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

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

ČIMBENICI UDRUŽENI S USTRAJNOM GENITALNOM INFEKCIJOM HUMANIM PAPILOMAVIRUSOM U MANJOJ SKUPINI RUMUNJSKIH ŽENA

The aim of the study was to assess the role of behavioral factors in persistence of human papillomavirus (HPV) genital infection. Out of a cohort of 605 women included in a study of HPV infection prevalence, 142 HPV positive women (aged 18-57) were retested after a 12-month interval. None of the patients underwent surgical treatment during that period. Selected patients were asked for a second smear for cytologic analysis and HPV genotyping. A questionnaire that included information regarding reproductive health, sexual activity and smoking status was filled-in. After 12 months, 46 of 142 (32.39%) women had persistent HPV infection, with genotypes 16 and 18 found in 27 cases. On the other hand, 17 of 142 (11.97%) women had acquired new infections replacing the baseline genotypes. In our study, smoking (OR=2.320, p=0.0330) and sexual behavior (OR=5.333, p=0.0180 for more than three sexual partners; OR=2.427, p=0.0238 for cases where the partner was involved in another sexual relationship) were associated with viral persistence, while long-term contraception did not yield statistically significant results.Cilj ovoga istraživanja bio je procijeniti ulogu čimbenika ponašanja na ustrajnost genitalne infekcije humanim papilomavirusom (HPV). Od 605 žena uključenih u ispitivanje učestalosti infekcije HPV-om 142 žene pozitivne na HPV (u dobi od 18 do 57 godina) ponovno su testirane nakon 12 mjeseci. Tijekom tog razdoblja nijedna od tih bolesnica nije bila podvrgnuta kirurškom liječenju. Od odabranih bolesnica zatražen je drugi obrisak za citološku analizu i genotipiziranje HPV-a. Ispunjen je upitnik s podacima o reprodukcijskom zdravlju, seksualnim aktivnostima i pušenju. Nakon 12 mjeseci 46/142 (32,39%) žena imalo je ustrajnu infekciju HPV-om; u 27 slučajeva utvrđeni su genotipovi 16 i 18. S druge strane, 17/142 (11,97%) žena imalo je novo stečene infekcije koje su zamijenile prvobitne genotipove. U našem istraživanju je pušenje (OR=2,320, p=0,0330) i spolno ponašanje (OR=5,333, p=0,0180 za više od tri seksualna partnera; OR=2,427, p=0,0238 u slučajevima kad je partner imao i drugi seksualni odnos) bilo udruženo s ustrajnošću virusa, dok dugotrajna kontracepcija nije pokazala statistički značajne rezultate

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

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