Scheungraber Cornelia, Koenig Urte, Fechtel Beatrix, Kuehne-Heid Rosemarie, Duerst Matthias, Schneider Achim
Department of Gynecology, Friedrich Schiller University Jena, Jena, Germany.
J Low Genit Tract Dis. 2009 Jan;13(1):13-6. doi: 10.1097/LGT.0b013e318180438a.
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.
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.
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).
Ridge sign is a highly specific marker for CIN 2 or 3 and associated with HPV 16 and young age.
评估阴道镜检查中脊状征的观察者间和观察者内相关性，及其与宫颈上皮内瘤变（CIN）2或3、特定人乳头瘤病毒（HPV）类型和患者年龄的关联。
对592例患者的阴道镜照片、宫颈涂片以及活检或锥形活检的组织学结果进行评估。3名经验不同的妇科医生对阴道镜照片进行回顾性分析，以确定鳞柱交界（脊状征）处是否存在不透明醋酸白脊。
CIN阴道镜分级的观察者间可靠性在18.2%至82.3%之间。关于脊状征，根据观察者经验，观察者间一致性在25.3%至49.4%之间，观察者内可靠性在56.4%至67.5%之间（Cohen卡方值=0.310 - 0.469）。在592例患者中，最有经验的研究者诊断出83例（14.0%）有脊状征。这83名女性中有53例（63.8%）经组织学确诊为CIN 2或3。脊状征检测CIN 2或3的敏感性为33.1%；特异性为93.1%。有脊状征的女性比无脊状征的女性明显年轻（p <.001）。脊状征与HPV 16的存在相关（p <.001）。
脊状征是CIN 2或3的高度特异性标志物，与HPV 16和年轻年龄相关。
