IANS - Acetic acid and Lugol's

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<blockquote>Anonymous wrote:Thank you for participating in the course! In general we have a low threshold for biopsies because it is difficult to exclude HSIL based on visualization alone. I do think your approach&nbsp; to perform biopsies on everything that is acetowhite and lugol’s negative is reasonable, however, you will have to balance your goal of being thorough with patient ability to tolerate a longer exam with more biopsies. I would, as you go along, aim to discern whether there are particular characteristics that are more suggestive of HSIL in these acetowhite and lugol’s negative areas given that it may not be logistically feasible to biopsy everything you see. Vascular changes like mosaic pattern or atypical vessels are particularly suggestive of HSIL and can help you prioritize. Most HSIL will have vascular changes. If you aren't seeing any vascular changes consider whether you are using high enough magnification and enough acetic acid for the vasculaity to appear. Also, document the different findings and then compare to when you get the pathology results. Review the pictures and compare those that were HSIL with those that weren't. &nbsp;This will help you hone your sklls for differentiating HSIL from non-HSIL.&nbsp;

Cristina Brickman 
Coure Director 
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