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01-04-2017 | Topic Paper

Update on histopathological evaluation of lymphadenectomy specimens from prostate cancer patients

Authors: Alessandro Conti, Matteo Santoni, Luciano Burattini, Marina Scarpelli, Roberta Mazzucchelli, Andrea B. Galosi, Liang Cheng, Antonio Lopez-Beltran, Alberto Briganti, Francesco Montorsi, Rodolfo Montironi

Published in: World Journal of Urology | Issue 4/2017

Abstract

Background

Metastases to lymph nodes (LNs) represent an unfavorable prognostic factor in patients with prostate cancer (PCa). Histological examination represents the gold standard in the evaluation of the lymphadenectomy (LND) specimens for the presence of secondary deposits.

Methods and results

The metastatic detection rate can vary according to the approach adopted in the microscopic analysis of the LNs, which includes frozen-section examination, total inclusion of the tissue with and without whole-mount sections, serial sectioning, and the application of immunohistochemistry. The assessment of the sentinel LN, the search for micrometastases, and the evaluation of atypical LN metastatic sites further contribute to the detection of the metastatic spread.

Conclusion

In this review, an update on the histopathological evaluation of LND specimens in patients with PCa is given, and focus is made on their clinical and prognostic significance.

Cheng L, Zincke H, Blute ML, Bergstralh EJ, Scherer B, Bostwick DG (2001) Risk of prostate carcinoma death in patients with lymph node metastasis. Cancer 91:66–73CrossRefPubMed

Pierorazio PM, Gorin MA, Ross AE, Feng Z, Trock BJ, Schaeffer EM, Han M, Epstein JI, Partin AW, Walsh PC, Bivalacqua TJ (2013) Pathological and oncologic outcomes for men with positive lymph nodes at radical prostatectomy: the Johns Hopkins Hospital 30-year experience. Prostate 73:1673–1680PubMed

Briganti A, Karnes JR, Da Pozzo LF, Cozzarini C, Gallina A, Suardi N, Bianchi M, Freschi M, Doglioni C, Fazio F, Rigatti P, Montorsi F, Blute ML (2009) Two positive nodes represent a significant cut-off value for cancer specific survival in patients with node positive prostate cancer. A new proposal based on a two-institution experience on 703 consecutive N + patients treated with radical prostatectomy, extended pelvic lymph node dissection and adjuvant therapy. Eur Urol 55:261–270CrossRefPubMed

Gandaglia G, Karnes RJ, Cozzarini C, Montorsi F, Briganti A (2015) Node-positive prostate cancer: a call for level 1 evidence. Oncology (Williston Park) 29:118, 125, 141

Ploussard G, Briganti A, de la Taille A, Haese A, Heidenreich A, Menon M, Sulser T, Tewari AK, Eastham JA (2014) Pelvic lymph node dissection during robot-assisted radical prostatectomy: efficacy, limitations, and complications-a systematic review of the literature. Eur Urol 65:7–16CrossRefPubMed

Briganti A, Blute ML, Eastham JH, Graefen M, Heidenreich A, Karnes JR, Montorsi F, Studer UE (2009) Pelvic lymph node dissection in prostate cancer. Eur Urol 55:1251–1265CrossRefPubMed

Heidenreich A, Ohlmann CH, Polyakov S (2007) Anatomical extent of pelvic lymphadenectomy in patients undergoing radical prostatectomy. Eur Urol 52:29–37CrossRefPubMed

Heidenreich A, Pfister D, Thuer D, Brehmer B (2011) Percentage of positive biopsies predicts lymph node involvement in men with low-risk prostate cancer undergoing radical prostatectomy and extended pelvic lymphadenectomy. BJU Int 107:220–225CrossRefPubMed

Liu JJ, Lichtensztajn DY, Gomez SL, Sieh W, Chung BI, Cheng I, Brooks JD (2014) Nationwide prevalence of lymph node metastases in Gleason score 3 + 3 = 6 prostate cancer. Pathology 46:306–310CrossRefPubMed

10.

Kryvenko ON, Epstein JI (2015) Re: Nationwide prevalence of lymph node metastases in Gleason score 3 + 3 = 6 prostate cancer. Pathology 47:394CrossRefPubMed

11.

Weingartner K, Ramaswamy A, Bittinger A, Gerharz EW, Voge D, Riedmiller H (1996) Anatomical basis for pelvic lymphadenectomy in prostate cancer: results of an autopsy study and implications for the clinic. J Urol 156:1969–1971CrossRefPubMed

12.

Kluth LA, Abdollah F, Xylinas E, Rieken M, Fajkovic H, Seitz C, Sun M, Karakiewicz PI, Schramek P, Herman MP, Becker A, Hansen J, Ehdaie B, Loidl W, Pummer K, Lee RK, Lotan Y, Scherr DS, Seiler D, Ahyai SA, Chun FK, Graefen M, Tewari A, Nonis A, Bachmann A, Montorsi F, Gönen M, Briganti A, Shariat SF (2014) Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment. Br J Cancer 111:213–219CrossRefPubMedPubMedCentral

13.

Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, Bianchi M, Sun M, Freschi M, Salonia A, Karakiewicz PI, Rigatti P, Montorsi F (2012) Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol 61:480–487CrossRefPubMed

14.

Epstein JI, Oesterling JE, Eggleston JC, Walsh PC (1986) Frozen section detection of lymph node metastases in prostatic carcinoma: accuracy in grossly uninvolved pelvic lymphadenectomy specimens. J Urol 136:1234–1237PubMed

15.

Young MP, Kirby RS, O’Donoghue EP, Parkinson MC (1999) Accuracy and cost of intraoperative lymph node frozen sections at radical prostatectomy. J Clin Pathol 52:925–927CrossRefPubMedPubMedCentral

16.

Beissnedr RS, Stricker JB, Speights VO, Coffield KS, Spiekerman AM, Riggs M (2002) Frozen section diagnosis of metastatic prostate adenocarcinoma in pelvic lymphadenectomy compared with nomogram prediction of metastasis. Urology 59:721–725CrossRef

17.

Joniau S, Van den Bergh L, Lerut E, Deroose CM, Haustermans K, Oyen R, Budiharto T, Ameye F, Bogaerts K, Van Poppel H (2013) Mapping of pelvic lymph node metastases in prostate cancer. Eur Urol 63:450–458CrossRefPubMed

18.

Mattei A, Fuechsel FG, Bhatta Dhar N (2008) The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multimodality mapping study. Eur Urol 53:118–125CrossRefPubMed

19.

Weckermann D, Dorn R, Trefz M, Wagner T, Wawroschek F, Harzmann R (2007) Sentinel lymph node dissection for prostate cancer: experience with more than 1,000 patients. J Urol 177:916–920CrossRefPubMed

20.

Holl G, Dorn R, Wengenmair H, Weckermann D, Sciuk J (2009) Validation of sentinel lymph node dissection in prostate cancer: experience in more than 2,000 patients. Eur J Nucl Med Mol Imaging 36:1377–1382CrossRefPubMed

21.

van der Poel HG, Buckle T, Brouwer OR, Valdes Olmos RA, van Leeuwen FW (2011) Intraoperative laparoscopic fluorescence guidance to the sentinel lymph node in prostate cancer patients: clinical proof of concept of an integrated functional imaging approach using a multimodal tracer. Eur Urol 60:826–833CrossRefPubMed

22.

Yuen K, Miura T, Sakai I, Kiyosue A, Yamashita M (2015) Intraoperative fluorescence imaging for detection of sentinel lymph nodes and lymphatic vessels during open prostatectomy using indocyanine green. J Urol 194:371–377CrossRefPubMed

23.

Hruby S, Englberger C, Lusuardi L, Schätz T, Kunit T, Abdel-Aal AM, Hager M, Janetschek G (2015) Fluorescence guided targeted pelvic lymph node dissection for intermediate and high risk prostate cancer. J Urol 194:357–363CrossRefPubMed

24.

Jeschke S, Lusuardi L, Myatt A, Hruby S, Pirich C, Janetschek G (2012) Visualisation of the lymph node pathway in real time by laparoscopic radioisotope- and fluorescence-guided sentinel lymph node dissection in prostate cancer staging. Urology 80:1080–1086CrossRefPubMed

25.

Perry-Keene J, Ferguson P, Samaratunga H, Nacey JN, Delahunt B (2014) Total submission of pelvic lymphadenectomy tissues removed during radical prostatectomy for prostate cancer increases lymph node yield and detection of micrometastases. Histopathology 64:399–404CrossRefPubMed

26.

Montironi R, Scarpelli M, Galosi AB, Lopez-Beltran A, Mazzucchelli R, Montorsi F, Cheng L (2014) Total submission of lymphadenectomy tissues removed during radical prostatectomy for prostate cancer: possible clinical significance of large-format histology. Hum Pathol 45:2059–2062CrossRefPubMed

27.

Epstein JI, Egevad L, Humphrey PA, Montironi R, Members of the ISUP Immunohistochemistry in Diagnostic Urologic Pathology Group (2014) Best practices recommendations in the application of immunohistochemistry in the prostate: report from the International Society of Urologic Pathology consensus conference. Am J Surg Pathol 38:e6–e19CrossRefPubMed

28.

Clobes H, Fossa SD, Waehre H, Jocham D, Berner A (2000) The immunohistochemical assessment of occult regional lymph node metastases in patients with T3pN0M0 prostate cancer before definitive radiotherapy. BJU Int 85:270–275CrossRefPubMed

29.

Schiavina R, Capizzi E, Borghesi M, Vagnoni V, Romagnoli D, Rocca GC, Giunchi F, D’Errico A, De Giovanni A, Rizzi S, Brunocilla E, Martorana G, Fiorentino M (2015) Nodal occult metastases in intermediate- and high-risk prostate cancer patients detected using serial section, immunohistochemistry, and real-time reverse transcriptase polymerase chain reaction: prospective evaluation with matched-pair analysis. Clin Genitourin Cancer 13:e55–e64CrossRefPubMed

30.

Gomella LG, White JL, McCue PA, Byrne DS, Mulholland SG (1993) Screening for occult nodal metastasis in localized carcinoma of the prostate. J Urol 149:776–778PubMed

31.

Kollermann J, Heseding B, Helpap B, Köllermann MW, Pantel K (1999) Comparative immunocytochemical assessment of isolated carcinoma cells in lymph nodes and bone marrow of patients with clinically localized prostate cancer. Int J Cancer 84:145–149CrossRefPubMed

32.

Gallee MP, Visser-de Jong E, van der Korput JA, van der Kwast TH, ten Kate FJ, Schroeder FH, Trapman J (1990) Variation of prostate-specific antigen expression in different tumour growth patterns present in prostatectomy specimens. Urol Res 18:181–187CrossRefPubMed

33.

Goldstein NS (2002) Immunophenotypic characterization of 225 prostate adenocarcinomas with intermediate or high Gleason scores. Am J Clin Pathol 117:471–477CrossRefPubMed

34.

Roudier MP, True LD, Higano CS, Vesselle H, Ellis W, Lange P, Vessella RL (2003) Phenotypic heterogeneity of end-stage prostate carcinoma metastatic to bone. Hum Pathol 34:646–653CrossRefPubMed

35.

Paterson RF, Gleave ME, Jones EC, Zubovits JT, Goldenberg SL, Sullivan LD (1999) Immunohistochemical analysis of radical prostatectomy specimens after 8 months of neoadjuvant hormonal therapy. Mol Urol 3:277–286PubMed

36.

Pagliarulo V, Hawes D, Brands FH, Groshen S, Cai J, Stein JP, Lieskovsky G, Skinner DG, Cote RJ (2006) Detection of occult lymph node metastases in locally advanced node-negative prostate cancer. J Clin Oncol 24:2735–2742CrossRefPubMed

37.

Varma M, Jasani B (2005) Diagnostic utility of immunohistochemistry in morphologically difficult prostate cancer: review of current literature. Histopathology 47:1–16CrossRefPubMed

38.

Kalos M, Askaa J, Hylander BL, Repasky EA, Cai F, Vedvick T, Reed SG, Wright GL Jr, Fanger GR (2004) Prostein expression is highly restricted to normal and malignant prostate tissues. Prostate 60:246–256CrossRefPubMed

39.

Sheridan T, Herawi M, Epstein JI, Illei PB (2007) The role of P501S and PSA in the diagnosis of metastatic adenocarcinoma of the prostate. Am J Surg Pathol 31:1351–1355CrossRefPubMed

40.

Yin M, Dhir R, Parwani AV (2007) Diagnostic utility of p501 s (prostein) in comparison to prostate specific antigen (PSA) for the detection of metastatic prostatic adenocarcinoma. Diagn Pathol 2:41CrossRefPubMedPubMedCentral

41.

Gary B, Azuero R, Mohanty GS, Bell WC, Eltoum IE, Abdulkadir SA (2004) Interaction of Nkx3.1 and p27kip1 in prostate tumor initiation. Am J Pathol 164:1607–1614CrossRefPubMedPubMedCentral

42.

Gurel B, Ali TZ, Montgomery EA, Begum S, Hicks J, Goggins M, Eberhart CG, Clark DP, Bieberich CJ, Epstein JI, De Marzo AM (2010) NKX3.1 as a marker of prostatic origin in metastatic tumors. Am J Surg Pathol 34:1097–1105CrossRefPubMedPubMedCentral

43.

Gu Z, Thomas G, Yamashiro J, Shintaku IP, Dorey F, Raitano A, Witte ON, Said JW, Loda M, Reiter RE (2000) Prostate stem cell antigen (PSCA) expression increases with high gleason score, advanced stage and bone metastasis in prostate cancer. Oncogene 19:1288–1296CrossRefPubMed

44.

Miyake H, Kurahashi T, Hara I, Takenaka A, Fujisawa M (2007) Significance of micrometastases in pelvic lymph nodes detected by real-time reverse transcriptase polymerase chain reaction in patients with clinically localized prostate cancer undergoing radical prostatectomy after neoadjuvant hormonal therapy. BJU Int 99:315–320CrossRefPubMed

45.

Isebaert S, Haustermans K, Van den Bergh L, Joniau S, Dirix P, Oyen R, Deroose CM, Van Poppel H, Lerut E (2013) Identification and characterization of nodal metastases in prostate cancer patients at high risk for lymph node involvement. Acta Oncol 52:1336–1344CrossRefPubMed

46.

Schilling D, Hennenlotter J, Sotlar K (2010) Quantification of tumor cell burden by analysis of single cell lymph node disaggregates in metastatic prostate cancer. Prostate 70:1110–1118CrossRefPubMed

47.

Wawroschek F, Wagner T, Hamm M, Weckermann D, Vogt H, Märkl B, Gordijn R, Harzmann R (2003) The influence of serial sections, immunohistochemistry, and extension of pelvic lymph node dissection on the lymph node status in clinically localized prostate cancer. Eur Urol 43:132–136CrossRefPubMed

48.

Schilling D, Hennenlotter J, Gakis G, Schwentner C, Kuehs U, Stenzl A, Sotlar K (2012) Prospective assessment of histological serial sectioning of pelvic lymph nodes in prostate cancer: a cost-benefit analysis. BJU Int 110:E166–E171CrossRefPubMed

49.

Madsen EV, van Dalen J, van Gorp J, Borel Rinkes IH, van Dalen T (2008) Strategies for optimizing pathologic staging of sentinel lymph nodes in breast cancer patients. Virchows Arch 453:17–24CrossRefPubMed

50.

Engvad B, Poulsen MH, Staun PW, Walter S, Marcussen N (2014) Histological step sectioning of pelvic lymph nodes increases the number of identified lymph node metastases. Virchows Arch 464:45–52CrossRefPubMed

51.

Stanik M, Capak I, Macik D, Vašina J, Lžičařová E, Jarkovský J, Šustr M, Miklánek D, Doležel J (2014) Sentinel lymph node dissection combined with meticulous histology increases the detection rate of LN metastases in prostate cancer. Int Urol Nephrol 46:1543–1549CrossRefPubMed

52.

Fukuda M, Egawa M, Imao T, Takashima H, Yokoyama K, Namiki M (2007) Detection of sentinel node micrometastasis by step section and immunohistochemistry in patients with prostate cancer. J Urol 177:1313–1317CrossRefPubMed

53.

Davids V, Kidson SH, Hanekom GS (2003) Melanoma patient staging: histopathological versus molecular evaluation of the sentinel node. Melanoma Res 13:313–324CrossRefPubMed

54.

Terakawa T, Miyake H, Kurahashi T, Furukawa J, Takenaka A, Fujisawa M (2009) Improved sensitivity for detecting micrometastases in pelvic lymph nodes by real-time reverse transcriptase polymerase chain reaction (RT-PCR) compared with conventional RT-PCR in patients with clinically localized prostate cancer undergoing radical prostatectomy. BJU Int 103:1074–1078CrossRefPubMed

55.

Schostak M, Krause H, Miller K, Schrader M, Kempkensteffen C, Kollermann J (2007) Does the molecular staging in pelvic lymph nodes improve the detection of relevant prostate cancer metastases? An assessment after 6 years. BJU Int 99:1409–1414CrossRefPubMed

56.

Fujisawa M, Miyake H (2008) Significance of micrometastases in prostate cancer. Surg Oncol 17:247–252CrossRefPubMed

57.

Ferrari AC, Stone NN, Kurek R, Mulligan E, McGregor R, Stock R, Unger P, Tunn U, Kaisary A, Droller M, Hall S, Renneberg H, Livak KJ, Gallagher RE, Mandeli J (2006) Molecular load of pathologically occult metastases in pelvic lymph nodes is an independent prognostic marker of biochemical failure after localized prostate cancer treatment. J Clin Oncol 24:3081–3088CrossRefPubMed

58.

Schiavina R, Scattoni V, Castellucci P, Picchio M, Corti B, Briganti A, Franceschelli A, Sanguedolce F, Bertaccini A, Farsad M, Giovacchini G, Fanti S, Grigioni WF, Fazio F, Montorsi F, Rigatti P, Martorana G (2008) 11C-choline positron emission tomography/computerized tomography for preoperative lymph-node staging in intermediate-risk and high-risk prostate cancer: comparison with clinical staging nomograms. Eur Urol 54:392–401CrossRefPubMed

59.

Cheng L, Pisansky TM, Ramnani DM, Leibovich BC, Cheville JC, Slezak J, Bergstralh EJ, Zincke H, Bostwick DG (2000) Extranodal extension in lymph node-positive prostate cancer. Mod Pathol 13:113–118CrossRefPubMed

60.

Fleischmann A, Schobinger S, Markwalder R, Burkhard F, Thalmann GN, Studer UE (2008) Prognostic factors in lymph node metastases of prostatic cancer patients: the size of the metastases but not extranodal extension independently predicts survival. Histopathology 53:468–475CrossRefPubMed

61.

Boormans JL, Wildhagen MF, Bangma CH, Verhagen PC, van Leenders GJ (2008) Histopathological characteristics of lymph node metastases predict cancer-specific survival in node-positive prostate cancer. BJU Int 102:1589–1593CrossRefPubMed

62.

Fleischmann A, Schobinger S, Schumacher M, Thalmann GN, Studer UE (2009) Survival in surgically treated, nodal positive prostate cancer patients is predicted by histopathological characteristics of the primary tumor and its lymph node metastases. Prostate 69:352–362CrossRefPubMed

63.

Griebling TL, Ozkutlu D, See WA, Cohen MB (1997) Prognostic implications of extracapsular extension of lymph node metastases in prostate cancer. Mod Pathol 10:804–809PubMed

64.

Berney DM, Wheeler TM, Grignon DJ, Epstein JI, Griffiths DF, Humphrey PA, van der Kwast T, Montironi R, Delahunt B, Egevad L, Srigley JR, ISUP Prostate Cancer Group (2011) International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes. Mod Pathol 24:39–47CrossRefPubMed

65.

Passoni NM, Fajkovic H, Xylinas E, Kluth L, Seitz C, Robinson BD, Rouprêt M, Chun FK, Lotan Y, Roehrborn CG, Crivelli JJ, Karakiewicz PI, Scherr DS, Rink M, Graefen M, Schramek P, Briganti A, Montorsi F, Tewari A, Shariat SF (2014) Prognosis of patients with pelvic lymph node (LN) metastasis after radical prostatectomy: value of extranodal extension and size of the largest LN metastasis. BJU Int 114:503–510CrossRefPubMed

66.

Carlsson SV, Tafe LJ, Chade DC, Sjoberg DD, Passoni N, Shariat SF, Eastham J, Scardino PT, Fine SW, Touijer KA (2013) Pathological features of lymph node metastasis for predicting biochemical recurrence after radical prostatectomy for prostate cancer. J Urol 189:1314–1318CrossRefPubMed

67.

Mikel Hubanks J, Boorjian SA, Frank I, Gettman MT, Houston Thompson R, Rangel LJ, Bergstralh EJ, Jeffrey Karnes R (2014) The presence of extracapsular extension is associated with an increased risk of death from prostate cancer after radical prostatectomy for patients with seminal vesicle invasion and negative lymph nodes. Urol Oncol 32(26):e21–e27

68.

Ball MW, Partin AW, Epstein JI (2015) Extent of extraprostatic extension independently influences biochemical recurrence-free survival: evidence for further pT3 subclassification. Urology 85:161–164CrossRefPubMed

69.

Kothari PS, Scardino PT, Ohori M, Kattan MW, Wheeler TM (2001) Incidence, location, and significance of periprostatic and periseminal vesicle lymph nodes in prostate cancer. Am J Surg Pathol 25:1429–1432CrossRefPubMed

70.

Montironi R, Scarpelli M, Mazzucchelli R, Lopez-Beltran A, Santoni M, Briganti A, Montorsi F, Cheng L (2014) Does prostate acinar adenocarcinoma with Gleason Score 3 + 3=6 have the potential to metastasize? Diagn Pathol 9:190CrossRefPubMedPubMedCentral

71.

Kim IY, Modi PK, Sadimin E, Ha YS, Kim JH, Skarecky D, Cha DY, Wambi CO, Ou YC, Yuh B, Park S, Llukani E, Albala DM, Wilson T, Ahlering T, Badani K, Ahn H, Lee DI, May M, Kim WJ, Lee DH (2013) Detailed analysis of patients with metastasis to the prostatic anterior fat pad lymph nodes: a multi-institutional study. J Urol 190:527–534CrossRefPubMed

72.

Deng FM, Mendrinos SE, Das K, Melamed J (2012) Periprostatic lymph node metastasis in prostate cancer and its clinical significance. Histopathology 60:1004–1008CrossRefPubMed

73.

Gonzalez-Roibon N, Han JS, Lee S, Feng Z, Arslankoz S, Smith N, Pierorazio PM, Humphreys E, Deweese TL, Partin AW, Bivalacqua TJ, Han M, Trock B, Netto GJ (2013) Comparison of biochemical recurrence-free survival between periprostatic and pelvic lymph node metastases of prostate cancer. Int J Surg Pathol 21:352–357CrossRefPubMedPubMedCentral

74.

Meinhardt W, van der Poel HG, Valdes Olmos RA, Bex A, Brouwer OR, Horenblas S (2012) Laparoscopic sentinel lymph node biopsy for prostate cancer: the relevance of locations outside the extended dissection area. Prostate Cancer 2012:751–753CrossRef

75.

Maurer T, Weirich G, Schottelius M (2015) Prostate-specific membrane antigen-radioguided surgery for metastatic lymph nodes in prostate cancer. Eur Urol 68:530–534CrossRefPubMed

Title: Update on histopathological evaluation of lymphadenectomy specimens from prostate cancer patients
Authors: Alessandro Conti
Matteo Santoni
Luciano Burattini
Marina Scarpelli
Roberta Mazzucchelli
Andrea B. Galosi
Liang Cheng
Antonio Lopez-Beltran
Alberto Briganti
Francesco Montorsi
Rodolfo Montironi
Publication date: 01-04-2017
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 4/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-015-1752-8

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Update on histopathological evaluation of lymphadenectomy specimens from prostate cancer patients

Abstract

Background

Methods and results

Conclusion

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Abstract

Background

Methods and results

Conclusion

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