Complete absence of iodine uptake may signify invasive cancer. Colposcopic findings in a 29-year-old gravida 0 with no prior history of disease are presented. The cervical smear was reported as class V-p, and HPV 16 was detected. Colposcopy after iodine application and color shift with the Spectra A mode (KARL STORZ Image1 S) shows central iodine-negative areas at 1 to 3 o’clock and 5 o’clock in an atypical T-zone type 2. This is an abnormal colposcopic finding suspicious for cancer.

Histopathology of tissue sampled by loop biopsy shows atypical cells with strong expression of the markers Ki67 and p16 extending into the upper third of the epithelium. While the basement membrane on the left side of the image is still intact, it is penetrated by atypical cell complexes in the right third of the image. The diagnosis is undifferentiated invasive squamous cell carcinoma. Following laparoscopic sentinel lymphadenectomy and radical vaginal trachelectomy, the disease was finally staged as pT1b1 pN0 (0/2 sn) G3 L0 V0 Pn0.