Case |
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Speculum examination |
After normal saline |
After acetic acid |
After acetic acid with green filter |
After Lugol’s iodine |
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Nil or transparent | Thin, milky | Distinct, stearin | |
Nil or diffuse | Sharp but irregular, jagged, satellites | Sharp and even, difference in level | |
Fine, regular | Absent | Coarse or atypical vessels | |
< 5 mm | 5-15 mm or 2 quadrants | >15 mm, 3-4 quadrants, or endocervically undefined | |
Brown | Faintly or patchy yellow | Distinctly yellow |
Provisional diagnosis: | Type 1 transformation zone; high-grade squamous intraepithelial lesion (HSIL). |
Management: | LLETZ (type 1 excision). |
Histopathology: | HSIL-CIN3. |
Comment: | Although the acetowhite lesion is visible only in part of the posterior lip, all four quadrants are iodine-negative. The entire iodine-negative area should be excised during LLETZ. The acetowhite area may not be visible in parts of high-grade lesions, due to erosion. |
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