Cervical cancer screening

Training Module 2

Aided Visual Inspection of the Cervix
"Acetic Acid Test"
Picture Atlas

Saloney Nazeer
Geneva WHO Collaborating Centre in Education and Research in Human Reproduction

Click over the pictures to enlarge
Normal cervix, acetic acid pool visible at 6 o'clock. No medical intervention required.
Call for re-screening according to established policy.
MII1.jpg (53030 octets)
Normal cervix, negative Acetic Acid Test (AAT), small condyloma acuminatum on left vaginal wall (9 o'clock). No medical intervention required.
Call for re-screening according to established policy.
MII2.jpg (52860 octets)
Normal cervix, negative AAT. Some degree of ectopy is visible and subsequently, the squamo-columnar junction line is clearly visible. White endocervical mucous is present. No medical intervention required.
Call for re-screening according to established policy.
MII3.jpg (57059 octets)
Severe postmenopausal atrophy of the squamous epithelium, negative AAT. Refer the patient to Primary Health Clinic for treatment if patient symptomatic. MII4.jpg (62438 octets)
Cervical polyp, negative AAT. No medical intervention required.
Call for re-screening according to established policy.
MII5.jpg (53374 octets)
Normal cervix, negative AAT. Ectopy is present with metaplastic epitheliumgrowing medially at 12 o'clock (containing crypt openings). Posteriorly several "bands" of metaplastic epithelium are visible. Outside the squamo-columnar junction line the transformation zone is visible as a slightly white circular area. No medical intervention required.
Call for re-screening according to established policy.
MII6.jpg (61614 octets)
Marked ectopy, negative AAT. No medical intervention required.
Call for re-screening according to established policy.
MII7.jpg (56956 octets)
Nabothian cyst at 5 o'clock. Atypical acetowhite lesion at 11 o'clock extending up into the canal - colposcopy indicated. Take swab for culture (if facilities available).
Refer the patient to Primary Health Clinic.
MII8.jpg (49901 octets)
Atypical lesion anteriorly, positive AAT - repeat screening in 6 month's time. Refer the patient to Primary Health Clinic. MII9.jpg (54524 octets)
Acetowhite metaplastic epithelium anterior and posterior. Atypical lesion at 12 o'clock (at the periphery). Refer the patient to Primary Health Clinic. MII10.jpg (59177 octets)
Condylomata acuminata at 10 o'clock. Refer the patient to Primary Health Clinic. MII11.jpg (51899 octets)
Negative with acetowhite metaplasia. Crypt openings are present within metaplastic epithelium. At 1 o'clock Nabothian cyst is present (yellow). False negative AAT. Refer the patient to Primary Health Clinic. MII12.jpg (58375 octets)
Normal with acetowhite metaplasia in the transformation zone. False positive AAT. Refer the patient to Primary Health Clinic. MII13.jpg (56088 octets)
Condylomata acuminata at 6 o'clock, acetowhite metaplasia anterior. Refer the patient to Primary Health Clinic. MII14.jpg (52768 octets)
Atypical acetowhite lesion extending up into the canal - colposcopy and biopsy indicated. Refer the patient to Primary Health Clinic. MII15.jpg (47230 octets)
Positive AAT. Probably normal, but a biopsy is desired in order to rule out cancer. Refer the patient to Primary Health Clinic. MII16.jpg (52756 octets)
Positive AAT. Probably normal, but abnormal blood vessels indicate biopsy. Refer the patient to Primary Health Clinic. MII17.jpg (51696 octets)
Low grade SIL (CIN I) at 12 o'clock with acetowhite metaplastic epithelium posterior. Refer the patient to Primary Health Clinic. MII18.jpg (56082 octets)
Positive AAT, low grade SIL (condylomata acuminata). Refer the patient to Primary Health Clinic. MII19.jpg (57120 octets)
Positive AAT, high grade SIL anterior (CIN II). Refer the patient to Primary Health Clinic. MII20.jpg (42269 octets)
Positive AAT, high grade SIL (CIN III) at 5 o'clock. Acetowhite metaplastic epithelium anterior. Refer the patient to Primary Health Clinic. MII21.jpg (42066 octets)
Leukoplakia before application of acetic acid; probably high grade SIL (CIN III). Refer the patient to Oncology Centre. MII22.jpg (54090 octets)
Infiltrating cancer. Refer the patient to Oncology Centre. MII23.jpg (64856 octets)
Infiltrating cancer. Refer the patient to Oncology Centre. MII24.jpg (50027 octets)

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Edited by Aldo Campana,