (SUSPECT-2): a single-center prospective trial. BMC Cancer. 19(1):1110, 2019
Forghani R et al: Head and neck squamous cell carcinoma: prediction of cervical lymph node metastasis by dual-energy CT texture analysis with machine learning. Eur Radiol. 29(11):6172-6181, 2019
Noor A et al: Predictive value of computed tomography in identifying extracapsular spread of cervical lymph node metastases in p16 positive oropharyngeal squamous cell carcinoma. J Med Imaging Radiat Oncol. 63(4):500-509, 2019
Tian S et al: Prognostic value of radiographically defined extranodal extension in human papillomavirus-associated locally advanced oropharyngeal carcinoma. Head Neck. 41(9):3056-3063, 2019
Traylor KS et al: Squamous Cell Carcinoma: PET/CT and PET/MRI of the Pretreatment and Post-Treatment Neck. Semin Ultrasound CT MR. 40(5):400-413, 2019
Abdel Razek AAK et al: Arterial spin labeling perfusion-weighted MR imaging: correlation of tumor blood flow with pathological degree of tumor differentiation, clinical stage and nodal metastasis of head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol. 275(5):1301-1307, 2018
Dai YL et al: State of the art MRI in head and neck cancer. Clin Radiol. 73(1):45-59, 2018
Kann BH et al: Pretreatment Identification of Head and Neck Cancer Nodal Metastasis and Extranodal Extension Using Deep Learning Neural Networks. Sci Rep. 8(1):14036, 2018
Mundada P et al: Utility of MRI with morphologic and diffusion weighted imaging in the detection of post-treatment nodal disease in head and neck squamous cell carcinoma. Eur J Radiol. 101:162-169, 2018
Zhang H et al: Utility of PET-CT in detecting nodal metastasis in cN0 early stage oral cavity squamous cell carcinoma. Oral Oncol. 80:89-92, 2018
Cho JK et al: Preoperative 18F-FDG-PET/CT vs Contrast-Enhanced CT to Identify Regional Nodal Metastasis among Patients with Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg. 157(3):439-447, 2017
Kelly HR et al: Chapter 2 Squamous Cell Carcinoma of the Head and Neck-Imaging Evaluation of Regional Lymph Nodes and Implications for Management. Semin Ultrasound CT MR. 38(5):466-478, 2017
Kulzer MH et al: Chapter 1 Neck Anatomy, Imaging-Based Level Nodal Classification and Impact of Primary Tumor Site on Patterns of Nodal Metastasis. Semin Ultrasound CT MR. 38(5):454-465, 2017
Aiken AH et al: Implementation of a novel surveillance template for head and neck cancer: neck imaging reporting and data system (NI-RADS). J Am Coll Radiol. 13(6):743-746.e1, 2016
de Bree R et al: Radiologic extranodal spread and matted nodes: Important predictive factors for development of distant metastases in patients with high-risk head and neck cancer. Head Neck. 38 Suppl 1:E1452-8, 2016
Fujita A et al: Imaging characteristics of metastatic nodes and outcomes by HPV status in head and neck cancers. Laryngoscope. 126(2):392-8, 2016
Gaddikeri S et al: Dynamic contrast-enhanced MR imaging in head and neck cancer: techniques and clinical applications. AJNR Am J Neuroradiol. 37(4):588-95, 2016
Kim SG et al: Potential role of PET/MRI for imaging metastatic lymph nodes in head and neck cancer. AJR Am J Roentgenol. 1-9, 2016
Aiken AH et al: Accuracy of preoperative imaging in detecting nodal extracapsular spread in oral cavity squamous cell carcinoma. AJNR Am J Neuroradiol. 36(9):1776-81, 2015
de Bree R et al: Advances in diagnostic modalities to detect occult lymph node metastases in head and neck squamous cell carcinoma. Head Neck. 37(12):1829-39, 2015
Eisenmenger LB et al: Imaging of head and neck lymph nodes. Radiol Clin North Am. 53(1):115-32, 2015
Forghani R et al: Imaging evaluation of lymphadenopathy and patterns of lymph node spread in head and neck cancer. Expert Rev Anticancer Ther. 15(2):207-24, 2015
Lee JR et al: Preoperative contrast-enhanced CT versus ¹⁸F-FDG PET/CT evaluation and the prognostic value of extranodal extension for surgical patients with head and heck squamous cell carcinoma. Ann Surg Oncol. 22 Suppl 3:S1020-7, 2015
Maxwell JH et al: Accuracy of computed tomography to predict extracapsular spread in p16-positive squamous cell carcinoma. Laryngoscope. 125(7):1613-8, 2015
Payne KF et al: The role of diffusion-weighted magnetic resonance imaging in the diagnosis, lymph node staging and assessment of treatment response of head and neck cancer. Int J Oral Maxillofac Surg. 44(1):1-7, 2015
Plaxton NA et al: Characteristics and Limitations of FDG PET/CT for Imaging of Squamous Cell Carcinoma of the Head and Neck: A Comprehensive Review of Anatomy, Metastatic Pathways, and Image Findings. AJR Am J Roentgenol. 205(5):W519-31, 2015
Barchetti F et al: The role of 3 Tesla diffusion-weighted imaging in the differential diagnosis of benign versus malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma. Biomed Res Int. 2014:532095, 2014
Grégoire V et al: Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol. 110(1):172-81, 2014
Chai RL et al: Accuracy of computed tomography in the prediction of extracapsular spread of lymph node metastases in squamous cell carcinoma of the head and neck. JAMA Otolaryngol Head Neck Surg. 139(11):1187-94, 2013
Hoang JK et al: Evaluation of cervical lymph nodes in head and neck cancer with CT and MRI: tips, traps, and a systematic approach. AJR Am J Roentgenol. 200(1):W17-25, 2013
Fukunari F et al: Cervical lymph nodes with or without metastases from oral squamous carcinoma: a correlation of MRI findings and histopathologic architecture. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 109(6):890-9, 2010
Ghadjar P et al: Incidence of small lymph node metastases with evidence of extracapsular extension: clinical implications in patients with head and neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 78(5):1366-72, 2010
Vandecaveye V et al: Applications of diffusion-weighted magnetic resonance imaging in head and neck squamous cell carcinoma. Neuroradiology. 52(9):773-84, 2010
Holzapfel K et al: Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes. Eur J Radiol. 72(3):381-7, 2009
Vandecaveye V et al: Head and neck squamous cell carcinoma: value of diffusion-weighted MR imaging for nodal staging. Radiology. 251(1):134-46, 2009
Kimura Y et al: MR imaging criteria for the prediction of extranodal spread of metastatic cancer in the neck. AJNR Am J Neuroradiol. 29(7):1355-9, 2008
Nakamura T et al: Nodal imaging in the neck: recent advances in US, CT and MR imaging of metastatic nodes. Eur Radiol. 17(5):1235-41, 2007
Vogl T et al: Lymph node staging. Top Magn Reson Imaging. 2007 Aug;18(4):303-16. Review. Erratum in: Top Magn Reson Imaging. 18(6):471, 2007
Abdel Razek AA et al: Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol. 16(7):1468-77, 2006
Gor DM et al: Imaging of cervical lymph nodes in head and neck cancer: the basics. Radiol Clin North Am. 44(1):101-10, viii, 2006
Kawai Y et al: Turbo short tau inversion recovery imaging for metastatic node screening in patients with head and neck cancer. AJNR Am J Neuroradiol. 27(6):1283-7, 2006
Schöder H et al: 18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. J Nucl Med. 47(5):755-62, 2006
King AD et al: Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US. Radiology. 230(3):720-6, 2004
Ahuja A et al: Sonography of neck lymph nodes. Part II: abnormal lymph nodes. Clin Radiol. 58(5):359-66, 2003
Fischbein NJ et al: Assessment of metastatic cervical adenopathy using dynamic contrast-enhanced MR imaging. AJNR Am J Neuroradiol. 24(3):301-11, 2003
Giridharan W et al: Lymph node metastases in the lower neck. Clin Otolaryngol. 28(3):221-6, 2003
Kosuda S et al: Feasibility and cost-effectiveness of sentinel lymph node radiolocalization in stage N0 head and neck cancer. Arch Otolaryngol Head Neck Surg. 129(10):1105-9, 2003
Sumi M et al: Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer. AJNR Am J Neuroradiol. 24(8):1627-34, 2003
Wax MK et al: The role of positron emission tomography in the evaluation of the N-positive neck. Otolaryngol Head Neck Surg. 129(3):163-7, 2003
Ishikawa M et al: MR imaging of lymph nodes in the head and neck. Magn Reson Imaging Clin N Am. 10(3):527-42, 2002
Som PM et al: Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR Am J Roentgenol. 174(3):837-44, 2000
Robbins KT: Classification of neck dissection: current concepts and future considerations. Otolaryngol Clin North Am. 31(4):639-55, 1998
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
Diagnostic Checklist
TERMINOLOGY
Abbreviations
Nodal squamous cell carcinoma (SCCa)
Synonyms
SCCa nodal metastases
Definitions
Metastatic spread of primary head & neck SCCa to lymph nodes
IMAGING
General Features
CT Findings
MR Findings
Ultrasonographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Sananmuang T et al: Pre- and post-radiotherapy radiologic nodal features and oropharyngeal cancer outcomes. Laryngoscope. 131(4):E1162-71, 2021
Stack BC Jr et al: FDG-PET/CT and Pathology in Newly Diagnosed Head and Neck Cancer: ACRIN 6685 Trial, FDG-PET/CT cN0. Otolaryngol Head Neck Surg. 164(6):1230-1239, 2021
Stadler TM et al: FDG-PET-CT/MRI in head and neck squamous cell carcinoma: Impact on pretherapeutic N classification, detection of distant metastases, and second primary tumors. Head Neck. 43(7):2058-2068, 2021
Driessen DAJJ et al: Novel Diagnostic Approaches for Assessment of the Clinically Negative Neck in Head and Neck Cancer Patients. Front Oncol. 10:637513, 2020
Elhalawani H et al: Data from a terminated study on iron oxide nanoparticle magnetic resonance imaging for head and neck tumors. Sci Data. 7(1):63, 2020
Faraji F et al: Computed tomography performance in predicting extranodal extension in HPV-positive oropharynx cancer. Laryngoscope. 130(6):1479-1486, 2020
Hiyama T et al: Extra-nodal extension in head and neck cancer: how radiologists can help staging and treatment planning. Jpn J Radiol. 38(6):489-506, 2020
Mahieu R et al: New Developments in Imaging for Sentinel Lymph Node Biopsy in Early-Stage Oral Cavity Squamous Cell Carcinoma. Cancers (Basel). 12(10), 2020
Yan F et al: Predictive value of computed tomography in identifying extranodal extension in human papillomavirus-positive versus human papillomavirus-negative head and neck cancer. Head Neck. ePub, 2020
de Veij Mestdagh PD et al: Mapping of sentinel lymph node drainage using SPECT/CT to tailor elective nodal irradiation in head and neck cancer patients (SUSPECT-2): a single-center prospective trial. BMC Cancer. 19(1):1110, 2019
Forghani R et al: Head and neck squamous cell carcinoma: prediction of cervical lymph node metastasis by dual-energy CT texture analysis with machine learning. Eur Radiol. 29(11):6172-6181, 2019
Noor A et al: Predictive value of computed tomography in identifying extracapsular spread of cervical lymph node metastases in p16 positive oropharyngeal squamous cell carcinoma. J Med Imaging Radiat Oncol. 63(4):500-509, 2019
Tian S et al: Prognostic value of radiographically defined extranodal extension in human papillomavirus-associated locally advanced oropharyngeal carcinoma. Head Neck. 41(9):3056-3063, 2019
Traylor KS et al: Squamous Cell Carcinoma: PET/CT and PET/MRI of the Pretreatment and Post-Treatment Neck. Semin Ultrasound CT MR. 40(5):400-413, 2019
Abdel Razek AAK et al: Arterial spin labeling perfusion-weighted MR imaging: correlation of tumor blood flow with pathological degree of tumor differentiation, clinical stage and nodal metastasis of head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol. 275(5):1301-1307, 2018
Dai YL et al: State of the art MRI in head and neck cancer. Clin Radiol. 73(1):45-59, 2018
Kann BH et al: Pretreatment Identification of Head and Neck Cancer Nodal Metastasis and Extranodal Extension Using Deep Learning Neural Networks. Sci Rep. 8(1):14036, 2018
Mundada P et al: Utility of MRI with morphologic and diffusion weighted imaging in the detection of post-treatment nodal disease in head and neck squamous cell carcinoma. Eur J Radiol. 101:162-169, 2018
Zhang H et al: Utility of PET-CT in detecting nodal metastasis in cN0 early stage oral cavity squamous cell carcinoma. Oral Oncol. 80:89-92, 2018
Cho JK et al: Preoperative 18F-FDG-PET/CT vs Contrast-Enhanced CT to Identify Regional Nodal Metastasis among Patients with Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg. 157(3):439-447, 2017
Kelly HR et al: Chapter 2 Squamous Cell Carcinoma of the Head and Neck-Imaging Evaluation of Regional Lymph Nodes and Implications for Management. Semin Ultrasound CT MR. 38(5):466-478, 2017
Kulzer MH et al: Chapter 1 Neck Anatomy, Imaging-Based Level Nodal Classification and Impact of Primary Tumor Site on Patterns of Nodal Metastasis. Semin Ultrasound CT MR. 38(5):454-465, 2017
Aiken AH et al: Implementation of a novel surveillance template for head and neck cancer: neck imaging reporting and data system (NI-RADS). J Am Coll Radiol. 13(6):743-746.e1, 2016
de Bree R et al: Radiologic extranodal spread and matted nodes: Important predictive factors for development of distant metastases in patients with high-risk head and neck cancer. Head Neck. 38 Suppl 1:E1452-8, 2016
Fujita A et al: Imaging characteristics of metastatic nodes and outcomes by HPV status in head and neck cancers. Laryngoscope. 126(2):392-8, 2016
Gaddikeri S et al: Dynamic contrast-enhanced MR imaging in head and neck cancer: techniques and clinical applications. AJNR Am J Neuroradiol. 37(4):588-95, 2016
Kim SG et al: Potential role of PET/MRI for imaging metastatic lymph nodes in head and neck cancer. AJR Am J Roentgenol. 1-9, 2016
Aiken AH et al: Accuracy of preoperative imaging in detecting nodal extracapsular spread in oral cavity squamous cell carcinoma. AJNR Am J Neuroradiol. 36(9):1776-81, 2015
de Bree R et al: Advances in diagnostic modalities to detect occult lymph node metastases in head and neck squamous cell carcinoma. Head Neck. 37(12):1829-39, 2015
Eisenmenger LB et al: Imaging of head and neck lymph nodes. Radiol Clin North Am. 53(1):115-32, 2015
Forghani R et al: Imaging evaluation of lymphadenopathy and patterns of lymph node spread in head and neck cancer. Expert Rev Anticancer Ther. 15(2):207-24, 2015
Lee JR et al: Preoperative contrast-enhanced CT versus ¹⁸F-FDG PET/CT evaluation and the prognostic value of extranodal extension for surgical patients with head and heck squamous cell carcinoma. Ann Surg Oncol. 22 Suppl 3:S1020-7, 2015
Maxwell JH et al: Accuracy of computed tomography to predict extracapsular spread in p16-positive squamous cell carcinoma. Laryngoscope. 125(7):1613-8, 2015
Payne KF et al: The role of diffusion-weighted magnetic resonance imaging in the diagnosis, lymph node staging and assessment of treatment response of head and neck cancer. Int J Oral Maxillofac Surg. 44(1):1-7, 2015
Plaxton NA et al: Characteristics and Limitations of FDG PET/CT for Imaging of Squamous Cell Carcinoma of the Head and Neck: A Comprehensive Review of Anatomy, Metastatic Pathways, and Image Findings. AJR Am J Roentgenol. 205(5):W519-31, 2015
Barchetti F et al: The role of 3 Tesla diffusion-weighted imaging in the differential diagnosis of benign versus malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma. Biomed Res Int. 2014:532095, 2014
Grégoire V et al: Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol. 110(1):172-81, 2014
Chai RL et al: Accuracy of computed tomography in the prediction of extracapsular spread of lymph node metastases in squamous cell carcinoma of the head and neck. JAMA Otolaryngol Head Neck Surg. 139(11):1187-94, 2013
Hoang JK et al: Evaluation of cervical lymph nodes in head and neck cancer with CT and MRI: tips, traps, and a systematic approach. AJR Am J Roentgenol. 200(1):W17-25, 2013
Fukunari F et al: Cervical lymph nodes with or without metastases from oral squamous carcinoma: a correlation of MRI findings and histopathologic architecture. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 109(6):890-9, 2010
Ghadjar P et al: Incidence of small lymph node metastases with evidence of extracapsular extension: clinical implications in patients with head and neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 78(5):1366-72, 2010
Vandecaveye V et al: Applications of diffusion-weighted magnetic resonance imaging in head and neck squamous cell carcinoma. Neuroradiology. 52(9):773-84, 2010
Holzapfel K et al: Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes. Eur J Radiol. 72(3):381-7, 2009
Vandecaveye V et al: Head and neck squamous cell carcinoma: value of diffusion-weighted MR imaging for nodal staging. Radiology. 251(1):134-46, 2009
Kimura Y et al: MR imaging criteria for the prediction of extranodal spread of metastatic cancer in the neck. AJNR Am J Neuroradiol. 29(7):1355-9, 2008
Nakamura T et al: Nodal imaging in the neck: recent advances in US, CT and MR imaging of metastatic nodes. Eur Radiol. 17(5):1235-41, 2007
Vogl T et al: Lymph node staging. Top Magn Reson Imaging. 2007 Aug;18(4):303-16. Review. Erratum in: Top Magn Reson Imaging. 18(6):471, 2007
Abdel Razek AA et al: Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol. 16(7):1468-77, 2006
Gor DM et al: Imaging of cervical lymph nodes in head and neck cancer: the basics. Radiol Clin North Am. 44(1):101-10, viii, 2006
Kawai Y et al: Turbo short tau inversion recovery imaging for metastatic node screening in patients with head and neck cancer. AJNR Am J Neuroradiol. 27(6):1283-7, 2006
Schöder H et al: 18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. J Nucl Med. 47(5):755-62, 2006
King AD et al: Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US. Radiology. 230(3):720-6, 2004
Ahuja A et al: Sonography of neck lymph nodes. Part II: abnormal lymph nodes. Clin Radiol. 58(5):359-66, 2003
Fischbein NJ et al: Assessment of metastatic cervical adenopathy using dynamic contrast-enhanced MR imaging. AJNR Am J Neuroradiol. 24(3):301-11, 2003
Giridharan W et al: Lymph node metastases in the lower neck. Clin Otolaryngol. 28(3):221-6, 2003
Kosuda S et al: Feasibility and cost-effectiveness of sentinel lymph node radiolocalization in stage N0 head and neck cancer. Arch Otolaryngol Head Neck Surg. 129(10):1105-9, 2003
Sumi M et al: Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer. AJNR Am J Neuroradiol. 24(8):1627-34, 2003
Wax MK et al: The role of positron emission tomography in the evaluation of the N-positive neck. Otolaryngol Head Neck Surg. 129(3):163-7, 2003
Ishikawa M et al: MR imaging of lymph nodes in the head and neck. Magn Reson Imaging Clin N Am. 10(3):527-42, 2002
Som PM et al: Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR Am J Roentgenol. 174(3):837-44, 2000
Robbins KT: Classification of neck dissection: current concepts and future considerations. Otolaryngol Clin North Am. 31(4):639-55, 1998
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