Lymph nodes in the human female breast: a review of their detection and significance.

Our experience led us to test the hypothesis that lymph nodes are not uncommon within the substance of the human female breast mound. The following specimen types and sources were used to survey the presence of intramammary lymph nodes in the human female breast mound: (1) cadaver breasts; (2) community hospital breast specimens; and (3) university and VA hospital specimens. We found true lymph nodes within and associated with breast specific tissue (ie, tissue that includes duct and gland structures), thereby validating the hypothesis posed. We discuss the significance of these findings in terms of our dominant patient care paradigm (the Triple Test-physical examination, imaging, and fine-needle aspiration [FNA]) and the choice of patient care management options. We conclude the following: lymph nodes occur in any quadrant of the breast mound; recognizing the possibility of intramammary lymph nodes is important when choosing between patient management options; intramammary lymph nodes can be sampled by FNA; intramammary lymph nodes can contain various disease processes; and in the Oregon Health Sciences University Multidisciplinary Breast Clinic, these intramammary lymph nodes are commonly identified by imaging methods and are more likely to be sampled by FNA than either by core or excisional biopsy.

[Tubal diseases: from diagnosis to intervention]. / Pathologie tubaire: du diagnostic à l'interventionnel.

Ninety years after it was first performed, hysterosalpingography remains one of the most important tests in helping an infertile couple decide between numerous treatment options. The application of angiographic techniques to hysterosalpingography has revolutionized diagnosis and treatment of proximal tubal obstruction. Results from worldwide centers have shown that nonsurgical catheter recanalization of proximally obstructed tubes can be accomplished in up to 90% of patients using standard techniques. Pregnancy incidence in a population who was recommended for tubal microsurgery or in vitro fertilization, but who underwent catheter tubal recanalization instead without any other therapy, was 58% at one year and all pregnancies were intrauterine. Fluoroscopic fallopian tube catheterization should be the first treatment for proximal tubal obstruction, with the more expensive and invasive procedures reserved for the small number of women who fail the radiologic procedure.

A review of selective salpingography and fallopian tube catheterization.

Use of selective salpingography and fallopian tube recanalization has revolutionized the diagnosis and treatment of infertility. Selective salpingography, a diagnostic procedure in which the fallopian tube is directly opacified through a catheter placed in the tubal ostium, has been used since the late 1980s to differentiate spasm from true obstruction and to clarify discrepant findings from other tests. In fallopian tube recanalization, a catheter and guide wire system is used to clear proximal tubal obstructions. The recanalization procedure is simple for interventional radiologists to perform and is successfully completed in most patients (71%-92%). Pregnancy rates after the procedure have been variable, with an average rate of 30%. The combination of selective salpingography with fallopian tube recanalization has improved the overall management of infertility caused by tubal obstruction. The same catheterization technique used in fallopian tube recanalization is currently being explored for use in tubal sterilization.