What are the recommendations for a patient undergoing an acetic acid work-up (acetic work up) for cervical cancer diagnosis?

From the Guidelines

For a patient undergoing an acetic acid work-up for cervical cancer diagnosis, it is crucial to prioritize the most recent and highest quality evidence, which recommends primary HPV testing every 5 years through age 65 years as the preferred screening method 1.

Recommendations for Acetic Acid Work-up

When an acetic acid work-up is necessary, the patient should avoid vaginal intercourse, douching, and using vaginal medications for at least 24-48 hours before the procedure.

• The patient should be positioned in the lithotomy position, and a speculum will be inserted to visualize the cervix.
• A 3-5% acetic acid solution (white vinegar) is then applied to the cervix using cotton swabs or by direct spray.
• After application, the clinician will wait 1-2 minutes for the acetic acid to react with cervical tissue.
• Abnormal tissue will appear white (acetowhite), while normal tissue remains pink. This visual inspection with acetic acid (VIA) works because the acetic acid causes temporary coagulation of nuclear proteins in cells with high nuclear-cytoplasmic ratios, such as dysplastic cells, making them appear white 1.

Post-Procedure Care and Follow-Up

Following the procedure, patients may experience mild cramping or spotting, which typically resolves within 24 hours.

• If the test reveals suspicious areas, additional procedures such as colposcopy, biopsy, or endocervical curettage may be recommended for definitive diagnosis.
• Patients should be informed that while VIA is a valuable screening tool, particularly in resource-limited settings, it is not as sensitive or specific as HPV testing or cytology (Pap smear) for detecting cervical abnormalities 1. It is essential to note that the American Cancer Society recommends primary HPV testing every 5 years through age 65 years as the preferred screening method, and VIA should be used in conjunction with or as an alternative to these methods only when necessary and in accordance with clinical guidelines.

From the Research

Acetic Acid Work-up for Cervical Cancer Diagnosis

• The acetic acid work-up, also known as Visual Inspection with Acetic Acid (VIA), is a screening method used to detect precancerous lesions and cervical cancer 2.
• VIA can be performed by nurses or midwives with appropriate training and is considered simple, accurate, cost-effective, and acceptable to most women 2.
• The World Health Organization (WHO) recommends VIA or Human Papillomavirus (HPV) DNA testing for cervical cancer screening in low-income countries 3.

Recommendations for Patients Undergoing Acetic Acid Work-up

• Patients undergoing VIA should be informed about the procedure and its potential outcomes 4.
• The procedure involves applying acetic acid to the cervix and observing for any abnormal changes 5.
• If the results are positive, further testing such as colposcopy-guided biopsy may be necessary to confirm the diagnosis 5.

Diagnostic Value of Acetic Acid

• The diagnostic value of VIA is comparable to the Pap smear, with a sensitivity of 70.8% and specificity of 95% 5.
• VIA performs well in detecting high-grade lesions and can be used as a screening modality for cervical cancer in low-resource settings 5.
• The prevalence of cervical cancer and precancerous lesions detected using VIA can vary depending on the population and setting 6.

Factors Associated with Positive VIA Results

• Factors such as alcohol consumption and HIV infection have been associated with positive VIA results 6.
• These factors can increase the risk of developing precancerous cervical lesions and cervical cancer 6.
• Enhancing screening programs using VIA can help identify cancerous lesions at an early stage for early intervention in resource-limited settings 6.