Evaluation after the application of acetic acid and uptake of Lugol's solution

Authors

DOI:

https://doi.org/10.5327/2237-4574-127%20

Keywords:

acetic acid, iodine, colposcopy

Abstract

Visual inspection with acetic acid (VIA) and Lugol’s iodine application (Schiller’s test) are accessible screening methods for detecting precancerous cervical lesions. VIA identifies areas of high cellular activity through acetowhite areas, while Schiller’s test highlights glycogen-deficient regions that do not uptake iodine. The sequential use of both tests improves diagnostic accuracy, especially in low-resource settings. Despite subjectivity and clinical factors such as menopause and pregnancy that may affect results, these methods remain valuable when performed correctly by trained professionals.

References

Claeys P, De Vuyst H, Gonzalez C, Garcia A, Bello RE, Temmerman M. Performance of the acetic acid test when used in field conditions as a screening test for cervical cancer. Trop Med Int Health. 2003;8(8):704-9. https://doi.org/10.1046/j.1365-3156.2003.01082.x

International Agency for Research on Cancer. Atlas of visual inspection of the cervix with acetic acid for screening, triage, and assessment for treatment [Internet]. Lyon: IARC; [acessado em 30 maio 2025]. Disponível em: https://screening.iarc.fr/atlasvia.php

Sankaranarayanan R, Shyamalakumary B, Wesley R, Sreedevi Amma N, Parkin DM, Nair MK. Visual inspection with acetic acid in the early detection of cervical cancer and precursors. Int J Cancer. 1999;80(2):161-3. https://doi.org/10.1002/(sici)1097-0215(19990105)80:1<161::aid-ijc28>3.0.co;2-8

Huy NVQ, Tam LM, Tram NVQ, Thuan DC, Vinh TQ, Thanh CN, et al. The value of visual inspection with acetic acid and Pap smear in cervical cancer screening program in low resource settings – a population-based study. Gynecol Oncol Rep. 2018;24:18-20. https://doi.org/10.1016/j.gore.2018.02.004

Vahedpoor Z, Behrashi M, Khamehchian T, Abedzadeh-Kalahroudi M, Moravveji A, Mohmadi-Kartalayi M. Comparison of the diagnostic value of the visual inspection with acetic acid (VIA) and Pap smear in cervical cancer screening. Taiwan J Obstet Gynecol. 2019;58(3):345-8. https://doi.org/10.1016/j.tjog.2019.03.010

Gupta P, Kaur T, Bedi S, Tuteja G. Visual inspection of the cervix with acetic acid and Pap smear test in cervical cancer screening. IOSR J Dent Med Sci. 2015;14(11):38-41. https://doi.org/10.9790/0853-141153841

Sankaranarayanan R, Nessa A, Esmy PO, Dangou JM. Visual inspection methods for cervical cancer prevention. Best Pract Res Clin Obstet Gynaecol. 2012;26(2):221-32. https://doi.org/10.1016/j.bpobgyn.2011.08.003

Xue P, Ng MTA, Qiao Y. The challenges of colposcopy for cervical cancer screening in LMICs and solutions by artificial intelligence. BMC Med. 2020;18(1):169. https://doi.org/10.1186/s12916-020-01613-x

Cooper DB, Dunton CJ. Colposcopy [Internet]. Treasure Island: StatPearls Publishing; 2023 [acessado em 3 jun. 2025]. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK564514/

Lee H, Kang Y, Ju W. Cervical cancer screening in developing countries: using visual inspection methods. Clin J Oncol Nurs. 2016;20(1):79-83. https://doi.org/10.1188/16.CJON.79-83

Sankaranarayanan R, Wesley R, Thara S, Dhakad N, Chandralekha B, Sebastian P, et al. Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol's iodine (VILI) in cervical cancer screening in Kerala, India. Int J Cancer. 2003;106(3):404-8. https://doi.org/10.1002/ijc.11245

Catarino R, Schäfer S, Vassilakos P, Petignat P, Arbyn M. Accuracy of combinations of visual inspection using acetic acid or Lugol iodine to detect cervical precancer: a meta-analysis. BJOG. 2018;125(5):545-53. https://doi.org/10.1111/1471-0528.14783

Reich O, Pickel H. 100 years of iodine testing of the cervix: a critical review and implications for the future. Eur J Obstet Gynecol Reprod Biol. 2021;261:34-40. https://doi.org/10.1016/j.ejogrb.2021.04.011

Mueller JL, Lam CT, Dahl D, Asiedu MN, Krieger MS, Bellindo-Fuentes Y, et al. Portable Pocket colposcopy performs comparably to standard-of-care clinical colposcopy using acetic acid and Lugol's iodine as contrast mediators: an investigational study in Peru. BJOG. 2018;125(10):1321-9. https://doi.org/10.1111/1471-0528.15326

Rahaman A, Anantharaju A, Jeyachandran K, Manideep R, Pal UM. Optical imaging for early detection of cervical cancer: state of the art and perspectives. J Biomed Opt. 2023;28(8):080902. https://doi.org/10.1117/1.JBO.28.8.080902

Sankaranarayanan R, Wesley RS. Anatomical and pathological basis of visual inspection with acetic acid (VIA) and with Lugol’s iodine (VILI). In: Sankaranarayanan R, Wesley RS, editors. A practical manual on visual screening for cervical neoplasia. Lyon: IARC Press; 2003. p. 1-14.

Burness JV, Schroeder JM, Warren JB. Cervical colposcopy: indications and risk assessment. Am Fam Physician. 2020;102(1):39-48. PMID: 32603071.

Published

2025-09-16

How to Cite

1.
Carvalho NS de, Tenorio S dos SQ, Herlain BMM da S, Kimura BR, Nazar RV. Evaluation after the application of acetic acid and uptake of Lugol’s solution. Rev Bras Patol Trato Genit Inferior [Internet]. 2025 Sep. 16 [cited 2026 May 23];9(1). Available from: https://rbptgi.emnuvens.com.br/revista/article/view/127

Issue

Section

Letters to Editor