title: The colposcopic feature ridge sign is associated with the presence of cervical intraepithelial neoplasia 2/3 and human papillomavirus 16 in young women.
abstract: 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.
  
  
  METHODS
  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 kappa=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).
  
  
  CONCLUSIONS
  Ridge sign is a highly specific marker for CIN 2 or 3 and associated with HPV 16 and young age.
authors.affiliation: Department of Gynecology, Friedrich Schiller University Jena, Jena, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Scheungraber
authors.forename: Urte
authors.initials: U
authors.lastname: Koenig
authors.forename: Beatrix
authors.initials: B
authors.lastname: Fechtel
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Kuehne-Heid
authors.forename: Matthias
authors.initials: M
authors.lastname: Duerst
authors.forename: Achim
authors.initials: A
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003127:Colposcopy; D005260:Female; D052162:Human papillomavirus 16; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D015588:Observer Variation; D030361:Papillomavirus Infections / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000821:virology