Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment

The margin of the acetowhite area on the cervix can have any of the following characteristics:

• Diffuse or indistinct
• Sharp and irregular (also described as feathery, angular, digitating, or geographical)
• Sharp and regular
• Sharp and raised

Thin transparent acetowhite areas that have diffuse or irregular margins are VIA-negative, because they are associated with non-neoplastic conditions such as squamous metaplasia or are due to low-grade squamous intraepithelial lesions (LSIL).

Acetowhite areas with angular, geographical, or digitating margins are more likely to be associated with infection with low-risk HPV types (condylomata) or to be due to CIN1. Usually these lesions are thin in density and are considered as VIA-negative. An acetowhite area may appear comparatively denser in spite of having irregular margins, and a positive diagnosis should be given on VIA.

Condylomata can sometimes have a dense white colour and a raised margin. They can be differentiated from high-grade lesions by their irregular, digitating, angulated margins and the presence of satellite lesions. Condylomata may be present within the TZ or outside the TZ. A dense acetowhite area that has an irregular, sharp margin and is located within the TZ should be considered as VIA-positive. Dense acetowhite lesions that are clearly outside the TZ should be diagnosed as VIA-negative.

A dense acetowhite area that has a distinct sharp, regular margin and is located in the TZ is VIA-positive and is likely to be associated with high-grade cervical neoplasia. A dense acetowhite area in the TZ with a sharp, raised margin with peeling edges can even be due to an early invasive cancer.