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screening

Practice targeted AMC-style multiple-choice questions on screening.

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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 58-year-old asymptomatic woman undergoes a screening mammogram. The image is shown. Which of the following is the MOST appropriate next step in the management of this patient?

A. MRI of the breast
B. Reassurance and routine screening in 1 year
C. Ultrasound of the breast
D. Excisional biopsy
E. Stereotactic core biopsy
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A contrast enhanced CT scan demonstrating an abdominal aortic aneurysm of 4.8 * 3.8 cm
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 72-year-old male with a history of smoking and hyperlipidemia presents for a health check. He is asymptomatic. A contrast-enhanced CT abdomen is performed as part of a screening protocol. An axial view is shown. Besides optimizing medical management, what is the MOST appropriate next step?

A. Repeat imaging in 6-12 months
B. Referral for immediate surgical repair
C. Initiate dual antiplatelet therapy
D. Prescribe a short course of oral corticosteroids
E. Order a D-dimer to rule out acute thrombosis
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A 28-year-old man presents to his general practitioner for a routine health check. He reports being in a non-monogamous relationship for the past year. He states he uses condoms inconsistently, particularly within the primary relationship where his partner's HIV status is unknown. He denies any recent febrile illness, rash, or lymphadenopathy. His last HIV test, performed 6 months ago, was negative. He has no other significant medical history. Considering his presentation and reported risk factors, which of the following is the most appropriate next step in his management according to Australian guidelines?

A. Order a comprehensive panel of sexually transmitted infection tests, excluding HIV, and review results.
B. Advise strict and consistent condom use for all sexual encounters.
C. Schedule a repeat HIV test in 6 months as part of routine screening.
D. Prescribe a course of post-exposure prophylaxis (PEP) immediately.
E. Discuss and offer HIV pre-exposure prophylaxis (PrEP) after confirming negative HIV status.
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A 58-year-old woman, otherwise healthy with no significant medical history, undergoes a routine screening mammogram. The report notes a new cluster of pleomorphic microcalcifications in the upper outer quadrant of her left breast, measuring approximately 1.5 cm, classified as BI-RADS 4. Clinical examination reveals no palpable mass or skin changes. She has no family history of breast cancer. What is the most appropriate next step in the management of this finding?

A. Fine needle aspiration cytology
B. Excisional biopsy
C. Repeat mammogram in 6 months
D. Stereotactic core needle biopsy
E. Ultrasound-guided core needle biopsy
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 58-year-old woman attends a routine mammography screening. She reports no palpable lumps, pain, or nipple discharge. Her family history is unremarkable. The image shows the findings of the current mammogram. What is the MOST appropriate next step in the management of this patient?

A. Reassurance and routine screening in 1 year
B. Excisional biopsy
C. MRI of the breast
D. Ultrasound of the breast
E. Stereotactic core biopsy
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A 28-year-old woman with a mother diagnosed with colorectal cancer at 45 and a maternal uncle at 50 seeks advice. She is otherwise well. What is the most appropriate next step in her management?

A. Annual FIT testing.
B. Consider prophylactic colectomy.
C. Genetic counselling and testing.
D. Colonoscopy screening at 40.
E. Reassurance and review.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 55-year-old woman presents for her routine biennial screening mammogram. She denies any breast lumps, pain, or nipple discharge. Her past medical history is notable only for well-controlled hypothyroidism. There is no family history of breast or ovarian cancer. Physical examination reveals no palpable abnormalities. The provided image is a magnified view from the craniocaudal projection of the left breast. Considering the clinical context and the findings demonstrated, what is the most appropriate immediate next step in the management of this patient?

A. Stereotactic core needle biopsy of the area
B. Perform a diagnostic ultrasound of the breast
C. Repeat screening mammography in 12 months
D. Refer for immediate surgical excision
E. Order genetic testing for BRCA1/BRCA2 mutations
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Following a positive genetic test for a hereditary cancer syndrome, what is the most important next step for the patient's family?

A. Advise increased cancer screening for all family members.
B. Offer genetic counselling and cascade testing to at-risk relatives.
C. Recommend prophylactic surgery for all first-degree relatives.
D. Focus solely on lifestyle changes for risk reduction.
E. Inform family the risk is only for future children.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman presents for routine screening mammography. She has no palpable lumps or skin changes. Her mother was diagnosed with breast cancer at age 68. The provided image is from her mammogram. What is the MOST appropriate next step in management?

A. MRI of the breast
B. Ultrasound of the breast
C. Reassurance and routine screening in one year
D. Stereotactic core biopsy
E. Excisional biopsy
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A 45-year-old woman has a mother diagnosed with colorectal cancer at age 55 and a maternal aunt with endometrial cancer at age 60. What is the most appropriate initial step regarding genetic testing for hereditary cancer syndrome?

A. Advise increased surveillance with colonoscopy every 5 years starting now.
B. Order germline testing for MLH1, MSH2, MSH6, and PMS2 genes.
C. Referral to a familial cancer clinic for risk assessment and counselling.
D. Order tumour testing for microsatellite instability (MSI) and immunohistochemistry (IHC).
E. Reassure the patient that this family history is not strongly suggestive of a hereditary syndrome.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 58-year-old woman presents for her scheduled screening mammogram. She reports no breast lumps, pain, or nipple discharge. Her past medical history includes well-controlled hypertension and osteoarthritis. She has no known family history of breast or ovarian cancer. Physical examination reveals no palpable abnormalities in either breast or axillae. The mammogram is performed, and the image provided is a detail from the craniocaudal view of the left breast. Considering the clinical presentation and the findings demonstrated in the provided image, what is the most appropriate immediate next step in the management of this patient?

A. Repeat mammography in 6 months
B. Ultrasound of the breast
C. Excisional biopsy
D. Referral for genetic counselling and testing
E. Stereotactic core biopsy of the suspicious area
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Which genetic variant classification most strongly mandates clinical action?

A. Pathogenic
B. Benign
C. Variant of uncertain significance (VUS)
D. Likely benign
E. Likely pathogenic
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 58-year-old woman presents for her scheduled screening mammogram. She denies any breast lumps, pain, or nipple discharge. She has no family history of breast cancer. Her physical examination is unremarkable. The image provided is a detail from her left craniocaudal view. Considering this finding, what is the most appropriate immediate next step in her clinical management?

A. Referral for breast ultrasound.
B. Discussion regarding prophylactic mastectomy.
C. Annual routine screening mammography.
D. Stereotactic core needle biopsy of the area of concern.
E. Repeat mammography with magnification views in 3 months.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman attends her routine mammogram. She has no palpable lumps or skin changes. Her previous mammograms have been normal. The provided image is from the current study. Which of the following is the MOST appropriate next step in management?

A. Stereotactic core biopsy
B. Excisional biopsy
C. Reassurance and routine screening in 2 years
D. Ultrasound of the breast
E. MRI of the breast
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman presents for her routine screening mammogram. She reports no breast symptoms, and physical examination is unremarkable. Her medical history includes well-controlled type 2 diabetes and hyperlipidaemia. She has no family history of breast cancer. The provided image is a magnified view from the craniocaudal projection of the right breast. Considering the clinical context and the findings demonstrated, what is the most appropriate immediate next step in the management of this patient?

A. Breast ultrasound of the area
B. Referral to a medical oncologist for systemic therapy planning
C. Repeat screening mammogram in 6 months
D. Stereotactic core needle biopsy of the area
E. Excisional biopsy under wire localisation
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CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 68-year-old man with known alcoholic cirrhosis presents for routine surveillance. He reports mild fatigue but no other symptoms. Liver function tests are within his baseline. Alpha-fetoprotein is 150 ng/mL (normal <10). The provided images are obtained. Considering the clinical context and the findings demonstrated in the images, what is the most appropriate immediate next step in this patient's management?

A. Referral for liver transplant assessment
B. Initiate treatment with transarterial chemoembolisation (TACE)
C. Percutaneous biopsy of the lesion
D. Commence systemic therapy with Sorafenib
E. Repeat imaging with MRI liver in 4 weeks
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A patient has a pathogenic variant in MLH1 identified via genetic testing. What cancer screening is most strongly indicated?

A. Colonoscopy every 1-2 years from age 25
B. Gastroscopy every 3-5 years from age 50
C. Annual mammography from age 30
D. Renal ultrasound every 2 years from age 30
E. Annual PSA testing from age 40
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A 28-year-old woman presents for a check-up, reporting occasional mild abdominal discomfort. Her father was diagnosed with colorectal cancer at age 48, and his tumour showed microsatellite instability. A paternal aunt had endometrial cancer at 55. Physical exam is normal. What is the most appropriate next step regarding genetic testing?

A. Order a colonoscopy immediately.
B. Test for FAP-associated genes.
C. Order faecal occult blood testing.
D. Offer genetic counselling and testing for Lynch syndrome.
E. Reassure and advise standard screening at age 50.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 65-year-old asymptomatic woman undergoes a screening mammogram. The image shows the findings. Her previous mammograms have been unremarkable. What is the MOST appropriate next step in the management of this patient?

A. Stereotactic core biopsy
B. MRI of the breast
C. Excisional biopsy
D. Ultrasound of the breast
E. Reassurance and routine screening in 1 year
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 55-year-old woman with no palpable breast lumps presents for a routine screening mammogram. The image is shown. What is the MOST appropriate next step?

A. Stereotactic core biopsy
B. Ultrasound of the breast
C. Reassurance and routine follow-up in 1 year
D. Excisional biopsy
E. MRI of the breast
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 55-year-old woman undergoes routine screening mammography. She is asymptomatic with no personal or family history of breast cancer. Physical examination is unremarkable. The provided image is a magnified view from the craniocaudal projection of the right breast. Based on the findings demonstrated, what is the most appropriate immediate next step in the management of this patient?

A. Stereotactic core needle biopsy of the area.
B. Order genetic testing for BRCA1/BRCA2 mutations.
C. Proceed directly to surgical excision.
D. Repeat screening mammography in 12 months.
E. Perform a diagnostic ultrasound of the breast.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman presents for her routine mammogram. She has no personal or family history of breast cancer. She denies any breast pain, nipple discharge, or palpable lumps. Clinical breast exam is unremarkable. Her previous mammograms have been negative. The current mammogram reveals findings as shown in the image. What is the MOST appropriate next step in management?

A. Ultrasound-guided core biopsy
B. MRI of the breast
C. Stereotactic core biopsy
D. Excisional biopsy
E. Reassurance and routine screening mammography in 1 year
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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 65-year-old male with Hepatitis C cirrhosis is undergoing routine surveillance. A liver lesion was identified on initial ultrasound, prompting a contrast-enhanced ultrasound study. Considering the findings demonstrated in the provided images, what is the most appropriate next step in the management of this patient?

A. Repeat ultrasound in 3 months
B. Refer for urgent liver transplant assessment
C. Prescribe antibiotics for suspected abscess
D. Liver biopsy for histological confirmation
E. Initiate palliative care
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 55-year-old woman attends for her routine screening mammogram. She has no breast symptoms and no family history of breast cancer. Her physical examination is unremarkable. The mammogram is performed, and a finding is noted in the upper outer quadrant of the left breast, as shown in the image. Based on the appearance of the finding demonstrated in the image, what is the most appropriate next step in her management?

A. Repeat mammography in 6 months.
B. Stereotactic core biopsy of the calcifications.
C. Breast ultrasound of the area.
D. Immediate surgical excision of the area.
E. Referral for breast MRI.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 62-year-old woman undergoes routine screening mammography. She is asymptomatic with no relevant family history of breast cancer. Physical examination is unremarkable. The provided image is a detail from her mammogram. Based on the findings demonstrated in the image, what is the most appropriate immediate next step in the management of this patient?

A. Refer directly to a breast surgeon for consultation.
B. Refer for breast MRI for further characterisation.
C. Proceed directly to core needle biopsy of the suspicious area.
D. Perform additional diagnostic mammographic views and potentially targeted ultrasound.
E. Schedule for routine annual screening mammography in 12 months.
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CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 68-year-old man with known alcoholic cirrhosis presents for routine surveillance. He reports mild fatigue. Liver function tests are within his baseline (Child-Pugh A). Alpha-fetoprotein is 150 ng/mL. The provided images are obtained. Considering the clinical context and the findings demonstrated in the images, which of the following treatment modalities is most likely to be considered first for this patient?

A. Transarterial chemoembolisation (TACE)
B. Surgical resection
C. Palliative care
D. Systemic targeted therapy (e.g., Sorafenib)
E. Liver transplantation assessment
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

A 58-year-old woman attends a routine mammography screening. She reports no palpable lumps, pain, or nipple discharge. Her family history is unremarkable. The current mammogram reveals new findings compared to her prior images from the last 5 years. The image is shown. What is the MOST appropriate next step?

A. Reassurance and repeat mammogram in 1 year
B. MRI of the breast
C. Excisional biopsy
D. Stereotactic core biopsy
E. Ultrasound of the breast
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

Mrs. Eleanor Vance, a 62-year-old retired teacher, presents for her routine biennial screening mammogram through the BreastScreen Australia program. She has no personal history of breast disease, and her family history is negative for breast or ovarian cancer in first-degree relatives. She is otherwise healthy, with a history of diet-controlled type 2 diabetes and osteoarthritis managed with paracetamol. She denies any breast pain, lumps, nipple discharge, or skin changes. Her last mammogram two years ago was reported as normal (BIRADS 1). Physical examination of both breasts and axillae is unremarkable. The current screening mammogram is performed. The image provided is a magnified view from the craniocaudal projection of the left breast, specifically highlighting an area that has been flagged for further assessment by the reporting radiologist due to a change from the previous study. Based on the appearance of the abnormality demonstrated in the provided image, which is the most appropriate method for obtaining a tissue diagnosis?

A. Surgical excisional biopsy with wire localisation as the initial diagnostic step
B. Ultrasound-guided core biopsy of the area corresponding to the mammographic finding
C. Follow-up mammography in 6 months to assess stability of the finding
D. Stereotactic core biopsy targeting the clustered microcalcifications
E. Fine needle aspiration cytology of the suspicious area
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A 33-year-old lady has an HNPCC gene mutation and two sisters with bowel cancer. She reports no change in bowel habits. What is the best surveillance for bowel cancer in this patient?

A. Annual or biennial colonoscopy starting now; discuss aspirin.
B. Colonoscopy at age 40, then every 5 years.
C. Annual iFOBT starting now.
D. Refer to a bowel cancer specialist.
E. Immediate colonoscopy, 5-year repeat, 2-year iFOBT, aspirin at 50.
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A 35-year-old healthcare worker has a positive tuberculin skin test (12mm induration) following a known occupational exposure. Her chest X-ray is clear, and she reports no symptoms. Which is the most appropriate next step in management?

A. Initiate treatment for latent tuberculosis infection.
B. Order an Interferon-Gamma Release Assay (IGRA).
C. Reassure the patient and advise annual screening.
D. Repeat the tuberculin skin test in three months.
E. Start a four-drug regimen for active tuberculosis.
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A middle-aged man who already has a 20% cardiovascular risk and is on lifestyle modification and statin therapy: Which one of the following helps you assess his cardiovascular risk?

A. Coronary artery angiogram
B. ECG
C. Exercise ECG
D. Echocardiogram
E. Coronary artery calcium score
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

Mrs. Eleanor Vance, a 62-year-old retired teacher, presents for her routine biennial screening mammogram through the BreastScreen Australia program. She has no personal history of breast disease, and her family history is negative for breast or ovarian cancer in first-degree relatives. She is otherwise healthy, with a history of diet-controlled type 2 diabetes and osteoarthritis managed with paracetamol. She denies any breast pain, lumps, nipple discharge, or skin changes. Her last mammogram two years ago was reported as normal (BIRADS 1). Physical examination of both breasts and axillae is unremarkable. The current screening mammogram is performed. The image provided is a magnified view from the craniocaudal projection of the left breast, specifically highlighting an area that has been flagged for further assessment by the reporting radiologist due to a change from the previous study. Based on the clinical presentation, the patient's history, and the specific finding demonstrated in the provided image from her screening mammogram, what is the most appropriate immediate next step in the management pathway for this patient?

A. Stereotactic vacuum-assisted core biopsy of the suspicious calcifications.
B. Proceed directly to surgical excision of the area under wire localisation.
C. Repeat the mammogram in 3-6 months with spot compression and magnification views.
D. Request a breast MRI with contrast to better delineate the extent of the abnormality.
E. Perform a targeted ultrasound of the area of concern.
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A 35yo woman's mother died of ovarian cancer at 45, and her paternal aunt had breast cancer at 50. She is concerned about her risk. What is the most appropriate initial step regarding genetic testing?

A. Reassure and advise lifestyle changes
B. Order BRCA1/BRCA2 testing
C. Refer for genetic counselling
D. Order mammography and pelvic ultrasound
E. Order a multi-gene panel
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A contrast enhanced CT scan demonstrating an abdominal aortic aneurysm of 4.8 * 3.8 cm
Image by James Heilman, MD CC BY-SA 3.0 · Source

An asymptomatic 70-year-old male undergoes a CT scan of the abdomen as part of an investigation for mild, intermittent lower back pain. His vital signs are stable, and physical examination is unremarkable. Considering the findings on the provided image, what is the most appropriate next step in this patient's management?

A. No further imaging required; manage back pain symptomatically.
B. Annual abdominal ultrasound surveillance.
C. Urgent referral for vascular surgical assessment.
D. Referral for a follow-up CT angiogram in 2 years.
E. Repeat CT scan in 6 months.
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Mammogram microcalcifications in carcinoma in situ, CC, details
Image by Jmarchn CC BY-SA 3.0 · Source

Mrs. Eleanor Vance, a 62-year-old retired teacher, presents for her routine biennial screening mammogram through the BreastScreen Australia program. She has no personal history of breast disease, and her family history is negative for breast or ovarian cancer in first-degree relatives. She is otherwise healthy, with a history of diet-controlled type 2 diabetes and osteoarthritis managed with paracetamol. She denies any breast pain, lumps, nipple discharge, or skin changes. Her last mammogram two years ago was reported as normal (BIRADS 1). Physical examination of both breasts and axillae is unremarkable. The current screening mammogram is performed. The image provided is a magnified view from the craniocaudal projection of the left breast, specifically highlighting an area that has been flagged for further assessment by the reporting radiologist due to a change from the previous study. Assuming that subsequent investigation of the area highlighted in the image confirms a diagnosis of ductal carcinoma in situ (DCIS) and the patient undergoes breast-conserving surgery, which of the following factors is most important in determining the need for adjuvant radiotherapy?

A. Patient's body mass index (BMI)
B. Margin status of the surgical excision specimen
C. Oestrogen receptor status of the DCIS cells
D. Ki-67 proliferation index of the DCIS cells
E. Presence of metastatic disease on staging scans
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