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Fine-needle aspirates might not provide diagnostic cellular tissue, whereas excisional biopsies rarely meet the appropriate margins (5 cm in two fascial planes) as required in the case of FISS, thus increasing the morbidity and mortality risks associated with sarcoma invasion (Stone et al., 2020)

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Additional oral calcium supplementation at a dose of 1.2 g/day when co-administered with metformin has previously shown to partially mitigate this effect of metformin suggesting its potential role in prevention of B12 deficiency