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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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  • Case: 130

  • Age: 40

  • Before application of acetic acid: Scanty thin curdy white discharge is present on the cervix. Note that a red patch around the external os is not always columnar epithelium. Wait until after application of acetic acid before trying to locate the SCJ.

  • Cervix before application of acetic acid:  
  •  Infective vaginal discharge:   
    Strawberry appearance of cervix
    Cervicitis
    Polyp
    Bleeding on contact
    White patch
    Growth
    Ulcer
    Erosion

    After application of acetic acid: Large dense acetowhite areas are seen around the external os occupying more than 75% of the ectocervix. The acetowhite areas extend into the endocervical canal. The SCJ is not visible. Multiple areas of peeled-off epithelium (at the 10, 12, and 6 oíclock positions) can be seen as red patches within the dense acetowhite lesion.

  • 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:  

  • After application of Lugolís iodine: The acetowhite area does not take up Lugolís iodine and appears bright mustard yellow.

  • Determined eligibility for ablative treatment:  

  • Histopathology: HSIL-CIN3

  • Remarks: A high-grade lesion may appear as a red patch in the transformation zone on visual examination. This may give a false interpretation of visualization of the SCJ. Always try to identify and locate the SCJ after application of acetic acid.





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