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Evaluation of Cervical Biopsies Guided by Visual Inspection With Acetic Acid

Sanad, Ahmad Sameer MD1; Ibrahim, Emad Mousa MD, MRCOG1; Gomaa, Wafaey MD2

Journal of Lower Genital Tract Disease: January 2014 - Volume 18 - Issue 1 - p 21–25
doi: 10.1097/LGT.0b013e31828ce581
Original Articles

Objective To evaluate the accuracy of visual inspection with acetic acid (VIA) in determining the site, the size, and the number of cervical biopsies in patients with positive cervical cytology.

Methods This study included 486 patients with positive cervical cytology who presented to the Gynaecological Oncology Unit of Minia Maternity University Hospital, Egypt, in the period between January 2008 and September 2011. Visual inspection with acetic acid was done for all patients. They were classified into 2 groups according to the results of VIA. Group 1 included VIA-negative women, whereas group 2 included VIA-positive women. All patients were reexamined with colposcopy to prove or disprove the presence of lesions. Cervical biopsies were taken from patients with positive VIA or colposcopically confirmed lesions using punch biopsy forceps. Biopsies were sent for histologic examination.

Results In group 1, 100 patients were VIA-negative, 66 of them were histopathologically free, whereas 34 patients had positive biopsy results. Group 2 included 386 patients: 31 were histologically free, 239 had cervical intraepithelial neoplasia (CIN) 1, whereas 116 had CIN 2 or worse.

Conclusions Visual inspection with acetic acid is a good test for aiding the diagnosis of CIN and may be helpful in determining the site, the size, and the number of biopsies in patients with positive cytologic results. Instead of colposcopy, VIA can be used in developing countries where colposcopic services are not available.

Results outline potential benefits of visual inspection with acetic acid at health care systems in developing countries to determine the site, the size, and the number of biopsies in areas lacking colposcopy.

Departments of 1Gynaecology and Obstetrics and 2Pathology, Faculty of Medicine, Minia University, El-Minia, Egypt

Reprint requests to: Ahmad Sameer Sanad, MD, Department of Gynaecology and Obstetrics, Faculty of Medicine, Minia University, El-Minia, Egypt. E-mail:

The authors have declared they have no conflicts of interest.

The study was conducted in and funded by Minia Maternity Hospital, Minia University, in collaboration with the Early Cancer Detection Unit and Department of Pathology, Faculty of Medicine, Minia University.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology