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"version": "1.0.0",
"name": "pubmed-PMC13900",
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"orig": "Comparison of written reports of mammography, sonography and magnetic resonance mammography for preoperative evaluation of breast lesions, with special emphasis on magnetic resonance mammography",
"text": "Comparison of written reports of mammography, sonography and magnetic resonance mammography for preoperative evaluation of breast lesions, with special emphasis on magnetic resonance mammography"
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"orig": "Sabine Malur; Department of Gynecology, Friedrich-Schiller University, Jena, Germany.; Susanne Wurdinger; Institute for Diagnostic and Interventional Radiology, Friedrich-Schiller University, Jena, Germany.; Andreas Moritz; Department of Gynecology, Friedrich-Schiller University, Jena, Germany.; Wolfgang Michels; Department of Gynecology, Friedrich-Schiller University, Jena, Germany.; Achim Schneider; Department of Gynecology, Friedrich-Schiller University, Jena, Germany.",
"text": "Sabine Malur; Department of Gynecology, Friedrich-Schiller University, Jena, Germany.; Susanne Wurdinger; Institute for Diagnostic and Interventional Radiology, Friedrich-Schiller University, Jena, Germany.; Andreas Moritz; Department of Gynecology, Friedrich-Schiller University, Jena, Germany.; Wolfgang Michels; Department of Gynecology, Friedrich-Schiller University, Jena, Germany.; Achim Schneider; Department of Gynecology, Friedrich-Schiller University, Jena, Germany."
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"orig": "Patients with abnormal breast findings ( n = 413) were examined by mammography, sonography and magnetic resonance (MR) mammography; 185 invasive cancers, 38 carcinoma in situ and 254 benign tumours were confirmed histologically. Sensitivity for mammography was 83.7%, for sonography it was 89.1% and for MR mammography it was 94.6% for invasive cancers. In 42 patients with multifocal invasive cancers, multifocality had been detected by mammography and sonography in 26.2%, and by MR mammography in 66.7%. In nine patients with multicentric cancers, detection rates were 55.5, 55.5 and 88.8%, respectively. Carcinoma in situ was diagnosed by mammography in 78.9% and by MR mammography in 68.4% of patients. Combination of all three diagnostic methods lead to the best results for detection of invasive cancer and multifocal disease. However, sensitivity of mammography and sonography combined was identical to that of MR mammography (ie 94.6%).",
"text": "Patients with abnormal breast findings ( n = 413) were examined by mammography, sonography and magnetic resonance (MR) mammography; 185 invasive cancers, 38 carcinoma in situ and 254 benign tumours were confirmed histologically. Sensitivity for mammography was 83.7%, for sonography it was 89.1% and for MR mammography it was 94.6% for invasive cancers. In 42 patients with multifocal invasive cancers, multifocality had been detected by mammography and sonography in 26.2%, and by MR mammography in 66.7%. In nine patients with multicentric cancers, detection rates were 55.5, 55.5 and 88.8%, respectively. Carcinoma in situ was diagnosed by mammography in 78.9% and by MR mammography in 68.4% of patients. Combination of all three diagnostic methods lead to the best results for detection of invasive cancer and multifocal disease. However, sensitivity of mammography and sonography combined was identical to that of MR mammography (ie 94.6%)."
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"orig": "Introduction",
"text": "Introduction",
"level": 1
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"self_ref": "#/texts/4",
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"children": [],
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"orig": "Mammography and sonography are the standard imaging techniques for detection and evaluation of breast disease [1]. Mammography is the most established screening modality [2]. Especially in young women and women with dense breasts, sonography appears superior to mammography, and differentiation between solid tumours and cysts is easier. Sensitivity and specificity of sonography or mammography are higher if sonography and mammography are combined [3].",
"text": "Mammography and sonography are the standard imaging techniques for detection and evaluation of breast disease [1]. Mammography is the most established screening modality [2]. Especially in young women and women with dense breasts, sonography appears superior to mammography, and differentiation between solid tumours and cysts is easier. Sensitivity and specificity of sonography or mammography are higher if sonography and mammography are combined [3]."
},
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"orig": "It is generally accepted that MR mammography is the most sensitive technique for diagnosis of breast cancer, whereas the reported specificity of MR mammography varies [4,5,6,7,8,9,10,11,12]. In those studies, MR mammography was performed and evaluated by highly specialized radiologists in a research setting. It was therefore the purpose of the present prospective study to compare the validity of MR mammography with mammography and sonography in clinical routine practice. Findings for the three diagnostic methods documented on routine reports that were available to the surgeon preoperatively formed the basis of this comparison. Special emphasis was placed on the identification of multifocal and multicentric invasive disease.",
"text": "It is generally accepted that MR mammography is the most sensitive technique for diagnosis of breast cancer, whereas the reported specificity of MR mammography varies [4,5,6,7,8,9,10,11,12]. In those studies, MR mammography was performed and evaluated by highly specialized radiologists in a research setting. It was therefore the purpose of the present prospective study to compare the validity of MR mammography with mammography and sonography in clinical routine practice. Findings for the three diagnostic methods documented on routine reports that were available to the surgeon preoperatively formed the basis of this comparison. Special emphasis was placed on the identification of multifocal and multicentric invasive disease."
},
{
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"children": [
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"label": "section_header",
"prov": [],
"orig": "Results",
"text": "Results",
"level": 1
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"$ref": "#/texts/6"
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"children": [],
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"orig": "All patients underwent breast surgery and all abnormal lesions identified by mammography, sonography or MR mammography were surgically removed. A total of 477 breast lesions were examined histologically, revealing the presence of 185 invasive cancers, 38 carcinomata in situ and 254 benign lesions (fibroadenoma, papilloma, intraductal or adenoid ductal hyperplasia, cystic mastopathia). There were four patients with malignant lesions in both breasts. In 42 patients multifocal tumours and in nine patients multicentric tumors were found on histological examination. Among the 185 invasive lesions, 178 were primary cancers, five were recurrences, one was metastatic and one was an angiosarcoma. The majority of invasive breast cancers were staged as pT1c (44%). Six per cent of tumors were detected in stage pT1a, 18% in stage pT1b, 25% in stage pT2, 3% in stage pT3 and 4% in stage pT4. The distribution of histopathological tumour types is shown in Table 1. The mean age of patients was 58 years (range 19-85 years).",
"text": "All patients underwent breast surgery and all abnormal lesions identified by mammography, sonography or MR mammography were surgically removed. A total of 477 breast lesions were examined histologically, revealing the presence of 185 invasive cancers, 38 carcinomata in situ and 254 benign lesions (fibroadenoma, papilloma, intraductal or adenoid ductal hyperplasia, cystic mastopathia). There were four patients with malignant lesions in both breasts. In 42 patients multifocal tumours and in nine patients multicentric tumors were found on histological examination. Among the 185 invasive lesions, 178 were primary cancers, five were recurrences, one was metastatic and one was an angiosarcoma. The majority of invasive breast cancers were staged as pT1c (44%). Six per cent of tumors were detected in stage pT1a, 18% in stage pT1b, 25% in stage pT2, 3% in stage pT3 and 4% in stage pT4. The distribution of histopathological tumour types is shown in Table 1. The mean age of patients was 58 years (range 19-85 years)."
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"orig": "The sensitivity of MR mammography was significantly higher than those of mammography and sonography (P < 0.005 and P < 0.05; Table 2). The specificity of sonography was significantly higher than those of mammography and MR mammography (P < 0.05 and P < 0.005; Table 2). The negative predictive values for sonography and MR mammography were significantly higher than that of mammography (P < 0.05 and P < 0.005; Table 2). With regard to accuracy, no significant difference between the three modalities was found (Table 2). Combining of all three diagnostic methods yielded the best results for detection of cancer (P < 0.005; Table 3). The sensitivity and negative predictive value for the combination of mammography and MR mammography, and the combination of sonography and MR mammography were significantly higher than those for the combination of mammograpy and sonography (P < 0.05; Table 3). The highest result for accuracy was seen for a combination of all three methods (P < 0.05; Table 3).",
"text": "The sensitivity of MR mammography was significantly higher than those of mammography and sonography (P < 0.005 and P < 0.05; Table 2). The specificity of sonography was significantly higher than those of mammography and MR mammography (P < 0.05 and P < 0.005; Table 2). The negative predictive values for sonography and MR mammography were significantly higher than that of mammography (P < 0.05 and P < 0.005; Table 2). With regard to accuracy, no significant difference between the three modalities was found (Table 2). Combining of all three diagnostic methods yielded the best results for detection of cancer (P < 0.005; Table 3). The sensitivity and negative predictive value for the combination of mammography and MR mammography, and the combination of sonography and MR mammography were significantly higher than those for the combination of mammograpy and sonography (P < 0.05; Table 3). The highest result for accuracy was seen for a combination of all three methods (P < 0.05; Table 3)."
},
{
"self_ref": "#/texts/9",
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"orig": "Mammography was false-negative in 30 out of 184 invasive cancers, sonography was false-negative in 20 out of 185 cancers, and 10 out of 185 invasive cancers were missed by MR mammography. The majority of false-negative findings was found in stage1 disease, ductal carcinoma and grade 3 tumors (Table 4). Of 10 invasive cancers missed by MR mammography, eight were found by mammography and sonography. By all three techniques, one invasive ductal carcinoma (pT1b) was misinterpreted as fibroadenoma. In another patient, a microinvasive lobular carcinoma of 5 mm diameter was not detected with mammography and MR mammography, whereas sonography detected a solid, benign tumour. MR mammography identified 10 invasive cancers (5.2%) that were missed by mammography and sonography, whereas one invasive cancer was found by mammography alone. By sonography alone, not a single case of invasive disease was detected when MR mammography or mammography were nonsuspected.",
"text": "Mammography was false-negative in 30 out of 184 invasive cancers, sonography was false-negative in 20 out of 185 cancers, and 10 out of 185 invasive cancers were missed by MR mammography. The majority of false-negative findings was found in stage1 disease, ductal carcinoma and grade 3 tumors (Table 4). Of 10 invasive cancers missed by MR mammography, eight were found by mammography and sonography. By all three techniques, one invasive ductal carcinoma (pT1b) was misinterpreted as fibroadenoma. In another patient, a microinvasive lobular carcinoma of 5 mm diameter was not detected with mammography and MR mammography, whereas sonography detected a solid, benign tumour. MR mammography identified 10 invasive cancers (5.2%) that were missed by mammography and sonography, whereas one invasive cancer was found by mammography alone. By sonography alone, not a single case of invasive disease was detected when MR mammography or mammography were nonsuspected."
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"$ref": "#/texts/16"
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"orig": "Discussion",
"text": "Discussion",
"level": 1
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"orig": "When the validity of individual diagnostic methods for detection of invasive breast cancer was analyzed, the sensitivity and specificity of mammography ranged from 79.9 to 89% and from 64 to 93.5%, respectively [6,7,13]; for sonography from 67.6 to 96% and from 93 to 97.7%, respectively [13,14]; and for MR mammography from 91 to 98.9 and from 20 to 97.4%, respectively [6,7,8,9,10,15,16,17].",
"text": "When the validity of individual diagnostic methods for detection of invasive breast cancer was analyzed, the sensitivity and specificity of mammography ranged from 79.9 to 89% and from 64 to 93.5%, respectively [6,7,13]; for sonography from 67.6 to 96% and from 93 to 97.7%, respectively [13,14]; and for MR mammography from 91 to 98.9 and from 20 to 97.4%, respectively [6,7,8,9,10,15,16,17]."
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"self_ref": "#/texts/12",
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"orig": "The performance of mammography, sonography and MR mammography was compared in three large series (Table 5). The present results are similar with regard to sensitivity and specificity for the detection of malignant breast lesions, with MR mammography reaching the highest sensitivity of all imaging procedures.",
"text": "The performance of mammography, sonography and MR mammography was compared in three large series (Table 5). The present results are similar with regard to sensitivity and specificity for the detection of malignant breast lesions, with MR mammography reaching the highest sensitivity of all imaging procedures."
},
{
"self_ref": "#/texts/13",
"parent": {
"$ref": "#/texts/10"
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"orig": "When combinations of all three technique were analyzed, mammography and sonography (standard method) had a sensitivity of 83% and a specificity of 92% for detection of malignant disease [3]. A combination of mammography, sonography and MR mammography (combined method) showed a sensitivity of 95% and a specificity of 64% [3]. For nonpalpable lesions, sensitivity increased from 73% by the standard method to 82% for the combined method. Specificity for the standard method (89%) was higher than that for the combined method (71%). For palpable lesions a sensitivity of 85% for the standard and 98% for the combined method was achieved, whereas specificity for the standard method was 100% compared with 45% for the combined methods [3]. The positive predictive value was 94% for the standard and 80% for the combined methods, and the negative predictive values were 78 and 89%, respectively [3]. In the present study, we also found the highest sensitivity, specificity, and positive and negative predictive values for the combination of all three methods. Combination of mammography and sonography was as sensitive as MR mammography alone (94.6% versus 94.6%).",
"text": "When combinations of all three technique were analyzed, mammography and sonography (standard method) had a sensitivity of 83% and a specificity of 92% for detection of malignant disease [3]. A combination of mammography, sonography and MR mammography (combined method) showed a sensitivity of 95% and a specificity of 64% [3]. For nonpalpable lesions, sensitivity increased from 73% by the standard method to 82% for the combined method. Specificity for the standard method (89%) was higher than that for the combined method (71%). For palpable lesions a sensitivity of 85% for the standard and 98% for the combined method was achieved, whereas specificity for the standard method was 100% compared with 45% for the combined methods [3]. The positive predictive value was 94% for the standard and 80% for the combined methods, and the negative predictive values were 78 and 89%, respectively [3]. In the present study, we also found the highest sensitivity, specificity, and positive and negative predictive values for the combination of all three methods. Combination of mammography and sonography was as sensitive as MR mammography alone (94.6% versus 94.6%)."
},
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"self_ref": "#/texts/14",
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"orig": "The majority of false-positive results for invasive cancer by MR mammography (80 out of 439) were caused by papillomas, intraductal hyperplasia grade 2 or 3, or fibroadenomas in the present series. These lesions have a good blood supply and may mimic invasive cancer [16,18].",
"text": "The majority of false-positive results for invasive cancer by MR mammography (80 out of 439) were caused by papillomas, intraductal hyperplasia grade 2 or 3, or fibroadenomas in the present series. These lesions have a good blood supply and may mimic invasive cancer [16,18]."
},
{
"self_ref": "#/texts/15",
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"$ref": "#/texts/10"
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"orig": "Ten out of 185 (5.4%) malignant lesions were classified as false-negative by MR mammography. On histology, the majority of false-negative invasive cancers were lobular cancers (four out of 10). Bone et al [18] reported false-negative results in 11 out of 155 readings, with the majority being lobular cancers on histology. Lack of tumour-induced neovascularity may explain such findings. In particular, invasive lobular cancers infiltrate the normal tissue with columns of single cells, and receive adequate oxygenation without the requirement for increased vascularization [19]. Buadu et al [11] found that lobular and mucinous carcinomas had a low microvessel density.",
"text": "Ten out of 185 (5.4%) malignant lesions were classified as false-negative by MR mammography. On histology, the majority of false-negative invasive cancers were lobular cancers (four out of 10). Bone et al [18] reported false-negative results in 11 out of 155 readings, with the majority being lobular cancers on histology. Lack of tumour-induced neovascularity may explain such findings. In particular, invasive lobular cancers infiltrate the normal tissue with columns of single cells, and receive adequate oxygenation without the requirement for increased vascularization [19]. Buadu et al [11] found that lobular and mucinous carcinomas had a low microvessel density."
},
{
"self_ref": "#/texts/16",
"parent": {
"$ref": "#/texts/10"
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"orig": "Multifocality of breast cancers can be recognized adequately by MR mammography [20,21]. Boetes et al [22] reported that all 61 multifocal cancers were detected by MR mammography, compared with 31% by mammography and 38% by sonography. Esserman et al [20] detected multifocality by MR mammography in 100% (10 out of 10) versus 44% (four out of nine) by mammography. Relevant changes in therapy due to additional multicentric and contralateral tumour findings by MR mammography occur in 18% of patients as compared with conventional imaging [23]. We found a detection rate of multifocality of 66.7% by MR mammography, as compared with 26.2% by mammography and sonography. However, in 16 patients multifocal invasive disease as diagnosed by MR mammography was shown to be unifocal by histology.",
"text": "Multifocality of breast cancers can be recognized adequately by MR mammography [20,21]. Boetes et al [22] reported that all 61 multifocal cancers were detected by MR mammography, compared with 31% by mammography and 38% by sonography. Esserman et al [20] detected multifocality by MR mammography in 100% (10 out of 10) versus 44% (four out of nine) by mammography. Relevant changes in therapy due to additional multicentric and contralateral tumour findings by MR mammography occur in 18% of patients as compared with conventional imaging [23]. We found a detection rate of multifocality of 66.7% by MR mammography, as compared with 26.2% by mammography and sonography. However, in 16 patients multifocal invasive disease as diagnosed by MR mammography was shown to be unifocal by histology."
},
{
"self_ref": "#/texts/17",
"parent": {
"$ref": "#/texts/10"
},
"children": [],
"label": "text",
"prov": [],
"orig": "Kramer et al [24] reported that MR mammography yielded the highest sensitivity for detection of multicentricity as compared with mammography and sonography (89, 66 and 79%, respectively) in 38 patients. These findings are comparable with the present results, in which eight out of nine multicentric cancers were diagnosed correctly.",
"text": "Kramer et al [24] reported that MR mammography yielded the highest sensitivity for detection of multicentricity as compared with mammography and sonography (89, 66 and 79%, respectively) in 38 patients. These findings are comparable with the present results, in which eight out of nine multicentric cancers were diagnosed correctly."
},
{
"self_ref": "#/texts/18",
"parent": {
"$ref": "#/texts/10"
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"children": [],
"label": "text",
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"orig": "Carcinoma in situ is identified by mammography through the presence of suspicious microcalcifications. Suspicious microcalcifications are more frequent in intraductal than in infiltrating cancers [25], which was also observed in the present series. Mammography showed a detection rate for carcinoma in situ of 78.9%, as compared with 65.8% by MR mammography; the combination of mammography and MR mammography lead to a detection rate of 86.4%. Fischer et al [26] reported that carcinoma in situ was identified by MR mammography in 25 out of 35 patients (72%); three ductal carcinomata in situ were detected by MR mammography exclusively. Sittek et al [27] reported that 14 out of 20 carcinomata in situ (70%) were correctly diagnosed by MR mammography on the basis of focal increase of signal intensity. Those authors concluded that carcinoma in situ is not reliably detected by MR mammography because of lack of a uniform pattern of enhancement. Esserman et al [20] reported a detection rate of 43% for ductal carcinoma in situ by MR mammography. Among 36 woman with carcinoma in situ, Gilles et al [28] demonstrated two cases without early contrast enhancement.",
"text": "Carcinoma in situ is identified by mammography through the presence of suspicious microcalcifications. Suspicious microcalcifications are more frequent in intraductal than in infiltrating cancers [25], which was also observed in the present series. Mammography showed a detection rate for carcinoma in situ of 78.9%, as compared with 65.8% by MR mammography; the combination of mammography and MR mammography lead to a detection rate of 86.4%. Fischer et al [26] reported that carcinoma in situ was identified by MR mammography in 25 out of 35 patients (72%); three ductal carcinomata in situ were detected by MR mammography exclusively. Sittek et al [27] reported that 14 out of 20 carcinomata in situ (70%) were correctly diagnosed by MR mammography on the basis of focal increase of signal intensity. Those authors concluded that carcinoma in situ is not reliably detected by MR mammography because of lack of a uniform pattern of enhancement. Esserman et al [20] reported a detection rate of 43% for ductal carcinoma in situ by MR mammography. Among 36 woman with carcinoma in situ, Gilles et al [28] demonstrated two cases without early contrast enhancement."
},
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"self_ref": "#/texts/19",
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"children": [],
"label": "section_header",
"prov": [],
"orig": "References",
"text": "References",
"level": 1
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"self_ref": "#/texts/20",
"parent": {
"$ref": "#/groups/0"
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"label": "list_item",
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"orig": "SG Orel; RH Troupin. Nonmammographic imaging of the breast: current issues and future prospects.. Semin Roentgenol (1993)",
"text": "SG Orel; RH Troupin. Nonmammographic imaging of the breast: current issues and future prospects.. Semin Roentgenol (1993)",
"enumerated": false,
"marker": "-"
},
{
"self_ref": "#/texts/21",
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"label": "list_item",
"prov": [],
"orig": "K Kerlikowske; D Grady; SM Rubin; C Sandrock; VL Ernster. Efficancy of screening mammography.. JAMA (1995)",
"text": "K Kerlikowske; D Grady; SM Rubin; C Sandrock; VL Ernster. Efficancy of screening mammography.. JAMA (1995)",
"enumerated": false,
"marker": "-"
},
{
"self_ref": "#/texts/22",
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"label": "list_item",
"prov": [],
"orig": "M M\u00fcller-Schimpfle; P Stoll; W Stern; S Kutz; F Dammann; CD Claussen. Do mammography, sonography and MR mammography have a diagnostic benefit compared with mammography and sonography?. AJR Am J Roentgenol (1997)",
"text": "M M\u00fcller-Schimpfle; P Stoll; W Stern; S Kutz; F Dammann; CD Claussen. Do mammography, sonography and MR mammography have a diagnostic benefit compared with mammography and sonography?. AJR Am J Roentgenol (1997)",
"enumerated": false,
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"self_ref": "#/texts/23",
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