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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 Click on the pictures to magnify and display the legends Before application of acetic acid: The cervix appears normal.
Cervix before application of acetic acid: Normal Abnormal After application of acetic acid: A large dense acetowhite area with raised margins is seen on the anterior lip, with extension to the vagina. Areas of peeled-off epithelium (erosion) are present at the 5–7 o’clock position and at the 12 o’clock position.
Cervix after application of acetic acid: Squamocolumnar junction visibility: Fully visible Not visible Partially visible Squamocolumnar junction location: Acetowhite area: Absent Present If present, description of acetowhite area: Colour: Dense Thin Margin: Diffuse Sharp but irregular Sharp and regular Sharp and raised Surface: Smooth Irregular Location: Within TZ or close to the external os (if SCJ is not visible) Outside TZ Size: Covering less than 75% of ectocervix Covering more than 75% of ectocervix VIA category: Negative Positive Suspicious of cancer Determined eligibility for ablative treatment: Eligible for ablation Not eligible Histopathology: Microinvasive squamous cell carcinoma
Remarks: A large lesion extending to the vagina with extensive eroded areas should be suspected as high-grade disease or even cancer.
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