The histopathologic patterns of cervical lesions and visual inspection with acetic acid on excised uterine cervices

The histologic patterns of cervical lesions as detected by visual inspection of the cervix with acetic acid (VIA) method were studied in 162 excised uterine cervices. There were 103 cervices of previous histologically confirmed cervical neoplasia treated by loop electrosurgical excision procedure (LEEP) or hysterectomy (group 1) and 59 cervices of hysterectomy specimens without known cervical pathology (group 2). Each freshly received cervix was examined with naked eye, photographed, 4% acetic acid applied, and then reexamined with naked eye for any color changes. Then it was rephotographed, divided spatially into 12 segments like on a face of a clock, processed to produce hematoxylin and eosin-stained glass slides, and histologically examined. The raised dull white changes, positive VIA, were highly correlated with the higher grade of cervical intraepithelial neoplasia (CIN) (CIN 2 + CIN 3). In group 1, the sensitivity of the acetic acid in detecting high-grade CIN was 98.6%, the specificity was 82.4%, the positive predictive value was 91.9%, and the negative predictive value was 96.6%. The flat white changes, negative VIA, were mostly correlated with CIN 1-koilocytosis. This study found that the validity of the VIA technique in detecting high-grade CIN was acceptable.