The paradigm of cervical cancer screening and precancer management is evolving rapidly. In higher-resource countries, testing for high-risk human papillomavirus (HPV) is gradually replacing Pap smear cytology as the screening test of choice. The majority of low- and middle-income countries (LMICs) are not yet ready to introduce the HPV detection test and have to rely on visual inspection after application of acetic acid (VIA) as the most feasible and affordable screening test. In spite of its several limitations, VIA is being widely used in resource-constrained settings. VIA will be relevant in LMICs even after the introduction of HPV testing, because VIA can be effectively used to triage HPV-positive women for further management.
Whatever screening approach is used, determining eligibility for treatment by an ablative technique requires assessment of the cervix after application of acetic acid and following some of the basic principles and steps of VIA.
This atlas is designed for providers of VIA or HPV testing, especially in a setting where the screen-positive women are immediately evaluated for treatment with either cryotherapy or thermal ablation (the screen-and-treat approach). The contents of the atlas are organized into three sections.
- Section 1 describes the principles of VIA, the consumables and equipment needed, the technique of VIA as a screening test or a test to triage HPV-positive women, documentation of the findings, and interpretation of the findings. This section also deals with how to manage the women with a positive VIA test and how to assess the cervix to determine eligibility for treatment by an ablative technique. Although visual inspection after application of Lugolís iodine (VILI) is not a well-recognized screening test, Lugolís iodine is often applied to the cervix to delineate a lesion before treatment. Hence, the changes observed after application of Lugolís iodine and how to interpret them are also described in this section.
- Section 2 (Cases) is a large repository of cervical images collected before and after application of acetic acid (and after application of Lugolís iodine, when a lesion is present). Readers can magnify the annotated images by clicking on them and learn about various normal and abnormal features of the cervix and how to interpret VIA findings. They will also learn from the case studies how to determine eligibility for ablative treatment.
- Section 3 (Quiz) is a self-learning module on image recognition. Readers will be provided with a randomly selected set of images and will have to interpret them and submit responses. The results will be provided immediately, for readers to perform self-assessment.
This atlas does not deal with the techniques of treatment of cervical precancer, which interested readers may learn from the Atlas of Colposcopy: Principles and Practice
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