The melanotic tissue and acetowhite lesion
were positives to HPV Types 6, 11 (Figs.
Coarse punctations or 13 13 mosaicism Unsatisfactory 7 7 Malignancy (intense acetowhite lesion
, coarse 2 2 irregular punctations, cork screw vessels TABLE 7: BIOPSY results Biopsy No.
VIA test was labelled as positive when a well-defined opaque acetowhite lesion
was found abutting or close to SCJ, while cytology was considered positive if reported as CIN or worse lesions.
The other specimen was a 10-mL cervicovaginal lavage, which was collected and analyzed for HPV DNA by polymerase chain reaction (PCR) as previously described using L1 consensus primers. Two cervigrams were then taken of the cervix following 5% acetic acid application. The colposcopic examination (Figure 1) revealed a large acetowhite lesion
on the anterior and posterior lips of the cervix.
Colposcopy with biopsy and endocervical curettage (ECC) revealed a flat acetowhite lesion
with coarse mosaic pattern, biopsy specimens of which showed moderate dysplasia (CIN-2) with coexistent HPV and no endocervical dysplasia.
The film was returned to the manufacturer for processing and then interpreted by a single cervicography-certified gynecological oncologist as follows: negative if normal; atypical if there was evidence of an acetowhite lesion
of doubtful significance either inside or outside the transformation zone or if there was evidence of atypical immature squamous metaplasia; positive if there was evidence of a minor-or major-grade lesion or cancer; and technically defective if the film was technically uninterpretable.
The acetowhite lesion
margin is feathered, and satellite lesions are present.
The patient was colposcopically examined, and cervical biopsies were collected from a densely acetowhite lesion
located within the transformation zone.
The film was returned to the manufacturer for processing and then interpreted by certified evluators as follows: "negative" if normal; "atypical" if there was evidence of an acetowhite lesion
outside the transformation zone, or inside the transformation zone but of doubtful significance, or of atypical immature squamous metaplasia; "positive" if there was evidence of minor or major grade lesion or cancer; and "technically defective" if the film was technically uninterpretable.
For the convenience of data analysis, Pap smear results were categorized as follows: within normal limits, "negative"; atypical squamous cells of undetermined significance, "atypia"; and low-grade and high-grade squamous intraepithelial lesions, "positive." Cervigrams were categorized according to interpretation: "negative" if normal; "atypical" if evidence of an acetowhite lesion
was found outside the transformation zone or inside the transformation zone but of doubtful significance, or if atypical immature squamous metaplasia was found; and "positive" if evidence of a minor or major grade lesion or cancer was found.
A common clinical problem for the colposcopist involves a woman who has an abnormal Papanicolaou smear (often squamous atypia) and an acetowhite lesion
on colposcopy which on biopsy is negative for condyloma or CIL.
In a setting of intermediate risk, the Working Group proposes, "multiple biopsies of acetowhite lesions
lead to increased detection of precancer."