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Umbilication Is a Strong Predictor of High-Grade Cervical Intraepithelial Neoplasia

Slama, Jiri MD, PhD1; Adamcova, Karolina MD1; Dusek, Ladislav MS, PhD2; Sosna, Ondrej MD, PhD1; Cibula, David MD, PhD1

Journal of Lower Genital Tract Disease: July 2013 - Volume 17 - Issue 3 - p 303–307
doi: 10.1097/LGT.0b013e31826f2532
Original Articles

Objective This study aimed to assess the diagnostic value of the colposcopic feature of umbilication for detecting high-grade cervical intraepithelial neoplasia (CIN 2/3).

Materials and Methods Study included 430 randomly selected women who underwent conization for CIN 2 or CIN 3. The control group consisted of 102 patients with biopsy-confirmed CIN 1. Colpophotographs and reports from colposcopy examinations from all patients were retrospectively analyzed by 2 independent colposcopy experts with the aim to assess the presence of umbilication. The occurence of more than 2 mosaic “tiles” with central punctation was considered to be a positive finding regardless of whether the mosaic pattern was coarse or fine. The prevalence of umbilication in CIN 1 and CIN 2/3 respectively was compared. The diagnostic value of umbilication alone and combination of umbilication and/or ridge sign was assessed.

Results Umbilication was detected in 10% and ridge sign in 10.2% of patients with CIN 2/3. Simultaneous presence of umbilication and ridge sign was rare (1.1%). The umbilication solely reached 12% sensitivity, 100% specificity, and 100% positive predictive value for the detection of underlying CIN 2/3.

Conclusions Umbilication is an age-independent colposcopic feature with very high specificity for predicting CIN 2/3.

Umbilication is an age-independent colposcopic feature, which highly specifically predicts underlying CIN 2/3.

1Gynecologic Oncology Centre, 1st Faculty of Medicine, Charles University and General University Hospital in Prague; and 2Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic

Reprint requests to: Jiri Slama, MD, PhD, Gynecologic Oncology Centre, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 18, 128 51 Prague 2, Czech Republic. E-mail:

The authors have declared they have no conflicts of interest.

Copyright © 2013 by the American Society for Colposcopy and Cervical Pathology