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

A precancer may be of any size, whereas invasive cancers are often large and extend beyond the TZ. Assessing the size of the acetowhite area is important, because it helps in selecting the method of treatment (described later). Hence, it is important for the VIA provider to document the size of the lesion if the VIA test is positive.

The size of the acetowhite area is assessed and is expressed as the number of quadrants of the cervix it occupies and the approximate percentage of the area of the cervix involved.

To estimate the size of the acetowhite area in terms of the number of quadrants it occupies, the cervix is divided into four quadrants by drawing two imaginary lines perpendicular to each other, intersecting at the centre of the external os. The size of the lesion is then expressed in terms of the number of quadrants it occupies.

The size of the lesion is also assessed in terms of the percentage of the area of the ectocervix involved. This is an approximation of the lesion size and is expressed as the acetowhite area occupying less than 75% of the ectocervix or more than 75% of the ectocervix. A lesion may be present in all four quadrants of the cervix but not occupy more than 75% of the ectocervix. Application of Lugol’s iodine makes the lesion very prominent and helps in assessing the exact size and extent of the lesion.