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

VIA procedure Ė Examination after application of 5% acetic acid Ė Abnormal features Ė Margin of acetowhite area

  

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.






























  


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