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

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.