Though the number of Vesicouterine Fistulas is steadily increasing in association with the increasing number of cesarean sections, clinical presentation can be subtle and not easily identified. In this case study, we will review the presenting symptoms of this complication and suggest an updated management protocol.

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#1016 Background: Sentinel node biopsy (SNB) is an accurate procedure for axillary staging and the surgeons' experience is crucial for its proper application. A training session involving 20-30 cases is widely practiced. In order to speed up this learning curve, surgeons were trained intraoperatively by one instructor. The purpose of this report was to evaluate the procedure by comparing the results of the instructor with those of the trainees.
 Material and Methods: Patients with invasive breast cancer (T0-T2[<3cm]N0M0) were considered eligible. Lymphatic mapping was obtained by peritumoral or periareolar injections of technetium with or without blue dye. Complementary axillary lymph node (LN) dissection was performed when SNB was unsuccessful or when SN were positive. Patients were distributed in 4 groups : (i) teacher's learning curve (SNB followed by complementary axillary dissection) (n=40), (ii) SNB by instructor (n=130), (iii) SNB by trainees with supervision from instructor (n=63), and (iv) SNB by trainees alone (n=303). The criteria of patients' selection, the parameters of success of the SNB procedure, and the LN metastases were compared. Reported p-values compare groups (ii) to (iv).
 Results : From May 1999 to December 2007, 808 patients underwent a SNB. The SN identification rate was 98% in the group (i), 98% in the group (ii), 97% in the group (iii), and 99% in the group (iv) (p=0.196). SN were positive in respectively 28%, 31%, 28%, and 29% of patients. Overall positive nodes (SN and LN) were diagnosed in respectively 28%, 31%, 30%, and 30% of patients (p=0.833). The distribution of isolated tumor cells, micrometastases, and metastases was not statistically different between the four groups (p=0.163).
 Conclusion: These comparable results confirm the success with which the SNB was taught. This strategy avoided the 20-30 SNB with complementary axillary dissection. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1016.