The role of inner border sign and ridge sign in detecting high-grade cervical intraepithelial neoplasia

Mihaela Grigore, Camelia Cojocaru, Sergiu Teleman


Background: The objectives of the study were to evaluate the role of two pathognomonic colposcopic signs (inner border sign and ridge sign) in detecting high-grade cervical lesions.

Methods: A total of 122 patients with abnormal Pap smear who had colposcopy and biopsy or loop electrosurgical excision procedure were included. The correlations between the two signs pathognomonic signs (inner border, ridge sign) and pathological results were established. We also compared the two signs with Reid colposcopic index (RCI) in detecting high-grade cervical lesions.

Results: Both pathognomonic signs proved to have a good accuracy in detecting high-grade lesions of the cervix. The sensitivity, specificity, PPV and NPV for the inner border sign and ridge sign were: 15%, 98%, 92%, 44%, respectively, and 30%, 94%, 88%, 47%, respectively. RCI has a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for predicting high-grade cervical intraepithelial lesions as follows: 86.3%, 83.6%, 88.7%, and 80.3%, respectively. The simultaneous presence of both signs increased the specificity and PPV to 100%, while sensitivity and NPV were 4% and 55%.

Conclusions: Pathognomonic signs - inner sign and ridge sign- have a good specificity in predicting high-grade cervical intraepithelial lesions, but they are present in only 9.8%, respectively 20.5% of cases with high-grade cervical intraepithelial lesions.


High-grade cervical lesions, Inner border sign, Ridge sign, Reid colposcopic index

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