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The Colposcopic Feature Ridge Sign Is Associated With the Presence of Cervical Intraepithelial Neoplasia 2/3 and Human Papillomavirus 16 in Young Women

Scheungraber, Cornelia MD1; Koenig, Urte MD1; Fechtel, Beatrix MD1; Kuehne-Heid, Rosemarie MD2; Duerst, Matthias PhD1; Schneider, Achim MD, MPH3

Journal of Lower Genital Tract Disease: January 2009 - Volume 13 - Issue 1 - p 13-16
doi: 10.1097/LGT.0b013e318180438a
Spanish Translation

Objective. Interobserver and intraobserver correlation between the colposcopic phenomenon ridge sign and its association with cervical intraepithelial neoplasia (CIN) 2 or 3, with a specific human papillomavirus (HPV) type, and with the age of the patient.

Study Design. Colpophotographs, cervical smears, and histologic results of punch or cone biopsies of 592 patients were evaluated. Colpophotographs were analyzed retrospectively for the presence or absence of an opaque acetowhite ridge at the squamocolumnar junction (ridge sign) by 3 gynecologists of different experience.

Results. Interobserver reliability for colposcopic grading of CIN was between 18.2% and 82.3%. Concerning the ridge sign, interobserver agreement varied between 25.3% and 49.4% according to the observers' experience, and intraobserver reliability varied between 56.4% and 67.5% (Cohen κ = 0.310-0.469). In 83 (14.0%) of 592 patients, a ridge sign was diagnosed by the most experienced investigator. Cervical intraepithelial neoplasia 2 or 3 was confirmed histologically in 53 of these 83 women (63.8%). Sensitivity of ridge sign for detection of CIN 2 or 3 was 33.1%; specificity was 93.1%. Women with ridge sign were significantly younger than women with no ridge sign (p <.001). Ridge sign was associated with the presence of HPV 16 (p <.001).

Conclusion. Ridge sign is a highly specific marker for CIN 2 or 3 and associated with HPV 16 and young age.

The colposcopic phenomenon of a ridge sign in an atypical transformation zone is strongly associated with the presence of high-grade cervical intraepithelial neoplasia, human papillomavirus 16, and young age.

1Department of Gynecology and 2Institute of Pathology, Friedrich Schiller University Jena, Jena, Germany, and 3Department of Gynecology, University Medicine Charité, Campus Benjamin Franklin and Campus Mitte, Berlin, Germany

Reprint requests to: Achim Schneider, MD, MPH, Department of Gynecology, University Medicine Charité, Campus Benjamin Franklin, Campus Mitte, Charitéplatz 1, D-10117 Berlin, Germany. E-mail:

©2009The American Society for Colposcopy and Cervical Pathology