DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20163834

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

Mihaela Grigore, Camelia Cojocaru, Sergiu Teleman

Abstract


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.


Keywords


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

Full Text:

PDF

References


Arbyn M, Castellsagué X, de Sanjosé S, Bruni L, Saraiya M, Bray, et al. Worldwide burden of cervical cancer in 2008. Ann Oncol. 2011;22:2675-86.

Reid R, Stanhope CR, Herschman BR, Crum CP, Agronow SJ. Genital warts and cervical cancer. IV. A colposcopic index for differentiating subclinical papillomaviral infection from cervical intraepithelial neoplasia. Am J Obstet Gynecol. 1984;149:815-23.

Ferris DG, Litaker MS, ALTS Group. Prediction of cervical histologic results using an abbreviated Reid Colposcopic Index during ALTS Am J Obstet Gynecol. 2006;194:704-10.

Mousavi AS, Fakour F, Gilani MM, Behtash N, Ghaemmaghami F, Karimi, et al. A prospective study to evaluate the correlation between Reid colposcopic index impression and biopsy histology. J Low Genit Tract Dis. 2007;11:147-50.

Massad LS, Jeronimo J, Katki HA, Schiffman M. National Institutes of Health/American Society for Colposcopy and Cervical Pathology Research Group. The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia. J Low Genit Tract Dis. 2009;13:137-44.

Ferris DG, Litaker M. ALTS Group. Interobserver agreement for colposcopy quality control using digitized colposcopic images during the ALTS trial. J Low Genit Tract Dis. 2005;9:29-35.

Bornstein J, Bentley J, Bösze P, Girardi F, Haefner H, Menton M, et al. 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol. 2012;120:166-72.

Scheungraber C, Glutig K, Fechtel B, Kuehne-Heid R, Duerst M, Schneider A. Inner border, a specific and significant colposcopic sign for moderate or severe dysplasia (cervical intraepithelial neoplasia 2 or 3). J Low Genit Tract Dis. 2009;13:1-4.

Scheungraber C, Koenig U, Fechtel B, Kuehne-Heid R, Duerst M, Schneider A. The colposcopic feature ridge sign is associated with the presence of cervical intraepithelial neoplasia 2/3 and human papillomavirus 16 in young women. J Low Genit Tract Dis. 2009;13:13-6.

Moss EL, Arbyn M, Dollery E, Leeson S, Petry KU, Nieminen P et al. European Federation of Colposcopy quality standards Delphi consultation. Eur J Obstet Gynecol Reprod Biol. 2013;170:255-8.

Shojaei H, Yarandi F, Ghozati L, Yarandi N, Izadi-Mood N, Eftekhar Z. Acceptable predictive accuracy of histopathology results by colposcopy done by Gynecology residents using Reid index. Arch Gynecol Obstet. 2013;287:345-9.

Vercellino GF, Erdemoglu E, Chiantera V, Vasiljeva K, Drechsler I, Cichon G, et al. Validity of the colposcopic criteria inner border sign, ridge sign, and rag sign for detection of high-grade cervical intraepithelial neoplasia. Obstet Gynecol. 2013;121:624-31.