November 2016 · Volume 5 · Issue 11 Page 3717 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Grigore M et al. Int J Reprod Contracept Obstet Gynecol. 2016 Nov;5(11):3717-3721 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Original Research Article The role of inner border sign and ridge sign in detecting high-grade cervical intraepithelial neoplasia Mihaela Grigore 1,2 *, Camelia Cojocaru 1 , Sergiu Teleman 3 INTRODUCTION Cervical cancer is the second most common cause of cancer death in women worldwide. Each year, 270,000 women die from cervical cancer, and another 500,000 are newly diagnosed. 1 Primary prevention of cervical cancer employs the human papillomavirus (HPV) vaccine, and secondary prevention is targeted at detecting preneoplastic lesions using screening techniques such as cytology or HPV testing. Patients with abnormal cytology or HPV results are further investigated using colposcopy and histology to detect high-grade cervical intraepithelial lesions (CINs). High-grade lesions are removed using excisional or ablative surgical techniques. Although colposcopy is mandatory for evaluating abnormal Pap smears, colposcopic findings can be misleading. The subjectivity of the findings imposed the implementation of a scoring system. The most commonly used system is the Reid Colposcopic Index (RCI), which is a method of colposcopically grading the severity of premalignant cervical lesions and could be useful in predicting the histologic grade of cervical disease, readily permitting differentiation between low-grade and high- grade disease. 2 Hence, the use of the RCI helps direct the clinician to perform a biopsy of the most significant abnormal cervical lesions and enhances the formulation of the colposcopic impression. 3 The accuracy of the RCI in different studies varies. Some investigations have 1 Medis Medical Centre, Iasi, Romania 2 Department of Obstetrics and Gynaecology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania 3 Department of Pathology, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania Received: 02 September 2016 Accepted: 028 September 2016 *Correspondence: Dr. Mihaela Grigore, E-mail: mihaela.grigore@edr.ro Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 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 DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20163834