Air pollution exposure and mammographic breast density in Tehran, Iran: a cross-sectional study.

BACKGROUND: Air pollution is one of the major public health challenges in many parts of the world possibly has an association with breast cancer. However, the mechanism is still unclear. This study aimed to find an association between exposure to six criteria ambient air pollutants (PM2.5, PM10, SO2, NO2, O3, and CO) and mammographic breast density (MBD), as one of the strongest predictors for developing breast cancer, in women living in Tehran, Iran. METHODS: Participants were selected from women attending two university hospitals for screening mammography from 2019 to 2021. Breast density was rated by two expert radiologists. Individual exposures to 3-year ambient air pollution levels at the residence were estimated. RESULTS: The final analysis in 791 eligible women showed that low and high breast density was detected in 34.8 and 62.2 of participants, respectively. Logistic regression analysis after considering all possible confounding factors represented that an increase in each unit of NO2 (ppb) exposure was associated with an increased risk of breast density with an OR equal to 1.04 (95CI: 1.01 to 1.07). Furthermore, CO level was associated with a decreasing breast density (OR = 0.40, 95CI = 0.19 to 0.86). None of the other pollutants were associated with breast density. CONCLUSION: Higher MBD was associated with an increased level of NO2, as a marker of traffic-related air pollution. Furthermore, CO concentration was associated with a lower MBD, while other criteria air pollutants were not related to MBD. Further studies are needed to evaluate the association between ambient air pollutants with MBD.

A Practical, Clinical User-Friendly Format for Breast Ultrasound Report.

OBJECTIVE: Breast ultrasound (BUS) is often performed as an adjunct to mammography in breast cancer screening or for evaluating breast lesions. Our aim was to design a practical and user-friendly format for BUS that could include the details of the Breast Imaging Reporting and Data System. MATERIALS AND METHODS: As a team of radiologists and surgeons trained in the management of breast diseases, we gathered and carried out the project in four phases-literature search and collection of present report formats, summarizing key points and preparing the first draft, seeking expert opinion and preparing the final format, and pilot testing-followed by a survey was answered by the research team's radiologists and surgeons. RESULTS: It produced a list of items to be stated in the BUS report, the final BUS report format, and the pilot format guide. Then, the radiologists used the format in three active ultrasound units in university-affiliated centers, and reports were referred to the surgeons. At the end of the project, the survey showed a high degree of ease of use, clarity, conciseness, comprehensiveness, and well-classified structure of the report format; but radiologists believed that the new organization took more time. CONCLUSION: We propose our design as a user-friendly and practical format for BUS reports. It should be used for a longer time and by various ultrasound centers in order to ascertain its benefits.

Abnormal anti-Müllerian hormone level may be a trigger for breast cancer in young women: A case-control study.

BACKGROUND: Anti-Müllerian hormone (AMH) is a known sensitive biomarker for fertility and ovarian reserve. The results of in vivo and human studies showed inconsistency with respect to the relation between AMH and breast cancer. OBJECTIVE: To compare the AMH level of young Iranian women with early breast cancer who have not received any treatment compared to that of healthy women. MATERIALS AND METHODS: In this case-control study, 58 breast cancer cases were recruited from the breast oncology clinic of two university hospitals. They were diagnosed with an in situ or invasive breast cancer before any anticancer treatment between August 2018 and April 2019. Healthy controls (n = 58) were selected from women referred to a gynecologic outpatient clinic without any symptoms of cancer or infertility. AMH was measured by the AMH enzyme-linked immunosorbent assay kits in one laboratory. RESULTS: Final analysis showed that the AMH means of case and control were not statistically significant (3.36 ± 2.95 vs 3.13 ± 1.79). However, the lower and higher AMH level categories are more prevalent in breast cancer compared to the control. Pearson's correlation test showed that the AMH level was negatively correlated with age (r = -0.44, p < 0.001). The results of logistic regression analysis considering confounding factors showed the positive association between breast cancer and lower (Odds Ratio [OR] = 5.98, p = 0.02) and higher quartile of AMH level (OR = 4.95, p = 0.01). CONCLUSION: Our results suggest that abnormal AMH level is more frequent in young breast cancer patients. Further investigation considering AMH determinants is required.

Sonoelastography for Skin Evaluation in Sclerodermic Patients.

BACKGROUND: The objective of the study is to evaluate elastography ultrasound findings in patients with scleroderma (SS) and to clarify the effectiveness of elastosonography to differentiate scleroderma lesions from any skin lesion considering tissue elasticity. METHODS: Thirty-six SS patients definite diagnosis of systemic sclerosis according to American College of Rheumatology criteria and 36 healthy subjects were enrolled. Volar aspect of the middle forearm and arm in addition to the dorsal aspect of the fingers were evaluated by sonoelastography. The RGB (red, green, blue) image is a three-dimensional matrix. A color image RGB is an M × N × 3 array of color pixels. The total pixels, total blue pixels, and blue index compared between SS cases and controls. RESULTS: Mean age of patients was 41.3 ± 10.3 years and mean age of controls was 39.8 ± 9.3 years. Mean-modified Rodnan skin score of the whole body was 11.9 and mean duration of disease was 6.2 years. Mean total blue pixels in the arm were significantly different between cases and controls. Mean total image pixels, total blue pixels, and blue index in the forearm were significantly different between cases and controls. Elastography findings in the finger were not significantly different between cases and controls. CONCLUSIONS: Sonoelastography could be used for evaluating skin of forearm in sclerodermic cases which will be helpful for disease evaluation in clinical course.

The Diagnostic Role of Magnetic Resonance Enterography as a Complementary Test to Colonoscopy in Active Crohn's Disease.

BACKGROUND According to recent studies comparing magnetic resonance enterography (MRE) with ileocolonoscopy for assessing inflammation of small bowel and colonic segments in adults with active Crohn's disease (CD), we aimed to compare the accuracy of these two diagnostic methods in Iranian population. METHODS During 2013-2014 a follow-up study was done on 30 patients with active CD in a gastroenterology clinic affiliated to Tehran University of Medical Sciences. MRE and ileocolonoscopy were performed for all the patients. All statistical analyses were performed using SPSS (version 18) and p-value<0.05 was considered as statistically significant. RESULTS Of the 30 patients with active CD, 11(36.7%) were men and 19 (63.3%) were women with mean age of 37.30±13.66 years (range: 19-67 years). MRE had sensitivity and specificity of 50% and 90% with positive predictive value (PPV) and negative predictive value (NPV) of 71.43 and 78.26, respectively for localizing sigmoid lesions and ileum had sensitivity and specificity of 84.21 and 45.45 with PPV and NPV of 72.73 and 62.50, respectively. CONCLUSION While moderate sensitivity and high specificity of MRE in localizing colonic lesions makes it an appropriate confirmatory test after colonoscopy, the reported high sensitivity and moderate specificity of MRE versus colonoscopy in detecting ileal lesions makes it a suitable screening test for ileal lesions. Finally we can conclude that MRE can be an important complementary test to colonoscopy in detecting active disease.

Application of Sonoelastography in Differential Diagnosis of Benign and Malignant Thyroid Nodules.

BACKGROUND: Sonoelastography is a new ultrasound method which could be helpful to determine which thyroid nodule is malignant. We designed this study to evaluate the accuracy of sonoelastography in differentiating of benign and malignant thyroid nodules in Iranian patients. METHODS: Forty thyroid nodules in forty consecutive patients who had been referred for sonography-guided fine-needle aspiration biopsy were evaluated. Gray scale ultrasound and elastosonography by real-time, freehand technique applied for all patients. Elastography findings were classified into four groups. Nodules which were classified as patterns 1 or 2 in elastogram evaluation were classified as benign and probably malignant if elastogram scans were patterns 3 and 4 of elastogram scan. RESULTS: Mean age ± standard deviation (SD) was 42.2 ± 12.6 years, and mean ± SD thyroid-stimulating hormone level was 1.4 ± 1.9 IU/ml. Thirty-five cases (87.5%) were female and 5 (12.5%) were male. Histological examination indicated 27 (67.5%) benign and 13 (32.5%) malignant nodules. The most elastogram score was 2 (50%) followed by score 3. The cut-off point of 2 considered as the best value to differentiate benign and malignant thyroid nodules with sensitivity and specificity of 61% and 78% (area under the curve = 0.76, 95% confidence interval: 0.6-0.92, P = 0.007). CONCLUSIONS: Sonoelastography could help to differentiate benign and malignant thyroid nodules. As our sample size was limited, larger studies are recommended.

Generation of a Four-Class Attenuation Map for MRI-Based Attenuation Correction of PET Data in the Head Area Using a Novel Combination of STE/Dixon-MRI and FCM Clustering.

PURPOSE: The aim of this study is to generate a four-class magnetic resonance imaging (MRI)-based attenuation map (µ-map) for attenuation correction of positron emission tomography (PET) data of the head area using a novel combination of short echo time (STE)/Dixon-MRI and a dedicated image segmentation method. PROCEDURES: MR images of the head area were acquired using STE and two-point Dixon sequences. µ-maps were derived from MRI images based on a fuzzy C-means (FCM) clustering method along with morphologic operations. Quantitative assessment was performed to evaluate generated MRI-based µ-maps compared to X-ray computed tomography (CT)-based µ-maps. RESULTS: The voxel-by-voxel comparison of MR-based and CT-based segmentation results yielded an average of more than 95 % for accuracy and specificity in the cortical bone, soft tissue, and air region. MRI-based µ-maps show a high correlation with those derived from CT scans (R (2) > 0.95). CONCLUSIONS: Results indicate that STE/Dixon-MRI data in combination with FCM-based segmentation yields precise MR-based µ-maps for PET attenuation correction in hybrid PET/MRI systems.