title: Umbilication is a strong predictor of high-grade cervical intraepithelial neoplasia.
abstract: 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).
  
  
  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 occurrence 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.
authors.affiliation: Gynecologic Oncology Centre, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Brno, Czech Republic. Jiri.Slama@vfn.cz
authors.forename: Jiri
authors.initials: J
authors.lastname: Slama
authors.forename: Karolina
authors.initials: K
authors.lastname: Adamcova
authors.forename: Ladislav
authors.initials: L
authors.lastname: Dusek
authors.forename: Ondrej
authors.initials: O
authors.lastname: Sosna
authors.forename: David
authors.initials: D
authors.lastname: Cibula
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D015331:Cohort Studies; D003127:Colposcopy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012720:Severity of Illness Index; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology*