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| <ref name="pmid22750769">{{cite journal |vauthors=Garg PK, Jain BK, Dubey IB, Sharma AK |title=Generalized lymphadenopathy: physical examination revisited |journal=Ann Saudi Med |volume=33 |issue=3 |pages=298–300 |date=2013 |pmid=22750769 |pmc=6078537 |doi=10.5144/0256-4947.2012.01.7.1525 |url=}}</ref><ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |date=March 2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="pmid12484692">{{cite journal |vauthors=Bazemore AW, Smucker DR |title=Lymphadenopathy and malignancy |journal=Am Fam Physician |volume=66 |issue=11 |pages=2103–10 |date=December 2002 |pmid=12484692 |doi= |url=}}</ref><ref name="pmid10549745">{{cite journal |vauthors=Soldes OS, Younger JG, Hirschl RB |title=Predictors of malignancy in childhood peripheral lymphadenopathy |journal=J. Pediatr. Surg. |volume=34 |issue=10 |pages=1447–52 |date=October 1999 |pmid=10549745 |doi=10.1016/s0022-3468(99)90101-x |url=}}</ref><ref name="pmid10189390">{{cite journal |vauthors=Ghirardelli ML, Jemos V, Gobbi PG |title=Diagnostic approach to lymph node enlargement |journal=Haematologica |volume=84 |issue=3 |pages=242–7 |date=March 1999 |pmid=10189390 |doi= |url=}}</ref>
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| {{familytree/start |summary=Management of lymphadenopathy}}
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| {{familytree | | | | | | | | | | Z01 | | | | | | | |Z01='''History'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; width: 20em; padding:1em;"><br><div style="float: left; text-align: left; width: 20em; padding:1em;">
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| :❑[[Patient]] [[age]] (specific demographic characteristics ([[age]]) of certain [[malignancy|malignancies]])<br>
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| :❑ Duration of [[lymphadenopathy]] (<2 weeks or >1 year without an increase in size has low malignant potential)<br>
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| :❑ Past medical history of underlying disease, suggestive of [[immunodeficiency]], or recurrent [[infections]]<br>
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| :❑ Sexual history suggestive of infection transmission<br>
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| :❑ Family history of certain malignant disorders ([[breast cancer]], or [[melanoma]])<br>
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| :❑ Exposure to communicable [[infectious disease]]s/ travel to high-risk areas<br>
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| :❑ Environmental exposure such as [[ultraviolet radiation|UV]] (skin cancer risk)/ animals/ occupational exposure <br>
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| :❑ Social history such as tobacco use, alcohol use (head and neck cancers risk)<br>
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| :❑ Associated symptoms such as [[pain]], [[fever]], [[weight loss]], [[anorexia]], [[cough]], or recurrent [[UTI]]s}}
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| {{familytree | | | | | | | | | | |!| | | | | | | }}
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| {{familytree | | | | | | | | | | M01 | | | | | | | M01='''[[Physical exam]]'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; width: 20em; padding:1em;"><br>'''Appearance of the [[patient]]'''<br>[[Cachexia]] or surgical scar marks demonstrating previous malignancy treatment<br>
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| ❑ [[Vital signs]]<br>
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| :❑ [[Temperature]]: High-grade / low-grade fever may demonstrate [[infection]]. <br>
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| :❑ [[Heart rate]]: [[Tachycardia]] with regular pulse may demonstrate [[infection]]. <br>
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| :❑ [[Respiratory rate]]: [[Tachypnea]] may demonstrate [[respiratory system]] involvement ([[infection]]\ [[metastasis]]).<br>
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| :❑ [[Blood pressure]]: [[Chronic hypertension]] or [[hypotension]] (may indicate [[sepsis]] as a complication).<br>
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| :❑ [[Oxygen saturation]]: may be low if the [[respiratory system]] is affected.<br>
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| ❑ HEENT<br>
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| ❑ [[Cardiovascular examination]]<br>
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| ❑ [[Respiratory examination]]<br>
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| ❑ [[Gastrointestinal system]] exam includes [[oral examination]], [[abdominal examination]], and [[digital rectal exam]]. <br>
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| :❑ [[Splenomegaly]]) may demonstrate [[infectious mononucleosis|IM]], [[Hodgkin's lymphoma|hodgkin's]]/ [[non-Hodgkin's lymphoma]], and [[sarcoidosis]]<br>
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| ❑ [[Limb (anatomy)|Extremities]] exam<br>
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| ❑ Skin exam: Evaluate for the lesions that indicate [[malignancy]] such as [[melanoma]]/ potential inoculation sites for germ such as traumatic lesions.}}
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| {{familytree | | | | | | | | | | |!| | | | | | |}}
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| {{familytree | | | | | | | | | | N01 | | | | | | | N01='''Palpable [[lymph node]]'''<div style="float: left; text-align: left; width: 20em; padding:1em;"><div class="mw-collapsible mw-collapsed"><br>
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| ❑ Location: (Localized vs generalized)<br>
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| :❑ For nodes involving several groups of nodes; suspect malignancy.<br>
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| :❑ An enlarged node in a lymphatic rich region; suspect local disease.<br>
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| :❑ Associated red streaking, suspect [[lymphangitis]].<br>
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| :❑ Left [[supraclavicular lymph nodes|supraclavicular L.N]] ([[Virchow's nodes]]); suspect [[gastric carcinoma]]<br>
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| :❑ Right [[supraclavicular lymph nodes|supraclavicular L.N]], suspect intra-thoracic carcinoma<br>
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| ❑ Dimensions <br>
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| The aforementioned dimensions are abnormal for a palpable [[lymph node]] but do not lead to the suspicion of a [[neoplasm]].
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| :❑ [[Supraclavicular lymph nodes|supraclavicular]], [[iliac lymph nodes|iliac]], [[epitrochlear lymph nodes|epitrochlear]], and [[popliteal lymph nodes]] >0.5cm <br>
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| :❑ [[Inguinal nodes]] > 1.5 cm <br>
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| :❑ Other area [[lymph nodes]] >1 cm <br>
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| ❑ Tenderness or pain: <br>
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| :❑ Suspect [[infection]]. <br>
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| :❑ A [[neoplastic]] node may also demonstrate [[pain]] due to [[hemorrhage]] associated with central necrosis or a brisk growing tumor.<br>
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| ❑ Consistency <br>
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| :❑ Hard on palpation; suspect [[chronic inflammation]]<br>
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| :❑ consistent- acute inflammation<br>
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| :❑ Stony-hard and painless nodes-metastatic cancer/ [[granuloma]] <br>
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| :❑ Firm and rubbery nodes- lymphoma<br>
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| :❑ Matted [[lymph nodes|L.N]] suspect [[mycobacterium]] / [[sarcoidosis]]/ [[lymphoma]] / [[metastatic carcinoma]])<br>
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| ❑ Mobility<br>
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| :❑ Freely movable; suspect [[infections]] and [[collagen vascular disease]]<br>
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| :❑ Fixed [[Lymph node|L.N]] to surrounding tissue; suspect [[malignancy]]}}.
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| {{familytree | | | | | | | | | | |!| | | | | | | }}
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| {{familytree | | | | | | | | | | U01 | | | | | | | U01='''Labs'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; width: 20em; padding:1em;">
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| ❑ [[CBC]] with differential<br>
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| ❑ [[ESR]]<br>
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| ❑ [[CMP]]<br>
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| ❑ [[Peripheral smaer]]<br>
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| ❑ [[Liver function tests|LFTs]]<br>
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| *''Labs may be required at a later stage pf diagnosis''}}
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| {{familytree | | | | | | | | | | |!| | | | | | | }}
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| {{familytree | | | | | | | | | | |!| | | | | | | }}
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| {{familytree | |,|-|-|-|v|-|-|-|-|+|-|-|-|-|.| | |}}
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| {{familytree | Y01 | | Y02 | |,| Y03 |.| | Y04 | | | |Y01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Diagnostic of self-limiting or benign disease'''<br>
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| [[Pharyngitis]], [[URTI]], [[conjunctivitis]], [[cat-scratch disease]], etc|Y02='''Suggests infection/ serious infection'''|Y03='''Unexplained'''|Y04='''Suggests malignancy'''}}
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| {{familytree | |!| | | |!| | |!| |!| |!| | |!|}}
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| {{familytree | K01 | | K02 | |!| K03 |!| | K04 | | K01=<div style="float: left; text-align: left; width: 20em; padding:1em;"> May require specific tests<div class="mw-collapsible mw-collapsed"><br>
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| ❑ Throat swab<br>
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| ❑ [[Sputum exam]]| K02=Perform specific tests<div style="float: left; text-align: left; width: 20em; padding:1em;"><div class="mw-collapsible mw-collapsed"><br>
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| ❑ [[Mononucleosis|IM]]: [[Mononucleosis laboratory findings|Heterophile Antibody]] and [[Mononucleosis laboratory findings|monospot test]] <br>
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| ❑ [[Syphilis]]: [[VDRL]], [[RPR]]<br>
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| ❑ [[HIV]]: [[HIV test#Antibody tests|HIV antibody test]] <br>
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| ❑ [[CMV]]: Anti CMV [[IgM]]<br>
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| ❑ [[Autoimmune disorders]]: [[ANA]], [[Rheumatoid factor]], etc<br>
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| ❑ [[Tuberculosis]]: [[PPD]]<br>
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| ❑ [[Cat scratch fever|Cat scratch disease]]: [[IgM]], [[IgG]]|K03=Risk factors for [[malignancy]]<br>Family history, [[age]], exposure, etc|K04=Perform specific tests}}
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| {{familytree | |!| | | |!| | |!| |!| |!| | |!|}}
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| {{familytree | |!| | |,|^|.| |!| |!| |!| | F01 |F01=Excisional biopsy}}
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| {{familytree | |!| B01 | | B02 | |!| |!| |,|^|-|.|B01=Positive|B02=Negative}}
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| {{familytree | |!| | |!| | | | | |!| |`| J01 | | J02 | |J01=Negative|J02=Positive}}
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| {{familytree | |!| | |!| | | | | |!| | | | | | | |!| | | |}}
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| {{familytree | K04 | | K05 | | | |!| | | | | | K03 | |K04=<div style="float: left; text-align: left; width: 20em; padding:1em;">❑ '''Treat'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; padding:1em;">with [[antibiotics]] if required and/ or symptomatic treatment<br>
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| ❑ For an untreatable or disease with residual symptoms counsel the [[patient]]<br>
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| ❑ Follow up for advancing or persistent [[lymphadenopathy|LAD]]|K05=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Treat'''<div class="mw-collapsible mw-collapsed"><br>
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| ❑ [[Mononucleosis medical therapy|IM treatment]]<br>
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| ❑ [[Syphilis medical therapy|Syphilis treatment]]<br>
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| ❑ [[HIV medical therapy|HIV treatment]]<br>
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| ❑ [[Cytomegalovirus infection medical therapy|CMV treatment]]<br>
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| ❑ [[Autoimmunity#Treatments|Treatment of autoimmune disorders]]<br>
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| ❑ [[Tuberculosis medical therapy|Tuberculosis treatment]]<br>
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| ❑ [[Cat scratch fever medical therapy|cat scratch disease treatment]]|K01=Low risk|K02=High risk|K03='''Treat'''<div class="mw-collapsible mw-collapsed"><div style="float: left; text-align: left; padding:1em;"><br>Surgical resection/ [[chemotherapy]]/ [[radiotherapy]]}}
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| {{familytree | | | | | | | | | | |!| | | | | | | |}}
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| {{familytree | | | | | | |,|-|-|-|^|-|-|.| | | | }}
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| {{familytree | | | | | | A01 | | | | | A02 | | | | | | |A01= Low risk<br> |A02=High risk}}
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| {{familytree | | | | | | |!| | | | | | |!| | | | }}
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| {{familytree | | | | | | |!| | | | | | B01 | | | | B01=<div style="float: left; text-align: left; line-height: 150% ">Specific tests/ [[biopsy]]}}
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| {{familytree | | | | | | |!| | | | | | | | | }}
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| {{familytree | | |,|-|-|-|^|-|-|.| | | | | | | | }}
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| {{familytree | | C01 | | | | | | C02 | | | | | | | | |C01=Localized|C02=Generalized}}
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| {{familytree | | |!| | | | | | | |!| | | | | | | | }}
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| {{familytree | | D01 | | | | | | D02 | | | | | | | | | D01=Review history and clues suggesting malignancy|D02=Review history and clues suggesting malignancy}}
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| {{familytree | | |!| | | | | | | |!| | | | | | | | }}
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| {{familytree | | E01 | | | | | | E02 | | | | | | | |E01=Observe 3-4 weeks|E02=Specific tests such as [[CXR]], [[ultrasound]], [[CT]], lab workup, [[biopsy]]}}
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| {{familytree | | |!| | | | | | |,|-|^|-|-|.| | | | | }}
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| {{familytree | |,|^|-|.| | | | F01 | | | F02 | | | | |F01=Undiagnostic|F02=Diagnostic}}
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| {{familytree | |!| | |!| | | | |!| | | | |!| | | | |}}
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| {{familytree | L01 | |L02| | |!| | | | |!| | | | | | |L01=Progress/persists|L02=Regress}}
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| {{familytree |!| | | |!| | | | |!| | | | |!| | | | | |}}
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| {{familytree |!| | | |G03 | | | G01 | | | G02 | | | | | | |G01=Biopsy|G02=Treatment|G03=No follow-up}}
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| {{familytree |!| | | |!| | | |,|-|^|.| | | | | | | | | | |}}
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| {{familytree |!| | | |!| | | H01 | | H02 | | | | | | | | | |H01=Positive|H02=Negative }}
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| {{familytree |!| | | |!| | | |!| | | |!| | | | | | | | | |}}
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| {{familytree |!| | | |!| | | I01 | | I02 | | | | | | | | | |I01=Treatment|I02= Follow-up}}
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| {{familytree |G01 | |!| | | | | | | | | | | | | | | | |G01=Biopsy}}
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| {{familytree |!| | | |!| | | | | | | | | | | | | | | | | |}}
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| {{familytree |)|-|-| Q01 | | | | | | | | | | | | | | | | | | Q01=Negative|}}
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| {{familytree |!| | | | | | | | | | | | | | | | | | | | | |}}
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| {{familytree |`|-|-| X01 | | | | | | | | | | | | | | | | | | | | | |X01=Positive}}
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| {{familytree | | | | |!| | | | | | | | | | | | | | | | | |}}
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| {{familytree | | | | Y01 | | | | | | | | | | | | | | | | | Y01=Treatment}}
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|
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| {{familytree/end}}
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