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Chapters
Introduction
Introduction
Visual inspection after application of acetic acid (VIA)
VIA as a screening test for cervical cancer
Advantages of VIA
Limitations of VIA
VIA to triage women positive on the HPV test
Determining eligibility for ablative treatment after application of acetic acid
In the context of VIA screening
In the context of HPV screening
Anatomical considerations
Anatomical considerations
Gross anatomy of female genital organs
External genitalia
Internal genitalia
Gross anatomy of cervix
Cervical epithelium
Cervical epithelium
Squamous epithelium
Columnar epithelium
Squamocolumnar junction
Physiological changes of cervical epithelium
Ectropion
Squamous metaplasia
Transformation zone of the cervix
Pregnancy
Atrophic changes
Congenital transformation zone (CTZ)
Neoplastic changes of the cervical epithelium
Genesis of cervical cancer
Cervical intraepithelial neoplasia (CIN)
Adenocarcinoma in situ (AIS)
Cervical cancers
Changes in the cervical epithelium after application of acetic acid
Pathophysiological basis
Instruments, consumables, and setup required for examination after application of acetic acid
Instruments and consumables required
Preparation of 5% dilute acetic acid
Setup for the procedures
VIA procedure
As a screening test or a triage test
Counselling
History taking
Preparation for VIA procedure
Steps for inspection of the external genitalia
Steps for insertion of the speculum and exposure of the cervix
Steps for examination before application of acetic acid
Steps
Normal findings
Normal cervicovaginal discharge
Bleeding through the external os
Nabothian cyst
Ectropion
Abnormal findings
Cervicovaginal inflammation
Cervical Polyp
Leukoplakia
Cervical condyloma
Growth or ulcer
Examination after application of acetic acid
Steps for applying acetic acid to the cervix
Detecting changes in the cervical epithelium after application of acetic acid
Normal findings
Squamous epithelium
Columnar epithelium
Squamocolumnar junction (SCJ)
Transformation zone (TZ)
Features during pregnancy
Abnormal features
Abnormal features
Rapidity of onset of acetowhitening
Intensity of acetowhitening
Margin of acetowhite area
Location of acetowhite area
Surface of acetowhite area
Size of acetowhite area
Conclusion of examination
Post-VIA counselling
Documentation of findings
Interpretation of VIA test results
Interpretation of VIA test results
VIA Negative
No acetowhite area
Columnar epithelium appearing white
Polyps with faint acetowhite change
Nabothian cysts appearing white
Line-like acetowhitening at the SCJ
Patchy acetowhite areas without any definite margin
Thin acetowhite areas with tongue-shaped projections towards the external os
Acetowhite areas away from the SCJ
VIA Positive
Dense acetowhite areas in the TZ with well-defined margins
Dense acetowhite area on columnar epithelium
Entire cervix appearing dense acetowhite
Leukoplakia becoming acetowhite
CTZ appearing acetowhite
Suspicious of invasive cancer
Preventing errors in VIA
Preventing errors in VIA
Inadequate exposure of the cervix
Inadequate visualization of the transformation zone
Inadequate visualization of the margins of acetowhite areas
Errors in assessment
Errors in assessment of acetowhite areas
Errors in recognizing cervical cancer
Errors in assessment of the postmenopausal cervix
Management of women with an abnormal VIA test
Management of women with an abnormal VIA test
Steps to determine eligibility for ablative treatment
Principles
Principles of treating cervical precancerous lesions
Criteria used to determine eligibility for ablative treatment
Steps to determine eligibility for ablative treatment
Role of Lugol’s iodine in identifying the transformation zone for treatment
Role of Lugol’s iodine in identifying the transformation zone for treatment
Steps for applying Lugol’s iodine to the cervix
Lugol’s iodine for pre-treatment assessment
Preparation of Lugol’s iodine
Treatment by cryotherapy
Principles
Cryosurgical unit
Ancillary instruments and consumables
Steps
Side-effects and complications
Post-treatment advice and follow-up
Video
Treatment by thermal ablation
Principles
The benchtop model
The battery-operated model
Complications
Video
Videos
Steps of applying acetic acid for VIA and identifying the transformation zone (VIA negative)
Steps of applying acetic acid for VIA, determining eligibility for ablation and treatment with thermal ablation
Preparation of Monsel’s solution
Preparation of Monsel’s solution
Infection prevention
Standard procedures for protection from infection
Essential steps for infection prevention in VIA screening or triage
Preparation of 0.5% chlorine solution
Case study
VIA-negative cases
VIA-positive cases
VIA-suspicious of cancer cases
Quiz
Acknowledgement
Suggested citation
Copyright
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Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment
/ Case study
Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment
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Cases study: VIA-negative cases
Click to return to the atlas
Click on the pictures to magnify and display the cases
Case
Picture
Age
VIA category
Eligibility for ablative treatment
(if HPV-positive)
Histology
1
33
Negative
Eligible for ablation
Not done
2
35
Negative
Eligible for ablation
Not done
3
47
Negative
Eligible for ablation
Not done
4
35
Negative
Eligible for ablation
Not done
5
31
Negative
Eligible for ablation
Not done
6
32
Negative
Eligible for ablation
Not done
7
54
Negative
Not eligible
Not done
8
55
Negative
Not eligible
Not done
9
39
Negative
Eligible for ablation
Not done
10
32
Negative
Eligible for ablation
Not done
11
52
Negative
Not eligible
Not done
12
54
Negative
Not eligible
Not done
13
47
Negative
Not eligible
Not done
14
30
Negative
Eligible for ablation
Not done
15
54
Negative
Not eligible
Not done
16
31
Negative
Eligible for ablation
Not done
17
30
Negative
Eligible for ablation
Not done
18
53
Negative
Not eligible
Not done
19
43
Negative
Eligible for ablation
Not done
20
42
Negative
Not eligible
Not done
21
30
Negative
Eligible for ablation
Not done
22
38
Negative
Eligible for ablation
Not done
23
32
Negative
Eligible for ablation
Not done
24
30
Negative
Eligible for ablation
Not done
25
32
Negative
Eligible for ablation
Not done
26
35
Negative
Eligible for ablation
Not done
27
30
Negative
Eligible for ablation
Not done
28
36
Negative
Eligible for ablation
Not done
29
36
Negative
Eligible for ablation
Not done
30
33
Negative
Eligible for ablation
Not done
31
50
Negative
Not eligible
Not done
32
35
Negative
Eligible for ablation
Not done
33
47
Negative
Eligible for ablation
Not done
34
36
Negative
Eligible for ablation
Not done
35
43
Negative
Eligible for ablation
Not done
36
39
Negative
Eligible for ablation
Not done
37
46
Negative
Eligible for ablation
Not done
38
49
Negative
Not eligible
Not done
39
39
Negative
Eligible for ablation
Not done
40
42
Negative
Eligible for ablation
Not done
41
38
Negative
Eligible for ablation
Not done
42
47
Negative
Eligible for ablation
Not done
43
50
Negative
Not eligible
Not done
44
41
Negative
Eligible for ablation
Not done
45
38
Negative
Eligible for ablation
Not done
46
31
Negative
Not eligible
Not done
47
41
Negative
Eligible for ablation
Not done
48
43
Negative
Not eligible
Not done
49
41
Negative
Not eligible
Not done
50
33
Negative
Eligible for ablation
Not done
51
35
Negative
Not eligible
Not done
52
35
Negative
Eligible for ablation
Not done
53
36
Negative
Eligible for ablation
Not done
54
36
Negative
Eligible for ablation
Not done
55
32
Negative
Eligible for ablation
Not done
56
41
Negative
Eligible for ablation
Not done
57
50
Negative
Not eligible
Not done
58
33
Negative
Eligible for ablation
Not done
59
45
Negative
Eligible for ablation
Not done
60
35
Negative
Eligible for ablation
Not done
61
38
Negative
Eligible for ablation
Not done
62
30
Negative
Eligible for ablation
Not done
63
32
Negative
Eligible for ablation
Not done
64
44
Negative
Eligible for ablation
Not done
65
35
Negative
Eligible for ablation
Not done
66
40
Negative
Eligible for ablation
Not done
67
34
Negative
Eligible for ablation
Not done
68
31
Negative
Eligible for ablation
Not done
69
43
Negative
Eligible for ablation
Not done
70
34
Negative
Eligible for ablation
Not done
71
30
Negative
Eligible for ablation
Not done
72
42
Negative
Eligible for ablation
Not done
73
40
Negative
Eligible for ablation
Not done
74
32
Negative
Eligible for ablation
Not done
75
33
Negative
Eligible for ablation
Normal
76
43
Negative
Eligible for ablation
Not done
77
36
Negative
Eligible for ablation
Not done
78
34
Negative
Eligible for ablation
Not done
79
42
Negative
Eligible for ablation
Not done
80
36
Negative
Not eligible
Not done
81
30
Negative
Eligible for ablation
Not done
82
33
Negative
Eligible for ablation
Not done
83
31
Negative
Eligible for ablation
Not done
84
37
Negative
Eligible for ablation
Not done
85
34
Negative
Eligible for ablation
Not done
86
33
Negative
Eligible for ablation
Normal
87
34
Negative
Eligible for ablation
Not done
88
35
Negative
Eligible for ablation
LSIL-HPV changes
89
34
Negative
Eligible for ablation
Not done
90
39
Negative
Eligible for ablation
Not done
91
31
Negative
Eligible for ablation
Normal
Total record number: 91
Click on the following link to view examples of
negative
,
positive
or
suspicious of cancer cases
.
Click to return to the atlas
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