Hilal Z, et al. - For the detection of dysplastic lesions of the cervix, the standard test comprised application of acetic acid to the cervix followed by a colposcopic assessment with or without colposcopically directed biopsy, researchers here aimed at prospectively defining the optimal timing for the colposcopic assessment of acetowhite lesions. They recruited 300 consecutive women who were referred to the colposcopy unit and recorded the most severe colposcopic lesion 1, 3, and 5 minutes after the application of acetic acid (primary study endpoint) using a standardized colposcopy protocol. Video documentation was performed of the time to the first appearance of the most severe colposcopic lesion, highest staining intensity, and fading of the most severe colposcopic lesion (secondary study endpoints, evaluated independently by 3 raters). The most severe colposcopic lesion was identified in 290 of 300 patients (96.7%) after 1 minute. No improvement in this proportion was noted after 3 minutes (290/300 [96.7%]) or after 5 minutes (233/264 [88.3%]). Hence, they propose that the best time to recognize lesions is 1 minute after the application of acetic acid. They suggest considering a continued evaluation for up to 3 minutes as possibly reasonable for an optimal high-grade squamous intraepithelial lesion yield. However, they commonly encountered fading of acetowhite lesions, particularly in high-grade squamous intraepithelial lesions, and support a recommendation of not lengthening colposcopy beyond 3 minutes.