The existence of epithelial cell displasia can be detected by some method approach i.e. Pap smear, gynescopy, colposcopy, histopathologic, and visual inspection with acetic acid. By evidence base medicine indicates that VIA (Visual Inspection with Acetic acid) constitute the methods that rely on to detect the existence of displasia with sensitivity and specificity do not different with Pap smear. Thus, VIA proper be chosen as the screening method on cervix cancer. A temporary, half part of Pap smear self can not be acted continue because less and do not provide the medium of therapy and many other problems.

The first time, VIA (visual inspection with acetic acid) is introduced by Hinselman (1925) by method to smear the cervix with cotton which has been dyed in to the acetic acid solution 3 – 5%. Giving that acetic acid will influent abnormal epithelial moreover will increase the osmolarity of extra cellular fluid too. This extra cellular fluid which has hypertonic characteristic will draw intra cellular fluid until be occurred membrane cell collapse and distance of cell become more nearly. As consequence if the surface of cell has got light, that light will not be continued in to stroma but be reflected out back until the surface of abnormal epithelial will become white color. So be named white epithelial.

If white increasingly and clear increasingly, high increasingly degree of it histological disorder. So sharp increasingly it boundary, high increasingly degree of it tissue disorder. Be need 1 – 2 minutes to see the changes on epithelial. Cervix which be given 5% acetic acid solution will has response faster than 3% that solution. The effect will loss after 50 – 60 seconds until by giving acetic acid will be gotten the result red homogeny color ( normal cervix picture), white spotted (displasia suspected). The lesion that be seen before application of acetic acid solution do not constitute of white epithelial but be named as leucosis plaque, usually be caused by keratin thickening (keratosis) process.

The Columnar squamo junction appears as around line that appear as consequence of thick difference between squamo epithelial and columnar stratum. The location of columna squamo junction we get on around of ostium uteri external. Morphology, be known 2 types of columnar squamo junction 1.e.: The first is original columnar squamo junction where original squamo epithelial which is covering portio vaginal connect with columnar epithelial endocervix. The connection of both of these epithelial has clear zone bordering. The secondly is functional or physiologic columnar squamo junction that is located between new squamo epithelial on zone transformation and endocervix columnar cell.

Zone transformation easy be showed by colposcopy , but by direct eye vision can be identified too i.e.: with characteristic existently of squamous epithelial with site gland orifice and ovular abothi out border of zone transformation.

On pre menopause and menopause ages, cervix become small increasingly as the consequent of less estrogen and then it cause squamo columnar junction that forward to ostium uteri external be accelerated go in the direction of. endocervix. On post menopause ages, new squamo columnar junction often has not seen. For that temporary meta plastic process generally begin on original squamo columnar junction and in accordance with centripetal go in the direction of. ostium uteri external. By that cause the examination of Visual Inspection with Acetic acid (VIA) on post menopause ages often become problem by no visible of this squamo columnar junction.

Appearance mechanism of white spotted on VIA investigation appropriate with appearance mechanism of white epithelium on colposcopy investigation. This squamous epithelial is thick and multi layer that has function as effective filter until cervix look young red or red it is caused by under blood vessel of it or stroma. On shift area (transformation zone) will be found meta plastic epithelial in many kind of it development. Its characteristic more thin than normal squamous epithelial and look red. Very fast epithelial regeneration, properly it is looked on immature squamous meta plastic tissue, and it looks opaque picture. Abnormal epithelial pre cancer different with normal epithelial because amount of its cells more add, bigger core until its appearance look opaque sometime be illustrated half of part red mix dirty grays, or white lusterless. On atrophic cervix, post menopause or before adolescent, squamous look more thin than normal and less of glycogen. Supply blood stroma becomes less until look characteristic as red whitely. Cervix appearance is related to tissue structure on stroma and tissue on surface.

The tissue that be bounced from stroma of normal epithelial will look young red. On normal epithelial (atypical) be found thickness added and change epithelial structure will cause the light that is bounced opaque appearance, especially after giving acetic acid. This opaque picture will appearance as white spotted.

Technique of VIA and Interpretation

Steps of VIA examination are enforced as bellows:

  • Patient with lithotomic position, we use speculum to look in cervix.

  • Look the cervix and let enforce assessment ie: do you find suspect cancer. If it has been suspected cancer VIA examination with lubricate acetic acid do not need be continued. Assess what do the squamo columnar junction can be looked all. If squamo columnar junction can not be looked all, so let enforce acetic acid lubrication, but give note that squamo columnar junction can not be looked all. Otherwise be continued with Pap smear test.

  • If squamo columnar junction looked all let be continued with lubricate acetic acid 3 – 5 % in cervix. And then wait a moment until one minute to see what does appear white epithelial appearance. Finally, let enforce assessment by category VIA like be lows:

    1. Normal: slick, young red, shape porsio normally.

    2. Atypical: cervicitis (inflammation, hyperemis) more fluor, polyp extropion or existent cervical wart.

    3. Abnormal: white plaque, acetowhite epithelial (white spotted). That indicates the lesion of cervix pre cancer.

    4. Cervix cancer: growth/development like cauliflower and easy to bleed.


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