HIFU and RFA Ablation for Thyroid and Parathyroid Disease

  • Petros Tsamatropoulos
  • Roberto ValcaviEmail author


Interventional thyroidology encompasses minimally invasive ultrasound-guided techniques to treat diseases of the endocrine neck (i.e., diseases of thyroid and parathyroid glands). Radiofrequency ablation (RFA) and high-intensity focused ultrasound (HIFU) ablation are two of these techniques, used to destroy thyroid nodules and tumors using hyperthermia without surgical removal. For thyroid RFA straight, internally cooled, short (7- or 10-cm), thin (18- or 19-gauge) electrode needles are currently used according to the moving shot technique and via a transisthmic approach. Indications for thyroid RFA are: (a) nonfunctioning, benign, solid or predominantly solid, thyroid nodules in patients presenting with local symptoms or cosmetic complaints when surgery is contraindicated or declined; (b) autonomously functioning thyroid nodules (AFTNs) causing problems related to thyrotoxicosis when surgery and radioidine are contraindicated or declined; (c) Recurrent thyroid cancers located in the thyroid bed as well as metastatic lymph nodes when surgery is contraindicated and radioiodine is ineffective. HIFU is a newly developed promising technology in the field of interventional thyroidology which has been used for the treatment of AFTNs, cold benign thyroid nodules and parathyroid lesions causing hyperparathyroidism. RFA and HIFU are performed by endocrinologists, interventional radiologists, and surgeons.


Interventional thyroidology Radiofrequency ablation HIFU ablation Thyroid nodule Thyroid ultrasound Autonomously functioning thyroid nodule Parathyroid adenoma Recurrent thyroid cancer Endocrine neck diseases Minimally invasive ultrasound-guided techniques 

Supplementary material

Video 36.1

RFA of cold benign thyroid nodules (MP4 121,675 kb)


  1. 1.
    Baek JH, Lee JH, Valcavi R, Pacella CM, Rhim H, Na DG. Thermal ablation for benign thyroid nodules: radiofrequency and laser. Korean J Radiol. 2011;12(5):525–40.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ha EJ, Baek JH, Lee JH. The efficacy and complications of radiofrequency ablation of thyroid nodules. Curr Opin Endocrinol Diabetes Obes. 2011;18(5):310–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Na DG, Lee JH, Jung SL, Kim JH, Sung JY, Shin JH, et al. Korean Society of Thyroid Radiology (KSThR); Korean Society of Radiology Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations. Korean J Radiol. 2012;13(2):117–25.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Garberoglio R, Aliberti C, Appetecchia M, Attard M, Boccuzzi G, Boraso F, et al. Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement. J Ultrasound. 2015;18(4):423–30.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Spiezia S, Garberoglio R, Di Somma C, Deandrea M, Basso E, Limone PP, et al. Efficacy and safety of radiofrequency thermal ablation in the treatment of thyroid nodules with pressure symptoms in elderly patients. J Am Geriatr Soc. 2007;55(9):1478–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Deandrea M, Limone P, Basso E, Mormile A, Ragazzoni F, Gamarra E, et al. US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules. Ultrasound Med Biol. 2008;34(5):784–91.CrossRefPubMedGoogle Scholar
  7. 7.
    Spiezia S, Garberoglio R, Milone F, Ramundo V, Caiazzo C, Assanti AP, et al. Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. Thyroid. 2009;19(3):219–25.CrossRefPubMedGoogle Scholar
  8. 8.
    Baek JH, Moon WJ, Kim YS, Lee JH, Lee D. Radiofrequency ablation for the treatment of autonomously functioning thyroid nodules. World J Surg. 2009;33(9):1971–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Shin JH, Baek JH, Ha EJ, Lee JH. Radiofrequency ablation of thyroid nodules: basic principles and clinical application. Int J Endocrinol. 2012;2012:919650.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Valcavi R, Tsamatropoulos P. Health-related quality of life after percutaneous radiofrequency ablation of cold, solid, benign thyroid nodules: a 2-year follow-up study in 40 patients. Endocr Pract. 2015;21(8):887–96.CrossRefPubMedGoogle Scholar
  11. 11.
    Deandrea M, Sung JY, Limone P, Mormile A, Garino F, Ragazzoni F, et al. Efficacy and safety of radiofrequency ablation versus observation for nonfunctioning benign thyroid nodules: a randomized controlled international collaborative trial. Thyroid. 2015;25(8):890–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Yoon HM, Baek JH, Lee JH, Ha EJ, Kim JK, Yoon JH, et al. Combination therapy consisting of ethanol and radiofrequency ablation for predominantly cystic thyroid nodules. AJNR Am J Neuroradiol. 2014;35(3):582–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Cibas ES, Ali SZ. NCI Thyroid FNA State of the Science Conference. the Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132(5):658–65.CrossRefPubMedGoogle Scholar
  14. 14.
    Kim HS, Choi BH, Park JR, Hahm JR, Jung JH, Kim SK, et al. Delayed surgery for parathyroid adenoma misdiagnosed as a thyroid nodule and treated with radiofrequency ablation. Endocrinol Metab (Seoul). 2013;28(3):231–5.CrossRefGoogle Scholar
  15. 15.
    Xu SY, Wang Y, Xie Q, Wu HY. Percutaneous sonography guided radiofrequency ablation in the management of parathyroid adenoma. Singapore Med J. 2013;54(7):e137–40.CrossRefPubMedGoogle Scholar
  16. 16.
    Carrafiello G, Laganà D, Mangini M, Dionigi G, Rovera F, Carcano G, et al. Treatment of secondary hyperparathyroidism with ultrasonographically guided percutaneous radiofrequency thermoablation. Surg Laparosc Endosc Percutan Tech. 2006;16(2):112–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Kim YS, Rhim H, Tae K, Park DW, Kim ST. Radiofrequency ablation of benign cold thyroid nodules: initial clinical experience. Thyroid. 2006;16(4):361–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Fuller CW, Nguyen SA, Lohia S, Gillespie MB. Radiofrequency ablation for treatment of benign thyroid nodules: systematic review. Laryngoscope. 2014;124(1):346–53.CrossRefPubMedGoogle Scholar
  19. 19.
    Bandeira-Echtler E, Bergerhoff K, Richter B. Levothyroxine or minimally invasive therapies for benign thyroid nodules. Cochrane Database Syst Rev. 2014;(6):CD004098.Google Scholar
  20. 20.
    Bernardi S, Dobrinja C, Fabris B, Bazzocchi G, Sabato N, Ulcigrai V, et al. Radiofrequency ablation compared to surgery for the treatment of benign thyroid nodules. Int J Endocrinol. 2014;2014:934595.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Che Y, Jin S, Shi C, Wang L, Zhang X, Li Y, Baek JH. Treatment of benign thyroid nodules: comparison of surgery with radiofrequency ablation. AJNR Am J Neuroradiol. 2015;36(7):1321–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Baek JH, Kim YS, Lee D, Huh JY, Lee JH. Benign predominantly solid thyroid nodules: prospective study of efficacy of sonographically guided radiofrequency ablation versus control condition. AJR Am J Roentgenol. 2010;194(4):1137–42.CrossRefPubMedGoogle Scholar
  23. 23.
    Faggiano A, Ramundo V, Assanti AP, Fonderico F, Macchia PE, Misso C, et al. Thyroid nodules treated with percutaneous radiofrequency thermal ablation: a comparative study. J Clin Endocrinol Metab. 2012;97(12):4439–45.CrossRefPubMedGoogle Scholar
  24. 24.
    Wong KP, Lang BH. Use of radiofrequency ablation in benign thyroid nodules: a literature review and updates. Int J Endocrinol. 2013;2013:428363.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Turtulici G, Orlandi D, Corazza A, Sartoris R, Derchi LE, Silvestri E, et al. Percutaneous radiofrequency ablation of benign thyroid nodules assisted by a virtual needle tracking system. Ultrasound Med Biol. 2014;40(7):1447–52.CrossRefPubMedGoogle Scholar
  26. 26.
    Cesareo R, Pasqualini V, Simeoni C, Sacchi M, Saralli E, Campagna G, et al. Prospective study of effectiveness of ultrasound-guided radiofrequency ablation versus control group in patients affected by benign thyroid nodules. J Clin Endocrinol Metab. 2015;100(2):460–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Ugurlu MU, Uprak K, Akpinar IN, Attaallah W, Yegen C, Gulluoglu BM. Radiofrequency ablation of benign symptomatic thyroid nodules: prospective safety and efficacy study. World J Surg. 2015;39(4):961–8.CrossRefPubMedGoogle Scholar
  28. 28.
    De Bernardi IC, Floridi C, Muollo A, Giacchero R, Dionigi GL, Reginelli A, et al. Vascular and interventional radiology radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: literature review. Radiol Med. 2014;119(7):512–20.CrossRefPubMedGoogle Scholar
  29. 29.
    Jeong WK, Baek JH, Rhim H, Kim YS, Kwak MS, Jeong HJ, et al. Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients. Eur Radiol. 2008;18(6):1244–50.CrossRefPubMedGoogle Scholar
  30. 30.
    Huh JY, Baek JH, Choi H, Kim JK, Lee JH. Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session-Prospective randomized study. Radiology. 2012;263(3):909–16.CrossRefPubMedGoogle Scholar
  31. 31.
    Lim HK, Lee JH, Ha EJ, Sung JY, Kim JK, Baek JH. Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients. Eur Radiol. 2013;23(4):1044–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Dobrinja C, Bernardi S, Fabris B, Eramo R, Makovac P, Bazzocchi G, et al. Surgical and pathological changes after radiofrequency ablation of thyroid nodules. Int J Endocrinol. 2015;2015:576576.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Ha EJ, Baek JH, Lee JH, Sung JY, Lee D, Kim JK, et al. Radiofrequency ablation of benign thyroid nodules does not affect thyroid function in patients with previous lobectomy. Thyroid. 2013;23(3):289–93.CrossRefPubMedGoogle Scholar
  34. 34.
    Ji Hong M, Baek JH, Choi YJ, Lee JH, Lim HK, Shong YK, et al. Radiofrequency ablation is a thyroid function-preserving treatment for patients with bilateral benign thyroid nodules. J Vasc Interv Radiol. 2015;26(1):55–61.CrossRefPubMedGoogle Scholar
  35. 35.
    Andrioli M, Valcavi R. The peculiar ultrasonographic and elastographic features of thyroid nodules after treatment with laser or radiofrequency: similarities and differences. Endocrine. 2014;47(3):967–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Valcavi R, Frasoldati A. Ultrasound-guided percutaneous ethanol injection therapy in thyroid cystic nodules. Endocr Pract. 2004;10(3):269–75.CrossRefPubMedGoogle Scholar
  37. 37.
    Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, et al. AACE/AME/ETA Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2010;16 Suppl 1:1–43.CrossRefPubMedGoogle Scholar
  38. 38.
    Haugen BR, Alexander EK, Bible KC, Doherty G, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Sung JY, Kim YS, Choi H, Lee JH, Baek JH. Optimum first-line treatment technique for benign cystic thyroid nodules: ethanol ablation or radiofrequency ablation? AJR Am J Roentgenol. 2011;196(2):W210–4.CrossRefPubMedGoogle Scholar
  40. 40.
    Sung JY, Baek JH, Kim KS, Lee D, Yoo H, Kim JK, Park SH. Single-session treatment of benign cystic thyroid nodules with ethanol versus radiofrequency ablation: a prospective randomized study. Radiology. 2013;269(1):293–300.CrossRefPubMedGoogle Scholar
  41. 41.
    Baek JH, Ha EJ, Choi YJ, Sung JY, Kim JK, Shong YK. Radiofrequency versus ethanol ablation for treating predominantly cystic thyroid nodules: a randomized clinical trial. Korean J Radiol. 2015;16(6):1332–40.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Lee JH, Kim YS, Lee D, Choi H, Yoo H, Baek JH. Radiofrequency ablation (RFA) of benign thyroid nodules in patients with incompletely resolved clinical problems after ethanol ablation (EA). World J Surg. 2010;34(7):1488–93.CrossRefPubMedGoogle Scholar
  43. 43.
    Jang SW, Baek JH, Kim JK, Sung JY, Choi H, Lim HK, et al. How to manage the patients with unsatisfactory results after ethanol ablation for thyroid nodules: role of radiofrequency ablation. Eur J Radiol. 2012;81(5):905–10.CrossRefPubMedGoogle Scholar
  44. 44.
    Baek JH, Jeong HJ, Kim YS, Kwak MS, Lee D. Radiofrequency ablation for an autonomously functioning thyroid nodule. Thyroid. 2008;18(6):675–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Sung JY, Baek JH, Jung SL, Kim JH, Kim KS, Lee D, et al. Radiofrequency ablation for autonomously functioning thyroid nodules: a multicenter study. Thyroid. 2015;25(1):112–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Durante C, Montesano T, Torlontano M, Attard M, Monzani F, Tumino S, et al. Papillary thyroid cancer: time course of recurrences during post surgery surveillance. Clin Endocrinol Metab. 2013;98(2):636–42.CrossRefGoogle Scholar
  47. 47.
    Samaan NA, Schultz PN, Hickey RC, Goepfert H, Haynie TP, Johnston DA, et al. The results of various modalities of treatment of well differentiated thyroid carcinomas: a retrospective review of 1599 patients. J Clin Endocrinol Metab. 1992;75(3):714–20.PubMedGoogle Scholar
  48. 48.
    Dupuy DE, Monchik JM, Decrea C, Pisharodi L. Radiofrequency ablation of regional recurrence from well-differentiated thyroid malignancy. Surgery. 2001;130(6):971–7.CrossRefPubMedGoogle Scholar
  49. 49.
    Monchik JM, Donatini G, Iannuccilli J, Dupuy DE. Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma. Ann Surg. 2006;244(2):296–304.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Baek JH, Kim YS, Sung JY, Choi H, Lee JH. Locoregional control of metastatic well-differentiated thyroid cancer by ultrasound-guided radiofrequency ablation. AJR Am J Roentgenol. 2011;197(2):W331–6.CrossRefPubMedGoogle Scholar
  51. 51.
    Park KW, Shin JH, Han BK, Ko EY, Chung JH. Inoperable symptomatic recurrent thyroid cancers: preliminary result of radiofrequency ablation. Ann Surg Oncol. 2011;18(9):2564–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Shin JE, Baek JH, Lee JH. Radiofrequency and ethanol ablation for the treatment of recurrent thyroid cancers: current status and challenges. Curr Opin Oncol. 2013;25(1):14–9.CrossRefPubMedGoogle Scholar
  53. 53.
    Lee SJ, Jung SL, Kim BS, Ahn KJ, Choi HS, Lim DJ, et al. Radiofrequency ablation to treat loco-regional recurrence of well-differentiated thyroid carcinoma. Korean J Radiol. 2014;15(6):817–26.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Wang L, Ge M, Xu D, Chen L, Qian C, Shi K, et al. Ultrasonography-guided percutaneous radiofrequency ablation for cervical lymph node metastasis from thyroid carcinoma. J Cancer Res Ther. 2014;10(Suppl):C144–9.PubMedGoogle Scholar
  55. 55.
    Lim HK, Baek JH, Lee JH, Kim WB, Kim TY, Shong YK, et al. Efficacy and safety of radiofrequency ablation for treating locoregional recurrence from papillary thyroid cancer. Eur Radiol. 2015;25(1):163–70.CrossRefPubMedGoogle Scholar
  56. 56.
    Kim JH, Yoo WS, Park YJ, Park DJ, Yun TJ, Choi SH, et al. Efficacy and safety of radiofrequency ablation for treatment of locally recurrent thyroid cancers smaller than 2 cm. Radiology. 2015;276(3):909–18.CrossRefPubMedGoogle Scholar
  57. 57.
    Baek JH, Lee JH, Sung JY, Bae JI, Kim KT, Sim J, et al. Korean Society of Thyroid Radiology. Complications encountered in the treatment of benign thyroid nodules with US-guided radiofrequency ablation: a multicenter study. Radiology. 2012;262(1):335–42.CrossRefPubMedGoogle Scholar
  58. 58.
    Ha EJ, Baek JH, Lee JH. Ultrasonography-based thyroidal and perithyroidal anatomy and its clinical significance. Korean J Radiol. 2015;16(4):749–66.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Ha EJ, Baek JH, Lee JH, Kim JK, Shong YK. Clinical significance of vagus nerve variation in radiofrequency ablation of thyroid nodules. Eur Radiol. 2011;21(10):2151–7.CrossRefPubMedGoogle Scholar
  60. 60.
    Shin JH, Jung SL, Baek JH, Kim JH. Rupture of benign thyroid tumors after radio-frequency ablation. AJNR Am J Neuroradiol. 2011;32(11):2165–9.CrossRefPubMedGoogle Scholar
  61. 61.
    Ha EJ, Baek JH, Kim KW, Pyo J, Lee JH, Baek SH, et al. Comparative efficacy of radiofrequency and laser ablation for the treatment of benign thyroid nodules: systematic review including traditional pooling and Bayesian network meta-analysis. J Clin Endocrinol Metab. 2015;100(5):1903–11.CrossRefPubMedGoogle Scholar
  62. 62.
    Lupo MA. Radiofrequency ablation for benign thyroid nodules - a look towards the future of interventional thyroidology. Endocr Pract. 2015;21(8):972–4.CrossRefPubMedGoogle Scholar
  63. 63.
    Esnault O, Franc B, Monteil JP, Chapelon JY. High-intensity focused ultrasound for localized thyroid-tissue ablation: preliminary experimental animal study. Thyroid. 2004;14(12):1072–6.CrossRefPubMedGoogle Scholar
  64. 64.
    Esnault O, Franc B, Chapelon YJ. Localized ablation of thyroid tissue by high-intensity focused ultrasound: improvement of noninvasive tissue necrosis methods. Thyroid. 2009;19(10):1085–91.CrossRefPubMedGoogle Scholar
  65. 65.
    Esnault O, Rouxel A, Le Nestour E, Gheron G, Leenhardt L. Minimally invasive ablation of a toxic thyroid nodule by high-intensity focused ultrasound. AJNR Am J Neuroradiol. 2010;31(10):1967–8.CrossRefPubMedGoogle Scholar
  66. 66.
    Esnault O, Franc B, Ménégaux F, Rouxel A, De Kerviler E, Bourrier P, et al. High-intensity focused ultrasound ablation of thyroid nodules: first human feasibility study. Thyroid. 2011;21(9):965–73.CrossRefPubMedGoogle Scholar
  67. 67.
    Korkusuz H, Fehre N, Sennert M, Happel C, Grünwald F. Early assessment of high-intensity focused ultrasound treatment of benign thyroid nodules by scintigraphic means. J Ther Ultrasound. 2014;2:18.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Korkusuz H, Sennert M, Fehre N, Happel C, Grünwald F. Local thyroid tissue ablation by high-intensity focused ultrasound: effects on thyroid function and first human feasibility study with hot and cold thyroid nodules. Int J Hyperthermia. 2014;30(7):480–5.CrossRefPubMedGoogle Scholar
  69. 69.
    Korkusuz H, Fehre N, Sennert M, Happel C, Grünwald F. Volume reduction of benign thyroid nodules 3 months after a single treatment with high-intensity focused ultrasound (HIFU). J Ther Ultrasound. 2015;3:4.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Korkusuz H, Sennert M, Fehre N, Happel C, Grünwald F. Localized thyroid tissue ablation by high intensity focused ultrasound: volume reduction, effects on thyroid function and immune response. Röfo. 2015;187(11):1011–5.PubMedGoogle Scholar
  71. 71.
    Kovatcheva RD, Vlahov JD, Stoinov JI, Zaletel K. Benign solid thyroid nodules: US-guided high-intensity focused ultrasound ablation-initial clinical outcomes. Radiology. 2015;276(2):597–605.CrossRefPubMedGoogle Scholar
  72. 72.
    Kovatcheva RD, Vlahov JD, Shinkov AD, Borissova AM, Hwang JH, Arnaud F, et al. High-intensity focused ultrasound to treat primary hyperparathyroidism: a feasibility study in four patients. AJR Am J Roentgenol. 2010;195(4):830–5.CrossRefPubMedGoogle Scholar
  73. 73.
    Kovatcheva RD, Vlahov JD, Stoinov JI, Kirilov GG, Krivoshiev SG, Arnaud F, et al. High-intensity focussed ultrasound (HIFU) treatment in uraemic secondary hyperparathyroidism. Nephrol Dial Transplant. 2012;27(1):76–80.CrossRefPubMedGoogle Scholar
  74. 74.
    Kovatcheva R, Vlahov J, Stoinov J, Lacoste F, Ortuno C, Zaletel K. US-guided high-intensity focused ultrasound as a promising non-invasive method for treatment of primary hyperparathyroidism. Eur Radiol. 2014;24(9):2052–8.CrossRefPubMedGoogle Scholar
  75. 75.
    Ambrosini CE, Cianferotti L, Picone A, Torregrossa L, Segnini G, Frustaci G, Cetani F, Basolo F, Marcocci C, Miccoli P. High-intensity focused ultrasound as an alternative to the surgical approach in primary hyperparathyroidism: a preliminary experience. J Endocrinol Invest. 2011;34(9):655–9.CrossRefPubMedGoogle Scholar

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© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Endocrine UnitCentro PalmerReggio EmiliaItaly

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