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

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VIA-positive cases                                                                              Click to return to the atlas
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  • Case: 140

  • Age: 32

  • Before application of acetic acid: The cervix is covered with thin normal mucoid secretion. The SCJ is fully visible on the ectocervix.

  • Cervix before application of acetic acid:  

  • After application of acetic acid: A large thin acetowhite area on the anterior lip arising from the SCJ is seen extending towards the vaginal fornix. Such lesions extend beyond the TZ.

    After application of acetic acid: The thin acetowhite area can be seen on the posterior lip also extending towards the vaginal fornix.

  • Cervix after application of acetic acid:
    • Squamocolumnar junction visibility:  
    • Squamocolumnar junction location:  
    • Acetowhite area:  
      • If present, description of acetowhite area:
        • Colour:  
        • Margin:  
        • Surface:  
        • Location:  
        • Size:  

  • VIA category:  

  • Determined eligibility for ablative treatment:  

  • Histopathology: Normal

  • Remarks: A large oblong (lozenge-shaped) thin acetowhite area with extension to the vaginal fornices is a characteristic feature of the congenital transformation zone (CTZ). It is a normal condition and does not require treatment. However, on naked-eye examination, the CTZ can mimic a low-grade lesion and should be categorized as VIA-positive. Large loop excision of the transformation zone (LLETZ) should not be attempted on such cases, even in a screen-and-treat setting. If there is any doubt, biopsies should be taken.





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