MRI and Gene Expression in Diagnosing Patients With Ductal Breast Cancer In Situ

December 17, 2025 updated by: ECOG-ACRIN Cancer Research Group

Prospective Study of Magnetic Resonance Imaging (MRI) and Multiparameter Gene Expression Assay in Ductal Carcinoma In Situ (DCIS)

This clinical trial studies magnetic resonance imaging (MRI) and gene expression in diagnosing patients with abnormal cells in the breast duct that have not spread outside the duct. MRI uses radio waves and a powerful magnet linked to a computer to create detailed pictures of areas inside the body. MRI may help find and diagnose patients with breast cancer. It may also help doctors predict a patient's response to treatment and help plan the best treatment. Genetic studies may help doctors predict the outcome of treatment and the risk for disease recurrence. Performing MRI with genetic studies may help determine the best treatment for patients with breast cancer in situ.

Study Overview

Detailed Description

PRIMARY OBJECTIVES:

I. To estimate the proportion of patients with ductal carcinoma in situ (DCIS) diagnosed on core needle biopsy judged to be breast conservation candidates based upon standard imaging (mammography +/- sonography) and physical examination (a) who convert to mastectomy in step 1 based on MRI findings, and (b) who have a mastectomy as the final surgical procedure in step 2.

SECONDARY OBJECTIVES:

I. To assess the relation between baseline clinical covariates (e.g., tumor grade, necrosis, histologic type, mammographic lesion size), MRI morphologic and kinetic features, and the DCIS score.

II. To assess the diagnostic accuracy of MRI in extent of disease evaluation in patients with DCIS.

III. To estimate the proportion of patients who require re-operation because of inadequate excision after MRI.

IV. To estimate the proportion of patients who proceed to mastectomy after an initial attempt at wide local excision because of either inadequate tumor-free margins (< 2 mm), or other reasons.

V. To estimate the 5-year and 10-year ipsilateral breast event (in situ and invasive) rate (IBE) among women with DCIS assessed with MRI preoperatively and treated with wide local excision without radiation therapy (if there is a low DCIS score) or with radiation therapy (if there is an intermediate-high DCIS score).

VI. To estimate the proportion of women with DCIS who receive treatment that is concordant with their treatment goals and concerns.

VII. To estimate the proportion of women with DCIS whose decision autonomy preference was concordant with perceived level of decision involvement.

VIII. To assess decision quality using knowledge score and decision process. IX. To assess concordance between decision autonomy preference and perceived level of decision involvement, knowledge and decision process scores as independent predictors of decision satisfaction at the first post-operative visit.

X. To assess the relationship of patient-reported outcomes and disease-specific covariates, and quality of life after treatment.

XI. To assess the role of disease status, diagnostic test results and surgeon recommendation as predictors of treatment received.

XII. To compare the patient-reported diagnostic testing burden of bilateral mammography and MRI as measured by Testing Morbidities Index (TMI).

OUTLINE:

STEP 1:

ARM A: Patients undergo MRI prior to surgery. Patients undergo additional imaging and/or biopsies if indicated based on MRI.

STEP 2: Patients are assigned to 1 of 2 treatment arms based on the results of the MRI.

ARM B: Patients undergo a mastectomy. Patients do not register for Step 3.

ARM C: Patients undergo wide local excision +/- re-excision. Patients may cross-over to Arm B if mastectomy is indicated. Tissue samples collected during surgery are used to calculate the DCIS score using genetic analysis testing. Patients may then proceed to Step 3.

STEP 3: Patients are assigned to 1 of 2 treatment arms based on the results of the DCIS score test.

ARM D (DCIS score < 39): Patients undergo endocrine therapy as directed.

ARM E (DCIS score >= 39): Patients undergo radiation therapy and endocrine therapy as directed.

After completion of study treatment, patients are followed up every 6 months for 5 years and then every 12 months for 5 years.

Study Type

Interventional

Enrollment (Actual)

368

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • California
      • San Diego, California, United States, 92120
        • Kaiser Permanente-San Diego Zion
      • San Marcos, California, United States, 92069
        • Kaiser Permanente-San Marcos
    • Connecticut
      • Greenwich, Connecticut, United States, 06830
        • Greenwich Hospital
      • Hartford, Connecticut, United States, 06102
        • Hartford Hospital
      • Meriden, Connecticut, United States, 06451
        • Midstate Medical Center
      • New Britain, Connecticut, United States, 06050
        • The Hospital of Central Connecticut
    • Delaware
      • Newark, Delaware, United States, 19713
        • Helen F Graham Cancer Center
      • Newark, Delaware, United States, 19713
        • Medical Oncology Hematology Consultants PA
      • Newark, Delaware, United States, 19718
        • Christiana Care Health System-Christiana Hospital
      • Newark, Delaware, United States, 19713
        • Regional Hematology and Oncology PA
    • Florida
      • Atlantis, Florida, United States, 33462
        • John Fitzgerald Kennedy Medical Center
    • Illinois
      • Chicago, Illinois, United States, 60611
        • Northwestern University
      • Harvey, Illinois, United States, 60426
        • Ingalls Memorial Hospital
      • Naperville, Illinois, United States, 60540
        • Edward Hospital/Cancer Center
      • Plainfield, Illinois, United States, 60585
        • Edward Hospital/Cancer Center?Plainfield
      • Springfield, Illinois, United States, 62781
        • Memorial Medical Center
      • Springfield, Illinois, United States, 62703
        • Springfield Clinic
    • Indiana
      • Avon, Indiana, United States, 46123
        • IU Health West Hospital
      • Indianapolis, Indiana, United States, 46202
        • Indiana University/Melvin and Bren Simon Cancer Center
      • Mishawaka, Indiana, United States, 46544
        • Memorial Regional Cancer Center Day Road
      • South Bend, Indiana, United States, 46601
        • Memorial Hospital of South Bend
    • Kansas
      • Dodge City, Kansas, United States, 67801
        • Cancer Center of Kansas - Dodge City
      • El Dorado, Kansas, United States, 67042
        • Cancer Center of Kansas - El Dorado
      • Lawrence, Kansas, United States, 66044
        • Lawrence Memorial Hospital
      • Salina, Kansas, United States, 67401
        • Cancer Center of Kansas - Salina
      • Wellington, Kansas, United States, 67152
        • Cancer Center of Kansas - Wellington
      • Wichita, Kansas, United States, 67208
        • Cancer Center of Kansas-Wichita Medical Arts Tower
      • Wichita, Kansas, United States, 67208
        • Associates In Womens Health
      • Wichita, Kansas, United States, 67214
        • Cancer Center of Kansas - Main Office
      • Wichita, Kansas, United States, 67214
        • Via Christi Regional Medical Center
      • Winfield, Kansas, United States, 67156
        • Cancer Center of Kansas - Winfield
    • Kentucky
      • Owensboro, Kentucky, United States, 42303
        • Owensboro Health Mitchell Memorial Cancer Center
    • Louisiana
      • Baton Rouge, Louisiana, United States, 70809
        • Louisiana Hematology Oncology Associates LLC
      • Baton Rouge, Louisiana, United States, 70809
        • Mary Bird Perkins Cancer Center
      • Baton Rouge, Louisiana, United States, 70809
        • Medical Oncology LLC
      • New Orleans, Louisiana, United States, 70121
        • Ochsner Medical Center Jefferson
    • Maryland
      • Salisbury, Maryland, United States, 21801
        • Peninsula Regional Medical Center
    • Minnesota
      • Minneapolis, Minnesota, United States, 55407
        • Abbott-Northwestern Hospital
    • Missouri
      • Springfield, Missouri, United States, 65804
        • Mercy Hospital Springfield
      • St Louis, Missouri, United States, 63131
        • Missouri Baptist Medical Center
      • St Louis, Missouri, United States, 63141
        • Mercy Hospital Saint Louis
    • New Jersey
      • Flemington, New Jersey, United States, 08822
        • Hunterdon Medical Center
      • Mount Holly, New Jersey, United States, 08060
        • Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington County
      • Somerville, New Jersey, United States, 08876
        • Robert Wood Johnson University Hospital Somerset
      • Voorhees Township, New Jersey, United States, 08043
        • Virtua West Jersey Hospital Voorhees
    • New York
      • The Bronx, New York, United States, 10461
        • Albert Einstein College of Medicine
      • The Bronx, New York, United States, 10467-2490
        • Montefiore Medical Center - Moses Campus
      • The Bronx, New York, United States, 10461
        • Montefiore Medical Center-Einstein Campus
    • North Carolina
      • Asheville, North Carolina, United States, 28816
        • Hope Women's Cancer Centers-Asheville
      • Asheville, North Carolina, United States, 28801
        • Cancer Care of Western North Carolina
      • Asheville, North Carolina, United States, 28801
        • Mission Hospital-Memorial Campus
      • Winston-Salem, North Carolina, United States, 27157
        • Wake Forest University Health Sciences
    • Ohio
      • Canton, Ohio, United States, 44710
        • Aultman Health Foundation
      • Cincinnati, Ohio, United States, 45219
        • The Christ Hospital
    • Pennsylvania
      • Bryn Mawr, Pennsylvania, United States, 19010
        • Bryn Mawr Hospital
      • Easton, Pennsylvania, United States, 18042
        • Easton Hospital
      • Gettysburg, Pennsylvania, United States, 17325
        • Adams Cancer Center
      • Hershey, Pennsylvania, United States, 17033-0850
        • Penn State Milton S Hershey Medical Center
      • Media, Pennsylvania, United States, 19063
        • Riddle Memorial Hospital
      • Paoli, Pennsylvania, United States, 19301
        • Paoli Memorial Hospital
      • Philadelphia, Pennsylvania, United States, 19104
        • University of Pennsylvania/Abramson Cancer Center
      • Phoenixville, Pennsylvania, United States, 19460
        • Phoenixville Hospital
      • Pottstown, Pennsylvania, United States, 19464
        • Pottstown Memorial Medical Center
      • Wynnewood, Pennsylvania, United States, 19096
        • Lankenau Medical Center
      • York, Pennsylvania, United States, 17405
        • WellSpan Health-York Hospital
    • Rhode Island
      • Providence, Rhode Island, United States, 02903
        • Rhode Island Hospital
      • Providence, Rhode Island, United States, 02908
        • Roger Williams Medical Center
    • South Carolina
      • Spartanburg, South Carolina, United States, 29303
        • Spartanburg Medical Center
    • Texas
      • Dallas, Texas, United States, 75246
        • Baylor University Medical Center
    • Utah
      • Salt Lake City, Utah, United States, 84112
        • Huntsman Cancer Institute/University of Utah
    • Washington
      • Seattle, Washington, United States, 98109
        • Seattle Cancer Care Alliance
      • Seattle, Washington, United States, 98195
        • University of Washington Medical Center
      • Seattle, Washington, United States, 98109
        • Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
    • Wisconsin
      • Oconomowoc, Wisconsin, United States, 53066
        • Oconomowoc Memorial Hospital-ProHealth Care Inc
      • Waukesha, Wisconsin, United States, 53188
        • Waukesha Memorial Hospital
      • Wausau, Wisconsin, United States, 54401
        • Aspirus Regional Cancer Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Registration to Step 1:
  • Patients must have pathologically confirmed diagnosis of unilateral ductal carcinoma in situ with no evidence of microinvasive or invasive disease obtained by core needle biopsy within 4 months of registration; patients diagnosed by surgical excision are not eligible; patients with synchronous bilateral disease are not eligible; patients with synchronous bilateral disease (i.e., synchronous DCIS or invasive cancer) are not eligible

    • Patients will be staged prior to registration according to the clinical staging criteria adapted from the American Joint Committee on Cancer (AJCC) Cancer Staging Data Forms of the AJCC Cancer Staging Manual, 7th Edition, 2009; Note: For consistency purposes, AJCC 7th Edition will continue to be used throughout the entire study enrollment period
  • Required studies include a bilateral screening mammogram within 6 months and diagnostic mammogram of the affected breast within 3 months prior to registration
  • Patients must not have previous ipsilateral invasive breast cancer or DCIS
  • Patients must not have known deleterious mutations in breast cancer (BRCA) genes
  • Patients must not have received hormonal therapy (i.e., tamoxifen, raloxifene, and/or aromatase inhibitors) for prevention of breast cancer within 3 months of the biopsy documenting DCIS
  • Patients must not have history of chemotherapy for cancer within 6 months prior to registration
  • No prior history of breast radiotherapy that will prevent the use of radiotherapy for the present DCIS
  • Patients must be judged to be suitable to undergo MRI and receive the contrast agent gadolinium (exclusions follow):

    • No history of untreatable claustrophobia;
    • No presence of metallic objects or implanted medical devices in body (i.e., cardiac pacemaker, aneurysm clips, surgical clips, prostheses, artificial hearts, valves with steel parts, metal fragments, shrapnel, tattoos near the eye, or steel implants);
    • No history of sickle cell disease;
    • No contraindication to intravenous contrast administration;
    • No known allergy-like reaction to gadolinium or moderate or severe allergic reactions to one or more allergens as defined by the American College of Radiology (ACR); patient may be eligible if willing to undergo pre-treatment as defined by the institution's policy and/or ACR guidance;
    • No findings consistent with renal failure, as determined by glomerular filtration rate (GFR) < 30 mL/min/1.73 m^2 based on a serum creatinine level obtained within 28 days prior to registration;
    • Weight lower than that allowable by the MRI table;
  • No prior MRI of the breasts within the 6 months prior to registration
  • Patients must be eligible for breast-conserving therapy (BCT) based on clinical examination and mammography; if ultrasound is performed, findings must also be consistent with eligibility for BCT
  • Patients must not have multicentric disease scheduled to undergo multiple lumpectomies; multifocal disease that can be encompassed in a single operative bed are eligible
  • Women must not be pregnant or breast-feeding; all females of childbearing potential must have a blood test or urine study within 3 weeks prior to registration to rule out pregnancy; a female of childbearing potential is any woman, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria:

    • Has not undergone a hysterectomy or bilateral oophorectomy; or
    • Has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
  • Women of childbearing potential must be strongly advised to use an accepted and effective method of contraception or to abstain from sexual intercourse for the duration of their participation in the study
  • Registration to Step 2:
  • MRI has been performed in Step 1, and additional imaging studies and biopsies performed if indicated
  • The clinician/patient has made the decision as to whether the patient will proceed to wide local excision or mastectomy
  • Registration to Step 3:
  • Patient's most recent surgery was wide local excision with or without re-excision and for which there was obtained clear (>= 2 mm) margins at breast conserving surgery, and the pathology reveals pure DCIS; patients with invasive cancer or DCIS with microinvasion will not be registered on step 3, but will be followed for clinical outcomes
  • The OncotypeDX Patient Report of the DCIS Score from the OncotypeDX Breast Cancer Assay performed by Genomic Health on the excision tissue have been uploaded by the site into the Rave electronic case report forms (eCRF)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Diagnostic
  • Allocation: Non-Randomized
  • Interventional Model: Crossover Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Arm A (MRI)
Patients undergo MRI prior to surgery. Patients undergo additional imaging and/or biopsies if indicated based on MRI.
Correlative studies
Ancillary studies
Other Names:
  • Quality of Life Assessment
Undergo MRI
Other Names:
  • MRI
  • Magnetic Resonance Imaging Scan
  • MRI Scan
  • NMRI
Correlative studies
Other Names:
  • Cytologic Sampling
Experimental: Arm B (mastectomy)
Patients undergo a mastectomy. Patients do not register for Step 3.
Correlative studies
Ancillary studies
Other Names:
  • Quality of Life Assessment
Correlative studies
Other Names:
  • Cytologic Sampling
Undergo mastectomy
Experimental: Arm C (wide local excision)
Patients undergo wide local excision +/- re-excision. Patients may cross-over to Arm B if mastectomy is indicated. Tissue samples collected during surgery are used to calculate the DCIS score using genetic analysis testing. Patients may then proceed to Step 3.
Correlative studies
Ancillary studies
Other Names:
  • Quality of Life Assessment
Correlative studies
Other Names:
  • Cytologic Sampling
Undergo wide local excision
Experimental: Arm D (endocrine therapy)
Patients undergo endocrine therapy as directed.
Correlative studies
Ancillary studies
Other Names:
  • Quality of Life Assessment
Correlative studies
Other Names:
  • Cytologic Sampling
Undergo endocrine therapy
Other Names:
  • Chemotherapy-Hormones/Steroids
  • Hormonal Therapy
  • Hormone Therapy
Experimental: Arm E (radiation therapy, endocrine therapy)
Patients undergo radiation therapy and endocrine therapy as directed.
Correlative studies
Ancillary studies
Other Names:
  • Quality of Life Assessment
Undergo radiation therapy
Other Names:
  • Cancer Radiotherapy
  • Irradiate
  • Irradiated
  • Irradiation
  • RT
Undergo endocrine therapy
Other Names:
  • Chemotherapy-Hormones/Steroids
  • Hormonal Therapy
  • Hormone Therapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Proportion of patients judged to be breast conservation candidates based upon standard imaging and physical examination who convert to mastectomy in step 1 based on MRI findings
Time Frame: After MRI (within 30 days following study entry), and prior to surgery
After MRI (within 30 days following study entry), and prior to surgery
Proportion of patients judged to be breast conservation candidates based upon standard imaging and physical examination who have a mastectomy as the final surgical procedure in step 2
Time Frame: Up to 12 months post-op
Up to 12 months post-op

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Factors associated with DCIS score
Time Frame: After surgery (DCIS Score is determined from surgical specimen)
The relation between baseline clinical covariates (tumor grade, necrosis, histologic type, mammographic lesion size), MRI morphologic and kinetic features, and the DCIS score will be assessed.
After surgery (DCIS Score is determined from surgical specimen)
Diagnostic accuracy of MRI in extent of disease evaluation in patients with DCIS
Time Frame: Up to 12 months post-op
Up to 12 months post-op
Proportion of patients who require re-operation because of inadequate excision after MRI
Time Frame: Up to 12 months post-op
A two-sided 95% Wilson confidence interval will be derived.
Up to 12 months post-op
Proportion of patients who proceed to mastectomy after an initial attempt at wide local excision because of either inadequate tumor-free margins (< 2mm), or other reasons
Time Frame: Up to 12 months post-op
A two-sided 95% Wilson confidence interval will be derived. In addition to the overall probability of conversion in this cohort, estimates will be stratified by the reason for conversion.
Up to 12 months post-op
IBE rate
Time Frame: At 5 years
Kaplan-Meier curves will be derived for the time to ipsilateral breast event for patients assigned to be treated with RT and those not treated with RT. Point estimates and 95% two-sided confidence intervals will be developed.
At 5 years
IBE rate
Time Frame: At 10 years
Kaplan-Meier curves will be derived for the time to ipsilateral breast event for patients assigned to be treated with RT and those not treated with RT. Point estimates and 95% two-sided confidence intervals will be developed.
At 10 years
Proportion of women who receive treatment that is concordant with their treatment goals and concerns
Time Frame: Up to 24 months post-op
The proportion of patients with concordant care will be calculated and a 95% Wilson confidence interval will also be derived.
Up to 24 months post-op
Proportion of women whose decision autonomy preference was concordant with perceived level of decision involvement
Time Frame: Up to 5 days after pre-surgical consultation
Concordance will be defined as an exact match between decision autonomy preference (patient-based, shared, surgeon-based) and perceived level of decision involvement (patient based, shared, surgeon-based) as assessed by the Control Preferences Scale, reduced to three categories. The proportion of patients with concordance will be calculated for the sample. In addition, the degree of concordance over the group will be determined using kappa analysis.
Up to 5 days after pre-surgical consultation
Decision quality, assessed using the composite of knowledge score and decision process score
Time Frame: Up to 5 days after pre-surgical consultation
To calculate knowledge score, a point for each correct answer on the knowledge questionnaire will be assigned, with missing responses receiving 0 points. A total score will be calculated for all patients who complete at least half of the items and scaled from 0-100%. To calculate a decision process score, a point will be assigned for each "yes" or "a lot/some" response. The sum will be scaled from 0-100%. The average of the two scores will be used as the outcome measure.
Up to 5 days after pre-surgical consultation
Role of concordance between decision autonomy preference and perceived level of decision involvement, knowledge and decision process scores as independent predictors of decision satisfaction
Time Frame: Assessed via questionnaire administered at first post-operative visit
Linear regression modeling will be used in which the response variable will be decision satisfaction. The independent variables will be the indicator of concordance between decision autonomy preference and perceived level of decision involvement, the knowledge score and the decision process score. Two-way interactions between predictors will also be examined.
Assessed via questionnaire administered at first post-operative visit
Patient-reported quality of life, measured using the Patient Reported Outcomes Measurement Information System (PROMIS)10 instrument
Time Frame: At 12 months post-op
The relationship of patient-reported outcomes and disease specific covariates, and quality of life will be assessed.
At 12 months post-op
Patient-reported quality of life, measured using the PROMIS10 instrument
Time Frame: At 24 months post-op
The relationship of patient-reported outcomes and disease specific covariates, and quality of life will be assessed.
At 24 months post-op
Role of disease status, diagnostic test results, and surgeon recommendation as predictors of treatment received
Time Frame: Up to 24 months post-op
Logistic regression modeling will be used in which the response variable will be the indicator of conversion to mastectomy (vs lumpectomy). The independent variables will include covariates describing disease status at baseline, MRI results, surgeon recommendation, patient decision involvement (such as the decision autonomy preference scale) and treatment concerns (as measured via the 7-item questionnaire). Separate analyses will be performed for conversion to mastectomy directly post MRI and conversion to mastectomy following BCS as the response variable.
Up to 24 months post-op
Patient-reported diagnostic testing burden of bilateral mammogram, MRI, and biopsies, measured by TMI
Time Frame: Up to 5 days after pre-surgical consultation
A Wilcoxon signed rank test will be used to compare TMI scores for mammography and MRI. In a secondary analysis regression modeling will be used to examine the effects of patient characteristics on the patient's perception of diagnostic test burden for the two modalities.
Up to 5 days after pre-surgical consultation

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Constance Lehman, ECOG-ACRIN Cancer Research Group

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 25, 2015

Primary Completion (Estimated)

November 1, 2027

Study Completion (Estimated)

November 1, 2027

Study Registration Dates

First Submitted

January 16, 2015

First Submitted That Met QC Criteria

January 27, 2015

First Posted (Estimated)

February 2, 2015

Study Record Updates

Last Update Posted (Estimated)

December 19, 2025

Last Update Submitted That Met QC Criteria

December 17, 2025

Last Verified

December 1, 2025

More Information

Terms related to this study

Other Study ID Numbers

  • E4112 (Other Identifier: ECOG-ACRIN Cancer Research Group)
  • UG1CA189828 (U.S. NIH Grant/Contract)
  • U10CA037403 (U.S. NIH Grant/Contract)
  • NCI-2014-01261 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
  • ECOG-E4112 (Other Identifier: DCP)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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