Atlas of Colposcopy: Principles and Practice

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Abnormal colposcopic findings – Grade 2 (major) changes (continued)  

  • Coarse punctation: If the red dots are prominent, are raised from the surface, are irregularly spread, and bleed on contact, the punctations are called coarse punctations. Coarse punctations signify a high-grade lesion or cancer.

  • Sharp border: A distinct and regular border signifies that the lesion may be neoplastic in origin. The border of the lesion may be raised from the surface in CIN3 or worse lesions.

  • Inner border sign: Low-grade and high-grade lesions may coexist, and there may be internal margins (borders) because of the abrupt change in the nature of a lesion or lesions. This is called a “lesion within a lesion” or the “inner border sign” and is a feature of high-grade neoplasia. The inner, more proximal lesion is more severe and of higher grade.

  • Ridge sign: If the acetowhite area is thick and elevated and is projected near the SCJ like the top of a wall or ridge, this is called the “ridge sign”. The ridge sign indicates the presence of a high-grade lesion.

  • Rag sign: In high-grade lesions and invasive cancers, the epithelium tends to peel off easily. The eroded area is visible, and the peeled-off epithelium is seen to be hanging like rags. This phenomenon is usually iatrogenic, caused by overenthusiastic rubbing of the epithelium.

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