205

«
-
2011
»
618.1006(035.3)
55.694.714 81 59
:
Vesna Kesic,
(the Medical School, University
of Belgrade, Council member of European Society of Gynecologic Oncology, Council
member of the International Gynecological Cancer Society, member of the Scientific
Committee and Head of Balkan's office in European School for Oncology),
;
.,
.
.,
.
59
.
.—
.:
, 2011. — 232 .
ISBN 978-5-9704-1818-5
—
,
.
,
,
,
-
,
,
(
,
.
).
.
.
-
.
.
,
,
,
618.1006(035.3)
.
55.694.714 81
«
-
».
».
©
©
«
., 2011
«
», ISBN 978-5-9704-1818-5
», 2011 ©
, 2011
,
,
:
Vesna Kesic,
, the Medical School,
University of Belgrade,
,—
8 , 176, 196, 22a, 22 ,
3.
Albert Singer,
, Department of
Women's Health, Wittington Hospital, London, QA Lead Colposcopist,
,—
19 , 226, , 29 , , , .
Alex Ferenczy,
,
, The
Sir Mortimer . Davis Jewish General Hospital, Montreal,
,—
17.
Cecil V Wright,
, Department of
Ob/ Gyn, University of Western Ontario, Monreal,
,—
15 , 18e, 21e,
26 , ,
, 34a.
Lazslo Szalay,
Cervical Cancer
Screening center , Budapest,
,—
20 , , , 27 , , , 31 , , , .
Peter Bosze,
, Department of
Ob/gyn Sn Stephan Hospital,
(the European Academy of Gynecological Cancer, EAGC),
,
—
6,7,8,9.
.,
.,
«
,
.
.
», —
, 23.
.,
.,
,
.
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216, 276, 28 .
106, 15 ,
-
.......................................................................... 9
................................................................................... 11
.............................................................................................................. 12
1.
1.1.
1.2.
1.3.
1.4.
1.5.
............................................ 14
14
15
16
18
,
19
1.6.
2.
2.1.
2.2.
2.3.
................... 20
............................................ 22
...................................... 23
.............. ................................ 23
................................................................................ 31
............................................................ 33
............................................ 34
3.
3.1.
3.2.
3.3.
3.4.
3.5.
................................................ 36
....................................... 36
...................................... 42
................................ 48
................ 49
......................................... 53
............................................ 55
4.
4.1.
4.2.
4.3.
4.4.
4.5.
.................................... 57
.......................................................... 57
..................................................... ........... 58
....................................................... 59
................. 62
........................................... 63
............................................ 65
.............. 66
...................................................................... 67
.................................................... 67
....................................... 73
................................................... 76
5.
5.1.
5.2.
5.3.
6.
6.1.
.............................................. 77
................................................. 77
6.2.
7.
7.1.
7.2.
7.3.
7.4.
...................................................... 80
................................................... 82
................................. 83
.............................................................................................. 83
..................................... 90
............................................................ 102
(
) ...................104
..................................................110
8.
8.1.
8.2.
8.3.
8.4.
8.5.
.......................... 112
.................................................................................112
...............................................................................117
.........................................119
.....................................................................................122
.....................................................130
..................................................135
9.
9.1.
9.2.
9.3.
9.4.
9.5.
....................................................... 137
..........................................................137
...................................................................137
........................................................................138
...................................................................138
..............................................141
..................................................141
10.
10.1.
10.2.
10.3.
10.4.
10.5.
........................................................... 142
..........................................................142
.................................................................144
...................................
144
....................................................................... 146
...................................................... 153
................................................. 154
11.
:
.................................................. 155
........................................... 155
...................................................... 159
.................................................... 167
....................................... 168
................................................. 171
11.1.
11.2.
11.3.
11.4.
12.
......................................................................................................... 172
12.1.
12.2.
12.3.
........................................... 172
173
CIN.
................................................ 176
12.4.
12.5.
12.6.
13.
13.1.
13.2.
13.3.
13.4.
..................................................................... 183
......................................................... 184
........................................................... 186
................................................. 195
...................................... 196
............................................ 196
.................... 196
—
...................................................................................... 197
—
. .. 201
................................................. 203
14.
14.1.
14.2.
........................................................................................... 204
................................... 204
....................................................... 205
................................................. 207
...................................... .............................................................. 208
.................................. ..................................................... 209
.........................................................................209
...............................................................213
,
................214
( FIGO) ..........................215
......................................................................................... 216
—
(ACW — Acetowhite Epithelium)
—
(ATZ — Atypical Transformation Zone)
AC —
(AV — Atypical Vessels)
B3T —
(CTZ — Congenital Transformation
Zone)
—
(HPV — Human Papilloma Virus)
—
—
(TZ — Transformation Zone)
—
,
(STI — Sexual
Transmitted infections)
—
—
( — Keratosis)
—
(CS — Colposcopy)
JI —
(L — Leukoplakia)
—
( — Mosaic)
—
(OSE — Original Squamous
Epithelium)
—
(ME — Metaplastic Epithelium)
—
( — Punctation)
—
( — Punch Biopsy)
—
(PVI — Papillomavirus Infection)
—
(PCR — Polimerase Chain Reaction)
—
(LEEP — Loop Electroexcisional Procedure)
—
(
— Cervical Cancer)
—
—
(
— Columnar Epithelium)
—
—
( — Ectopy)
—
(
— Endocervical curettage)
—
(En — Endometriosis)
ASCUS — Atypical squamous cells of undetermined significance (
)
CIN — Cervical Intraepithelial Neoplasia (
)
EAGC — European Academy of Gynaecological Cancer (
)
EFC — European Federation for Colposcopy and Pathology of the Lower Genital Tract
)
ESGO — European Society of Gynecological Oncology (
)
EUROGIN — European Organization for Genital Infections and Neoplasia
)
HSIL — High Grade Squamous Intraepithelial Lesions (
)
IARC — International Agency of Cancer Research (
)
IFCPC — International Federation for Colposcopy and Cervical Pathology
)
ISSDV — International Society for Study Vulvar Disease (
)
SIL — Law Grade Squamous Intraepithelial Lesions (
)
SIL — Squamous intraepithelial lesion (
)
VaIN — Vaginal Intraepithelial Neoplasia (
)
VTN — Vulvar Intraepithelial Neoplasia (
)
-
-
,
.
,
.
».
,
(
)
,
.
,
.
.
,
,
,
-
,
.
-
,
,
.
,
—
—
-
,
,
.
-
,
,
-
,
,
,
.
,
-
.
,
.
Vesna Kesic
10
[59].
15,1
17,3
100
.
,
,
,
,
-
.
,
,
,
.
:
;
•
•
•
•
;
;
.
,
.
,
—
,
—
.
«
».
,
,
.
-
.
.
,
,
,
.
,
[129, 130, 185].
,
.
-
,
,
.
,
.
1
1.1.
(
)
(
.).
1924 .
.6
1884
,
[5].
,
,
,
,
.
,
Williams,
1886 .
,
. Cullen 1900 .
in situ,
. [170].
,
.
- dersB 1932
,
,
,
».
,
.
—
1.2.
(
)
,
,
.
,
,
,
.
.
1959 . [5].
,
.
14
10,
,
[5].
.
.
.
Kraatz 1939 .
1940 .
-
[5].
Koller
(1963).
-
Vespi
-
[98].
:«
.
,
.
,
» [98].
. [42].
.
1942 .
V. Shtokel
.
,
,
,
,
-
[5].
.
.
,
,
,
,
,
,
.
[72, 77,82, 141, 166, 167].
60-
.
,
,
,
.
.
,
,
.
1.3.
,
,
.
,
[5].
1963 .,
.
,
,
-
.
[113].
,
1972 .
Map
(
)
(IFCPC).
-
.
,
-
.
—
,
.
.
[70].
.
,
.
.
,
Lane,
1964 . [29].
60
.
,
IFCPC (International
Federation for Colposcopy and Cervical Pathology), ESGO (European Society
of Gynecological Oncology), ISSDV (Inernational Society for Study Vulvar
Disease), EAGC
.
.
,
(
).
,
.
,
.
,
.
,
,
.
,
,
,
.
,
.
.
,
,
,
.
,
.
,
. [8, 9, 10, 25, 33, 42, 49, 53].
,
.
.
,
.
.
: .
,
,
.
.
,
,
,
,
.
.
,
.
,
.
,
.
,
.
.
,
XX .
.
1968 .
,
,
,
.
,
40
,
[82, 83,86, 141].
,
1.4.
,
.
,
[90].
.
1980 .
.
.
,
.
,
[5].
.
,
(
4 1).
,
EFC S.
,
.
Dexeus
,
,
,
-
[86].
1.5.
,
,
.
1
.
.
-
,
,
,
[66,74, 105, 111, 114, 118, 122, 126]:
;
;
,
•
•
•
-
;
•
)
;
•
;
;
•
•
;
.
•
80-
XX .
[197].
,
,
,
.
,
,
,
,
, ,
,
.
,
(
)
,
85%
[87, 110, 121].
(
)
.
,
.
,
,
.
[70,
77, 144, 161].
1.6.
,
.
SIL
,
,
.
,
-
.
,
SIL,
,
,
.
,
,
96
48%, LSIL/HSIL — 69 82%
[142].
(PPV)
LSIL — 78%,
HSIL
— 91%.
R. Volante et al. [183],
LSIL -51%,
HSIL - 63% ( =1 292).
,
.
-
.
,
,
.
(
.
Pretorius RG et al. (2004,
)
)
,
37%
HSIL
[154].
,
50%
D. Sokolov [173],
26% —
(J. Byrom et al., 2006) —
(
)—
V. Kesic [116].
(
HSIL
)
74%/91 %;
170
2
2—
[71].
,
,
.
.
(
LSIL
)
,
.
,
-
,
[60, 64, 76].
[164],
.
,
.
,
(
,
.).
,
[44].
,
.
80
,
,
-
.
.
,
.
.
,
,
.
1.
1924 .,
,
«
,
».
2.
60-
XX .,
.
3.
,
.
4.
,
.
,
5.
,
,
.
2
2.1.
,
,
,
.
.
,
—
,
,
)
(
2—3
.
,
,
.
,
-
,
.
,
,
. 1).
,
.
,
—
-
[23, 33].
(
)
(
(
),
).
-
,
,
:
,
,
,
.
15%
,
,
(
)
-
,
-
[23]
. 1.
(
,
,
,
150—200
,
)
,
,
,
4
,
(
-
).
-
(
4—5
—
(
.
).
.
. 1).
,
. 2.
-
.
,
,
.
.
.
2—3
,
,
.
,
,
,
.
-
,
.
.
,
,
,
[25, 33].
. 2.
(1),
(3),
(4),
.
,
—
(2)
-
[81].
(
)
,
,
4
-
.
.
.
,
-
,
,
),
.
,
,
,
.
,
[23].
,
.
,
[35].
.
-
1 .
,
,
—
.
(
. 3).
-10 (
.
,
).
. 3.
(Squamous metaplasia and transformation zone)
(
)—
,
.
,
-
,
.
,
,
,
.(
.
. 4).
,
,
.
,
.
—
-
[23].
.
-
,
.
(
)
,
,
(
.
. 4).
. 4.
,
(
)
(
(
-
)
.
16).
,
(
,
-
1 ).
,
,
.
,
[23,81].
,
.
,
[81].
«
»
«
»
-
«
»
),
,
,
.
,
.
,
[74].
,
.
-
.
[23].
—
-
«
».
(
).
,
.
,
(
).
,
,
,
,
,
.
-
.
.
[25].
,
—
.
,
,
,
,
.
,
,
,
—
,
,
90%
.
CIN.
(
.
)
7).
(
-
(Congenital transformation zone)
.
(
-
)
,
™,
.
,
,
.
:
,
,
-
,
.
,
[93, 127].
-
,
,
,
[63].
.
,
,
,
-
.
.
-
CIN
,
,
,
.
2.2.
,
-
in situ.
«
»
,
,
,
[20,
41].
,
,
,
,
.
(
1 ),
(
1 , )
(
1 )
,
,
,
,
,
.
.
,
,
-
,
[20].
,
,
(cancer).
,
(CIN I, II, III),
-
[33].
,
.
,
(
-
)
CIN.
,
William Farr 1856 ., «
.
—
.
,
:
,
,
,
-
» [12].
XI
(1975)
«
«
(CIN)
: CIN I CIN II
, CIN III —
(
in situ
CIN III
in situ»
»
. 5).
-
,
(23).
XX .
,
,
,
«
.
-
», «
»,
», «
«
CIN I
(
.
1 ).
»,
(
)
(Bethesda system, 1988 .,
1991 .).
.5
-
.
(
,
)
-
(LSIL), a CIN II- III
(HSIL).
-
.
(
)
,
[193].
. 5.
2.3.
(
)
-
.
(
)
95%
.
[1].
(
,
)
—
3—5%
,
,
.
.
:
~
;
—
30
—
(
);
:
.
— 10s— 10s
95% (>10
,
).
—
—
,
202
(
,
,
,
,
,
,
,
,
,
,
,
,
,
-
,
,
.).
-
,
,
Lactobacillus spp., Staphylococcus
epider- midis, Streptococcus spp., Peptostreptococcus spp., Eubacterium spp.
Micrococcus spp., Propionibacterium spp.,
Bacteroides spp., Ureaplasma urealiticum,
.
Clostridium spp., Candida spp.,
Gardnerella vaginalis, Bifidobacterium spp., Micoplasma hominis,
Actinomyces spp.,
.
,
Escherichia coli,
Staphylococcus aureus, Neisseria spp., Mycoplasma fermentans.
, .
,
,
, [1].
[3, 12, 25].
,
1.
(
)
-
,
-
.
,
2.
3.
—
,
.
.
—
4.
.
-
—
5.
.
,
6.
,
.
-
7.
,
(CIN 1, II, III),
.
-
8.
.
3
,
.
,
,
.
,
,
.
.
3.1.
,
,
,
[34, 35].
-
,
.
-
.
46
(
98%,
. 1).
,
(
(
2 ),
—
26).
.
(
)
.
1.
HSIL [57]
,
Reid R. (1991)
Soost H.J. (1991)
Tabarra S. (1992)
,
%
%
1012
52,0
92,0
277 842
78,1
94,4
75
66,0
82,0
Echini (1993)
2105
62,5
99,3
Mayeaux J. (1995)
453
45,0
80,0
Schneider A. (1996)
967
28,9
97,5
Malsuura Y. (1996)
151
51,0
95,0
Bishop J.W. (1997)
2320
63,6
99,7
210
64-74
77-89
8466
46,0
98,0
.(2001)
Petry K.U. (2003)
(
)
,
-
(
),
-
.
,
(
1:1)
20
.
:
-
,
G,
,
Y.
,
),
(Pap-smear test).
,
,
,
.
—
.
,
,
,
(
)
[34].
-
,
,
,
.
,
[112, 120].
,
[6].
—
—
12-
(
2 );
:
(
2 );
—
3-
,
;
4-
—
5-
—
,
(
,
2 );
.
,
,
,
,
[21].
(
-
,
);
-
;
.
.
;
.
,
,
-
60
-
,
,
-
,
.
(
)
3
:
ASCUS ( .
(LSIL) (
,
(
(
2 )
2 )
(HSIL) (
.
2 )
,
)
)
.
,
. 2.
2.
, 2001 (Terminology Bethesda System (TBS) [44]
AGC
Atypical glandular cells
AGC, favor
neoplastic
Atypical glandular cells, favor
neoplastic
ASC
Atypical squamous cells
ASCUS
Atypical squamous cells
undertermined significance
ASCH
Atypical squamous cells cannot
exclude HSIL
CIN 1, II, III
,
,
HSIL
Cervical intraepithelial neoplasia
grade 1, 2 or 3
CIS
Carcinoma in situ
HSIL
High grade
squamous intraepithelial lesion
LSIL
Low grade
squamous intraepithelial lesion
NOS
Not otherwise specified
SIL
Squamous intraepithelial lesion
1, 2
3in situ
.2
(
)
,
.
»
2001
«
:
» [33].
«
8000—12 000
5000
«
.
»
-
»
.
10
.
,
«
».
-
,
(
50
70%
-
).
«
»
,
,
,
,
75%
.
«
».
-
:
,
,
-
«
».
-
.
,
,
,
,
,
,
,
,
.
,
,
,
»
«
(SIL),
«
-
» (ASCUS).
«
,
» (ASCH)
ASCUS
(HSIL).
CIN
II
CIN III [44, 110].
,
.
,
-
(ASCUS),
-
.
,
(
. 3) [93, 120].
3.
__
(Papanicolau system)
(Bethesda system)
1
II
,
,
.3
(Papanicolau system)
Ilia
(Bethesda system)
ASCIIS (
ASCH (
•
)
)
AGUS
•
1116
LSIL (CIN1)
HSIL (CIN 2) AGC
IV
HSIL (CIN 3) AIS
V
.
[57].
,
.
,
:
,
,
.
3.2.
«
,
»
-
,
-
,
,
.
-
.
,
-
[23].
,
,
6.
(
),
,
,
,
[110, 189].
,
-
,
.
(
-
)
.
(
—
-
(
[41, 93, 112].
:
; punch-byopsy);
; excisional biopsy) (
.
11).
(Cervicalpunch-biopsy)
'.
•
;
-
•
;
;
•
•
•
;
,
Hbix
.
—
.
.
.
(
-
)
.
.
,
,
.
,
[84].
,
.
,
,
,
.
,
(
(
)
-
36).
[11, 57].
.
-
,
3
.
,
—
[72].
.
,
,
25
.
,
,
,
[191].
,
,
,
,
,
[45].
-
,
,
.
«
»,
-
.
,
,
.
,
,
,
[57, 93, 110].
,
:
-
—
,
;
(
—
3
),
,
).
2
(
;
—
.
.
;
—
;
-
—
;
—
;
,
—
.
,
[88, 170].
(
)
-
.
(
).
.
.
[116].
11.
(
)
-
.
.
,
(
Mark Stoler
«The Accuracy Of Colposcopic Biopsy: A Report From The Gardasil Clinical
Trials Pathology Panel»,
, 2007),
17 599
16—26
,
, .
100%
CIN II
48%
CIN III.
, ILIM.
,
[173].
,
(
,
.) [88].
:
Ferrum sulphate — 2100 g
Nitric acid — 150 ml
Sulphuric acid — 110 ml
Aqua distil. — 21
Nitric acid — q.s.
;
-
,
«
».
-
.
,
.
.
9, 10.
[Endocervical Curettage (
)]
,
,
(
-
)
.
.
.
,
-
.
,
-
,
.
.
-
.
,
,
,
,
,
[113, 193].
,
,
,
,
,
,
—
.
,
«
».
CIN
.
[193].
(Endocervical Brushing;
5
.
).
.
—
[88].
30—60
-
.
.
4-6
1%
3—5
,
-
4
2-4-8-10
0-3-6-9
.
.
.
,
,
,
.
.
3.3.
,
.
,
,
,
3—5%
,
.
,
.
80—83%,
,
HSIL
— 64-87% (
, 2006).
-
[186].
,
,
.
,
, UP/DIG ENE—
;
(VIA
.
V1LI)
.
[75].
3.4.
0,
,
,
(
-
)
-
.
[16, 18, 110, 111, 118, 175].
(
)
.
,
,
[26].
(88—100%)
(68—86%),
(68—97%)
(78—99%).
-
100% [93, 119, 195].
3
:
,
1.
.
,
,
, in situ
.
,
2.
,
.
—
,
,
.
,
-
,
3.
,
,
-
.
Hybride
Capture System (hc2).
,
13
.
Dige.
,
,
,
,
.
FDA
.
Digene,
:
,
;
[64, 80,
119].
,
95—100%
.
,
,
,
[44,61,108].
,
,
.
,
,
[26].
-
.
.
16IN
pl61NK4a
6/ 7
,
.
CIN
16™ ,
,
,
.
pl6INK4a
7 [19]. Pl6[NK4a
pRb (
,
;
[38, 115].
(mRNA)
,
)
pl6'NK4a
.
16
7
6
.
7
,
53,
).
_ pRt> (
6
.
6
7
[175, 197].
,
6
7.
m-RNA
;
6
7
-
.
7
,
(
)
,
-
,
.
7
,
.
7
.
-
mRNA 6
Proofer )
. 4.
7
(PreTect HPV.
4.
Lie
mRNA 6
et al. [128]
7
mRNA, %
DNA, %
20
100
90
11
82
(hc2)
Sjoborg et al. [175]
82
(Amplicor)
,
10%
PreTect HPV-Proofer
,
.
[128].
3.5.
.
(TruScreen) —
-
,
.
-
.
,
[171].
,
-
,
.
,
,
-
.
TruScreen
CIN.
TruScreen:
~
;
—
;
—
,
;
,
—
.
TruScreen
,
-
:
(
—
3
);
-
—
;
(
—
3
,
);
(
—
—
);
;
-
(
,
);
.
—
,
,
TruScreen
(70
CIN I
[163, 171].
TruScreen-mecma
10
TruScreen
;
,
,
.
( =651)
CIN II—III,
,
69%
).
TruScreen
5000
,
,
,
,
,
(67
45%
)
-
.5
5.
TruScreen
[163,171]
,%
,%
47—62
60—95
66—99
52—96
67—79
49—86
.
.
-
.
.5
-
,%
,%
TruScreen
70
81
TruScreen+
87
93
,
[119, 175, 185, 186].
,
,
.
,
1.
,
,
.
(
2.
)
,
«
»
-
.
3.
.
,
4.
.
.
.
,
.
.
.
,
8.
,
-
.
-
9.
,
.
4
4.1.
8—40
.
(
),
,
,
.
(
)—
,
.
—
(
,
.),
-
.
—
,
,
.
—
160—280
.
(
).
,
,
,
,
.
-
.
—
,
,
,
,
.
.
—
.
,
,
—
.
.
,
-
.
—
.
4.2.
(
)
.
,
.
,
,
,
.
7,5; 15;
.
(
30
),
,
,
80
,
,
.
-
,
,
,
.
,
.
,
,
,
,
-
.
,
,
,
.
[166, 193].
(
4 ).
,
-
.
4.3.
,
,
,
.
,
,
,
,
,
,
,
-
.
,
-
,
.
.
,
,
,
.
.
20—30
.
(
.
)
30
-
,
.
,
,
(
46):
;
—
—
—
—
;
;
;
—
—
—
—
;
3—5%
;
;
;
-
—
;
.;
—
—
—
—
—
—
;
;
;
;
.
(
9),
-
.
,
.
.
,
.
-
«
»
.
.
.
.
-
,
.
,
,
.
,
,
.
[22]. ©
.
,
,
,
,
[88].
—
.
,
,
.
.
.
,
[192].
.
,
,
.
,
.
,
,
.
.
.
3—5%
5%
).
,
,
3%
(
,
.
.
—
,
.
,
.
.
.
,
-
[113].
.
,
,
.
.
,
,
[192].
,
,
-
.
.
(
.
);
10.
4.4.
,
-
,
:
•
;
;
•
•
•
•
;
;
.
,
[192].
4.5.
.
—
-
,
.
,
,
.
.
. 6—8.
:
,
(
.
. 6),
,
,
(
—
( .
.
. 8).
—
—
.
. 7),
-
.
4
,
.
.
(
—
.
216, 27 ,
.
,
.
,
).
.
.
.
.
-
,
,
,
,
.
,
,
,
,
«
.
-
»
«
,
,
».
.
,
,
,
,
.
,
,
-
.
1.
,
.
2.
,
.
(
3.
7,5; 15; 30
,
),
.
,
4.
,
,
.
.
5.
.
,
6.
.
,
7.
,
.
8.
,
.
5
(
)
,
.
,
.
,
,
.
.
,
,
.
,
,
,
.
,
.
,
,
.
5.1.
,
,
-
;
;
;
-
,
;
(
);
;
.
5.2.
1.
2.
3.
4.
;
;
);
(
(
);
5.
6.
7.
8.
;
;
;
;
9.
.
—
,
.
,
,
,
,
.
,
,
(
5 ).
.
(
56).
,
.
,
—
,
.
,
,
.
,
,
.
.
,
.
(
5 ).
.
(
).
.
,
.
,
,
.
,
,
6 ),
(
,
,
,
.
.
,
.
,
(
,
66).
.
.
,
.
.
,
.
,
,
.
-
,
,
.
-
.
-
,
,
,
.
.
,
,
,
.
(
6 , ).
, 30-
).
(
)
—
.
),
(
—
.
,
(
,
76, )
.
-
,
-
,
(
7 ).
7
«
,
».
,
,
,
-
.
,
.
(
[Squamocolumnar Junction (SCJ)]
)
(
).
—
(
—
,
8 ),
-
.
(
.
(
86)
)
,
,
8 , ).
(
,
,
,
,
.
.
,
,
8 ).
-
.
,
.
,
.
.
-
:
.
,
(
)
.
,
,
(
(
9 , , ).
).
,
,
,
,
,—
-
(
9 , )
).
.
,
,
,
(
,
-
.
.
),
9 ).
,
,
.
3-5%,
,
,
,
-
,
.
.
,
,
.
,
,
,
.
,
, 0,5%
.
,
1—3
,
.
,
.
,
.
,
,
.
,
-
,
(
10 , ).
,
-
(
3%,
5%),
.
-
»
«
»(
).
)
,
.
,
(
11 ).
,
.
,
-
,
,
,
,
(
116).
,
:
—1 ,
2—3%
— 2—4 ,
— 300 .
,
.
11 , ).
,
-
,
(
).
,
,
.
,
.
,
.
,
,
.
SIL.
5.3.
(
Pixley, Burghardt, Rubin & Barbo, Reid et al.).
,
,
,
3
: Coppleson &
,
.
:
;
,
,
;
.
,
.
3
.
,
[165].
Coppleson-Pixley [80, 91].
1-
:
,
;
, CIN I;
,
-
,
.
.
,
.
CIN I
;
2-
:
;
CIN II—III;
,
,
,
,
.
.
.
3-
:
;
CIN III
;
,
,
,
300
,
.
-
,
,
[91].
. 6),
,
[165].
6.
,
0
1
2
.
,
.
)
.
,
,
»
,
,
,
.
.
0
1
2
.
/CIN I, 3-5
-
0-2
IN I—II, 6-8
-
IN II-III.
(Shafi
and Nazeer) (
7.
. 7).
,
[88]
0
LSIL
1
2
—
HSIL
—
30
30
—
—
1
350
.
1
—
350
—
—
—
— 10.
,
.
,
.
.
,
1.
,
,
.
:
2.
,
,
;
;
;
-
;
;
;
-
.
:
3.
,
,
,
-
,
,
,
,
-
.
-
4.
;
,
;
,
.
-
5.
,
,
.
6
6.1.
(
)
.
»
«
»
[111].
(
«
»
)
«
».
,
JI.H.
(1987)
.,
,
«
,
.
,
.
,
.
[9,10].
»
,
,
.
.
,
-
,
,
,
.
,
,
,
.
,
4
[5].
:
1.
1.1.
1.2.
.
.
—
.
—
1.3.
2.
2.1.
.
.
,
,
.
.
2.2.
2.3.
2.4.
3.
3.1.
3.2.
3.3.
3.4.
.
.
.
.
—
(
(
—
(
—
).
).
—
).
—
3.5.
3.6.
4.
.
(
,
,
).
(
,
,
.).
,
-
2,
.
,
,
,
:
,
,
,
.
.
,
2003 .,
»,
1.
findings)
«
1990 .
IFCPC
»
2002 .
[167].
-
.
(Normal colposcopy
(Original squamous
—
epithelium)
(Columnar epithelium)
( ) (Normal transformation zone
—
—
NTZ)
(Abnormal colposcopic
II.
findings)
.
( ) (Within the transformation zone)
(Acetowhite epithelium)
—
—
—
—
—
—
—
(Flat)
(Micropapillary or microconvoluted)
(Punctation)
(Mosaic)
(Iodine-negative epithelium)
. (Atypical vessels)
.
(
,
)
(Outside the transformation zone, e.g., ectocervix, vagina)
—
—
—
—
—
—
—
(
)
(
)
,
(Colposcopically suspect invasive carcinoma)
IV.
(
) (Unsatisfactory colposcopy)
—
(Squamocolumnar junction
not visible)
—
(Severe inflammation or severe
atrophy)
—
(Cervix not visible)
—
(Entire lesion not seen)
III.
V.
(
) (Miscellaneous findings)
(Non-acetowhite micro-
—
papillary surface)
—
—
—
—
—
—
(Exophytic condyloma)
) (Keratosis-Leukoplakia)
(Inflammation)
(Atrophy)
(Ulcer)
(Other)
(
,
,
.
-
,
,
.
.
6.2.
.
,
—
.
,
.
,
.
epidermidization
squamous prosoplasia
,
, squamous methaplasia,
-
,
-
,
[5].
,
-
,
-
,
.
(
,
)—
.
,
,
,
.
in situ (
,
«
», CIN
.)
,
,
-
,
.
,
-10.
—
,
.
.
—
,
.
,
1—3
,
-
.
-,
,
CIN.
-
—
.
-
,
.
,
,
,
.
—
,
,
.
—
,
-
:
;
-
;
;
;
;
;
;
[57].
,
.
,
—
[57, 81].
1.
,
—
.
-
2.
,
1990 .
,
-
2002 .
«
3.
», «
», «
»
4.
.
», «
.
», «
.
7
,
[22,61, 112, 166, 167].
7.1.
(
)
«
», «
(
» (squamos —
)
;
—
),
.
,
.
,
4
,
(
.
2).
,
,
.
,
,
.
,
(
,
,
12 ).
-
,
.
,
,
,
.
.
,
—
126).
(
.
,
,
.
.
.
(
-
),
,
,
,
-
.
.
,
..
.
:
,
.
,
.
.
(
.
)
,
.
(
13 ).
,
,
(
)(
136);
(
13 ).
(
).
,
13 , ).
.
,
,
«
».
,
.
,
,
,
.
.
.
,
.
.
.
.
,
,
.
,
-
,
,
.
.
.
,
»,
.
.
,
,
.
,
,
(
.
-
27 , , ).
.
,
»
«
,
,
.
.
(
«
)
»
«
-
».
(
)
(
»,
14 ).
.
.
,
,
(
),
,
.
,
.
,
,
.
,"
,
.
2.
,
,
,—
.
,
. 9.
:1—
;2—
;4—
;7—
;3—
;6—
;5—
(
);
(
. 9).
8—
.
.
,
.
,
.
(
)
.
,
,
,
.
,
.
,
2
(
.
146).
.
(
14 ).
.
.
,
.
.
.
,
(
14 ,
).
,
.
,
,
.
.
,
,
.
.
.
.
.
.
.
,
(
.
14 ).
1
.
.
2
,
.
.
3
.
,
.
.
,
10.
3
: 1, 2
3-
,
. 10.
.
,«
100%».
,
,
,
.
7.2.
,
.
,
,
CIN,
,
,
(
.
)
(
)
,
.
.
,
,
CIN,
.
CIN
,
(
,
(
.).
),
,
,
,
,
,
, CIN,
,
.
,
,
,
,
—
.
.
,
,
,
—
.
3-5%
.
.
15 , ),
(
15 );
(
15 , ),
.
LSIL,
:
(
,
HSIL.
15 , )
.
(
.
15 , ).
,
.
,
,
.
,
,
.
,
.
.
,
,
(
),
.
,
,
,
.
,
, CIN,
,
,
,
,
,
,
—
.
.
,
,
,
—
.
3-5%
.
.
15 , ),
(
15 );
(
15 , ),
.
LSIL,
:
(
,
HSIL.
15 , )
.
(
.
15 , ).
,
-
.
,
,
.
,
,
.
,
.
.
,
,
-
.
.
.
(
)
,
«
,
»,
.
»
,
,
,
,
.
, CIN,
.
.
,
.
,
,
,
,
16).
,
(
)
.
(
11 ).
,
.
,
,
.
,
,
,«
»
,
.
,
,
.
( )
,
«
,
,
,
»
.
,
.
«
» (ground)
,
(
),
,
(
,
. 11).
. 11.
:
!—
;2—
;3—
.
.
,
(
),
,
,
,
(
17 ).
,
,
,
-
(
)(
176)
. 12).
. 12.
:
1—
;2—
;3—
.
(
),
.
(
),
.
.
.
,
,
.
,
CIN
.
.
(
).
-
(
17 ).
(
«
»
«
».
)
(
.
,
(
.
. 13).
.
. 13.
.
.
,
,
(
. 14).
-
. 14.
:1—
;2—
;3
—
.
,
(
18 , ).
(
18 ).
18 ).
,
.
,
,
,
.
-
,
,
.
-
,
,
.
(
,
18 ).
-
,
.
-
.
,
.
,
,
.
,
.
,
(
18 , ).
,
.
(
)
,
).
,
10-
-
15-
.
.
.
.
,
:
,
, CIN,
,
.
,
,
CIN.
.
,
-
,
.
,
,
.
,
-
,
.
.
,
,
,
,
.
,
(
, 30-
)
.
.
(
. 15).
. 15.
:
1—
2—
3—
4—
5—
;
;
;
;
[170]
,
yfjin
(
.
,
,
19 )
,
,
,
(
196, ).
.
.
—
.
.
,
,
,
.
,
,
.
[5].
(
)
,
.
,
,
,
.
,
,
,
,
,
,
,
.
,
,
.
(
(
;
20 , , 21 ).
;
20 , )
«
» (abnormal TZ).
,
CIN (
)
,
,
(
)
,
.
,
;
,
,
.
,
.
,
[88,170].
,
,
,
,
.
(
)
2.!
.
,
,
(
21 , ).
.
.
.
—
,
.
,
[167, 170, 191].
CIN [127].
,
,
.
CIN
CIN
,
(
.
2)
CIN.
,
[23],
,
CIN
2
,
(
40
—
),
,
.
) in situ
,
[88].
.
,
-
,
in situ
,
,
,
[58].
,
,
,
,
.
,
,
(
20 , ).
-
,
in situ
:
,
,
,
(
20 ).
,
[58, 191].
,
,
,—
.
,
[25].
in situ
—
.
,
,
.
.
7.3.
,
,
«
».
.
.
[191].
,
,
,
,
.
42
[S. Dexeus et al., 88].
93%
FIGO
.
:
;
—
—
—
;
;
;
—
—
,
(
-
,
).
(
,
.
,
[S. Dexeus et al., 88].
,
.
,
,
•
•
•
•
•
•
•
[82, 88]:
;
,
;
;
;
;
;
,
,
.
22 ).
,
,
.
.
,
-
,
.
,
,
(
226).
,
,
,
.
.
,
,
-
.
.
,
,
.
-
(
22 ).
,
,
(
22 , ).
7.4.
)
,
(
,
,
.
,
).
,
-
.
8.
,
,
-
,
-
,
.
,
,
.
-
,
.
,
.
.
-
,
(
23)
,
-
.
.
(
8.
)
-
(
24),
.
,
,
,
.
-
.
.
,
[21, 191].
,
-
,
.
.
,
.
,
.
-
,
,
.
2—3
.
-
,
.
.
-
,
,
.
(
,
)
,
.
,
,
-
,
.
-
,
.
.
,
,
.
-
,
,
,
,
.
3—5%
-
.
-
,
,
.
-
.
,
.
,
,
,
1—2
.
(
.
)—
,
,
,
,
(
.
,
-
.
-
),
-
.
:
(3—4
)
,
.
[88].
.
,
.
,
,
.
,
,
,
(
—
25 )
,
-
,
,
(
256, ).
(
(
25 )
25 ).
.
,
.
,
.
,
,
,
,
26 ).
,
-
,
-
.
,
-
.
,
-
,
.
;
,
,
—
.
,
.
,
,
,
.
,
CIN.
—
,
-
,
.
,
,
,
,
.
,
,
.
,
,
,
,
.
.
,
.
,
.
,
,
,
.
(
(
26 ),
,
(
266),
26 , , , , ,
).
(
)
,
,
,
.
,
.
-
«
»,
,
-10 (
.
).
,
CIN,
,
,
,
.
.
,
,
JI ( )
,
,
,
. J1 ( ),
,
,
,
.
—
-
,
.
,
( )
-
,
,
.
,
( )
-
,
,
—
.
,
-
.
,
,
,
,
.
,
,
.
.
)
.
.
.
.
(
27 )
.
,
(
,
276, , , ),
,
,
.
,
.
.
,
,
;
.
CIN.
,
.
,
,
.
,
,
,
,
.
,
1.
,
-
.
,
,
.
-
2.
,
.
CIN,
-
,
,
.
-
3.
,
4.
(
,
),
(
),
-
.
CIN
-
,
CIN.
5.
,
.
-
6.
.
,
7.
,
,
,
,
,
-
,
-
,
,
,
,
.
8.
,
,
,
.
,
9.
-
.
,
10.
,
CIN
2
-
,
,
(
),
,
40
—
.
8
8.1.
,
,
,
,
.
.
,
.
[23].
,
,
.
,
[23].
,
.
2—3.
,
D. Luesley [88]
,
,
.
. 8.
8.
[88]
.
.
.
,
.
.
.
.
.
,
,
.
.
.
.
,
(
,
28 ).
,
.
-
,
—
.
,
-
,
,
.
(ectopia
gravidarum).
.
.
3%
,
.
.
,
,
[88].
,
,
.
,
,
,
,
(Cruickchank
,
.) [91].
:
;
-,
.
,
[42].
,
(
286).
,
,
,
,
.
.
.
,
.
.
,
,
,
.
,
,
,
,
.
,
,
,
.
.
.
,
.
,
.
.
CIN
, CIN
3%
,
1:2500.
— 75—85%
15—25%,
-
[20, 56, 184].
CIN
,
.
(
).
,
.
CIN
.
,
CIN I
.
CIN III,
-
,
,
,
.
.
,
,
CIN
,
,
[47].
CIN I—III
(
-
)
.
,
II),
(CIN I
,
,
.
CIN III
CIN II
III
CIN
.
.
,
60% [56, 92].
CIN
50
70%,
.
,
11
.
.
,1
[56]
.
9
,1
Fambrini et al. [92]
5
,3
.
27
.
.
18
.
,
(
3
),
(
).
.
,
1
.
.
.
.
,
,
.
,
.
,
,
.
,
,
.
CIN
6
.
6
,
.
3—4
,
.
.
.
,
.
,
.
,
,
,
.
.
CIN
,
,
[ 170].
8.2.
,
CIN.
,
,
-
[23].
,
.
,
,
.
,
.
,
.
,
,
[88].
,
.
,
,
,
.
,
,
[88].
,
,
,
.
,
. 9.
9.
[88]
.
.
.
.
,
.
.
.
,
.
,
,
.
.
.
.
,
,
—
.
;
,
—
(
296).
C1N
,
(
,
29 , , , ).
,
,
,
.
-
(
),
,
.
,
,
,
-
.
7—14
1
.
,
,
.
8.3.
.
,
,
.
,
[4].
,
,
.
.
,
,
.
,
.
,
,
,
,
,
.
[84].
,
.
,
,
,
.
.
,
,
.
(
(
29 ),
29 ),
.
,
,
,
,
(
30 , , ).
SIL,
,
.
.
,
(
)
(Smith J. et al. / Lancet. - 2003. - Vol. 361. - P. 1159-1167).
,
9
, 10 — 1000,
.
(
)
.
(
,
,
5
,
1000,
-
-
.)
(WHO. Medical eligibility criteria for
contraceptive use. Fourth edition, 2009).
2004
—
.
,
,
(EVA).
— 54 ,
—4
.
15
120
(
).
.
21
.
.
3
1
,
.
.
•
—
.
•
.
.
•
•
•
.
.
,
.
,
,
2322
1
,
,
(97,2%) (Dieben .
(
)
,
,
., 2002).
,
,
,
(
.,
.,
., 2006).
,
,
43%
.
63%
,
(Veres S.
., 2004).
,
,
2,7-
,
,
(Veres S.
., 2004).
,
.
.
,
3
)
.
,
1—2
,
.
8.4.
,
,
,
.
,
.
.
,
[23].
«
«
».
»
.
,
[23].
,
,
.
.
,
,
,
—
.
[84].
.
,
,
.
.
.
.
,
.
,
[ 124, 127].
,
,
,
.
,
.
.
(
316, ).
.
,
,
(
31 ).
(
31 , ).
,
.
,
.
,
.
,
,
,
,
,
.
,
,
[23].
,
,
,
,
,
,
.
,
(
,
),
.
.
,
.
,
[84].
.
,
,
,
-
.
,
,
—
.
.
.
[35].
,
,
-
,
;
,
.
,
.
(
,
,
31 ).
,
,
.
,
,
.
:
,
,
.
,
,
,
—
,
,
,
[47].
,
(
)(
31 , , ).
,
.
,
SIL
.
«
»
[23, 76, 93].
,
[23]:
1.
Chlamydia trachomatis,
Streptococcus spp., Staphylococcus spp., Neisseria gonorrhoeae,
Treponema pallidum, Mycobacterium tuberculosis, Actinomyces israelii;
Human papilloma uirus, Herpes simplex uirus type 2,
Cytomegalovirus hominis;
Candida albicans,
glabrata
.;
Trichomonas vaginalis,
Entamoeba histolytica;
Ureaplasma
urealyticum, Mycoplasma hominis.
2.
:
;
;
;
,
.
,
3.
:
(
),
-
.
.
—
.
;
.
.
,
,
,
-
,
—
-
,
,
,
.
[54, 55].
,
.
,
,
.
.
,
.
,
.
,
[61, 88].
,
(
)
(Cytomegalovirus hominis)
.
(
25—40
),
.
,
[191].
.
— . trachomatis,
[105].
,
.
,
,
|
,
,
. . trachomatis
.
,
.
,
.
,
.
,
.
,
,
,
.
— Treponema Pallidum.
.
,
2—3
,
)
[105].
(
).
4—5
.
,
6—9
.
,
,
,
.
,
,
.
,
,
,
,
.
,
,
,
-
,
,
,
,
.
,
Candida.
,
,
.
,
,
[23].
,
,
.
,
—
.
,
[22, 88].
,
,
,
Trichomonas Vaginalis.
.
.
,
,
-
[23, 105].
,
,
-
.
,
.
.
.
,
«
»,
).
,
.
.
.
.
,
[88].
.
.
—
,
,
.
,
.
,
.
.
8.5.
(
),
,
,
,
,
,
130
.
,
;
40
.
-
,
(
. 10) [16, 188].
10.
: 6 11.
40, 42, 43,44,54, 61,70, 25%
72, 81
.
: 16 18.
31,33, 35,39,45, 51,52,
56, 58, 59, 68, 73 82
(
).
.
,
,
-
,
(
100%
,
)
,
( 50—70%
).
-
,
[87, 146].
1—8
,
.
,
,
:
,
,
[44, 97, 168].
10—15
,
,
[168].
,
,
.
,
,
,
CIN.
.
(
:
,
,
)
.
.
—
32 , ).
,
,
.
,
,
.
[48].
,
[93].
,
.
,
.
,
,
,
,
.
,
(
,
,
32 ).
.
.
,
,
.
[158].
.
3—5%
,
,
(
«
»).
,
,
.
,
(
32 , ).
-
.
,
,
.
,
[103].
,
,
,
.
CIN
,
32 ).
,
.
» [103, 139].
.
-
,
,
[77,
93].
,
.
(
),
,
,
,
,
,
,
.
(
(77,8%),
— 91,7%),
(77,4%) [47].
(
).
,
(
32 , ).
.
.
CIN.
,
,
,
CIN
.
,
,
[158,
159].
,
,
,
.
,
.
.
,
;
.
.
.
,
[187].
90% (EUROGIN, 2004)
[47].
9, 10.
,
.
.
[93, 103].
.
(
.
10).
(
).
,
(
).
-Digene
CIN
,
.
—
[47].
,
1.
.
,
,
,
,
-
,
.
.
,
2.
CIN
,
,
.
,
3.
,
.
.
.
1.
,
,
.
2.
.
.
.
,
3.
,
,
—
,
C1N.
.
9
(Colposcopy of Vagina)
9.1.
,
,
,
.
,
;
.
,
.
,
,
[88].
,
VaIN
,
10%
[170].
9.2.
,
(
.
),
,
[88, 170].
.
,
,
,
.
.
,
,
.
,
,
.
9.3.
!),
.
,
,
,
,
.
.
.
[25].
9.4.
,
,
(VaIN),
,
,
,
[68, 83].
,
—
,
-
.
,
,
.
,
.
,
,
,
.
:
(
;
336);
;
.
,
,
[103].
),
(
),
ValN.
(
33 ).
:
,
,
,
,
;
,
«
»
;
;
,
-
.
.
.
,
[83, 191].
.
HSIL
.
,
,
,
[88]. \
.
.
.
.
;
,
3—5
,
,
.
.
,
.
,
,
.
.
(
),
4%
,
,
,
.
,
.
,
.
,
[77].
, ,
.
.
VAiN
,
CIN {25, 83].
,
,
,
.
(
, , , , ).
,
.
.
50—70%
.
,
,
,
.
9.5.
,
.
.
CIN
[25, 83].
.
;
1.
,
.
-
2.
,
.
,
3.
,
,
,
,
,
,
(VaIN),
.
-
—
-
10
(Colposcopy of Vulva)
10.1.
,
.
.
.
,
.
,
V. Sideri,
International Society for study of Vulvar Disease (ISSVD),
(Shakuntala Baliga, 2004).
,
,
:
,
,
,
,
,
( . 16).
,
,
[30].
,
,
,
[88, 170].
,
. 16.
,
,
,
,
,
.
.
,
(
-
—
).
,
,
.
,
—
; 9%
, 35-50%
, 35% —
.
,
[88].
75%
-
10.2.
.
7,5-
,
,
,
.
,
.
,
,
,
,
.
3—5
.
.
,
in vivo.
2%
,
.
5%
2—3
.
,
.
,
(
,
34 ).
,
[170].
,
.
10.3.
,
.
(
)
,
.
.
EMLA (eutectic
mixtures of local anestetic).
,
.
(
)
(
346).
.
;
[88].
.
,
,
.
,
.
.
.
,
,
(
).
.
.
Keyes punch
,
.
.
Keyes,
,
.
,
.
.
—
,
,
,
.
,
.
,
10.4.
,
,
,
[62].
.
1986 .
,
), VIN 3
», «
»
«
(
,
«
,
.
», «
[169].
»,
,
:
,
,
.
VIN.
VIN —
:
—
—
—
2003 . VIN I
123-
;
;
.
, a VIN 2).
VIN (
VIN III
3-
.
(Vulvar Intraepithelial Neoplasia; VIN)
VIN
.
.
VIN
,
.
,
,
[173].
,
,
1874 .
[170].
,
38 ).
(
in situ,
.
.
.
.
3-5%
,
.
.
,
.
VIN
,
,
.
.
-
.
.
VTN
.
.
A. Maclean (1998),
,
,
1000
243 [132].
•
•
•
•
•
•
•
•
•
•
— 243
— 56
— 23
— 25
— 98
— 32
VIN-82
— 23
—4
-2
,
.
[91].
,
35 ).
,
—
-
.
,
,
,
(
356).
.
,
.
.
,
(vestibulum),
,
,
(ISSVD)
(
).
,
,
,
(
),
[48].
,
,
(
,
,
),
.
introitus,
,
(
36 , ).
.
,
,
(
36 ).
,
,
(
)
,
.
,
.
,
,
,
.
.
,
,
.
,
,
-
.
(
),
,
.
,
.
,
.
,
.
,
[22, 88].
«
(lichen sclerosus).
»,
,
.
.
.
,
.
,
,
,
(
,
,
(squamoctllular hyperplasia)
,
,
.
,
(
37 , ).
37 , ).
,
[170,191].
.
.
,
,
[12].
[30].
:
,
,
,
, VIN,
,
,
,
.
-
,
,
—
.
,
),
),
(
-
(
.
37 ),
.
,
.
.
1937 .
,
,
,
.
,
,
.
[170].
,
.
,
,
,
:
,
,
,
,
.
,
,
,
[178].
,
-
,
.
.(condylomata acuminata)
611,
16[88].
,
.
(popular lesions)
.
.
,
10%
,
,
.
16
.
,
,
,
,
.
.
,
.
.
VIN [88].
.
,
.
.
.
,
.
:
.
.
.
:
,
[88, 170].
(White Lesion)
.
:
;
—
—
—
;
.
—
,
.
,
—
(
)
(
).
,
),
,
,
VIN.
(Red Lesion)
.
,
,
,
.
,
,
.),
,
.
,
(VIN,
,
).
.
,
(Dark Lesion)
.
-
.
.
,
,
,
.
[91].
:
—
—
—
—
;
,
,
;
VIN;
.
.
10.5.
,
,
.
[178].
11
:
,
.
,
,
-
.
.
,
,
[25, 30, 33,42,51, 110, 138].
11.1.
(
)
,
.
(
).
:
LEEP — loop elecrosurgical excision procedure (
);
LLETZ— large loop excision of transformation zone (
).
,
[30, 173].
-
[56, 138].
[167, 193].
,
.
,
,
,
-
.
:
•
30
;
•
,
;
;
•
•
.
,
,
,
.
.
2%
.
3-5
4—6
.
—
3-6-9-12
4-8-10-2
—
.
2%.
(
)
,
,
[41, 110,
127].
.
.
.
,
,
.
)
(
(
).
,
,
(
. 17.
) [110].
. 17).
,
,
.
(
38 , , ).
.
.
(
,
38 , , ).
.
,
CIN (
).
[170, 173].
CIN
.
.
-
,
,
,
360
4—6
.
[51]
.
.
CIN
.
(2%),
(10%),
,
1.70 (95%
,
,
1.62—4.46) [138]
,
. Kyrgiou et al. [125],
,
1.24—23.5).
1.82 (95%
1.09-3.06),
2.69 (95%
(Ablation)
(
:«
»,
,
»)
«
-,
»,
-,
«
-,
-
.
,
[41].
,
—
,
,
.
CIN
[33, 88, 193].
—
,
.
:
•
,
;
,
•
;
30
•
;
,
•
.
11.2.
(Laserotherapy)
(
,
,
,
.)
,
-
,
[39].
.
,
.
,
,
,
.
,
,
,
.
[33].
(Laser Ablation)
,
.
,
.
-
.
CIN
[15].
.
:
,
,
,
,
,
[7].
,
.
,
,
,
.
,
,
.
,
[39].
,
.
,
.
,
-
.
-
,
(
39 , ),
1—2
.
,
.
-
,
(
39 , ).
02
10,6
.
.
(
50—100
),
,
,
,
.
,
[15].
;
6
CIN
[193].
1
,
,
.
,
,
,
,
,
,
.
,
[32].
,
-
,
.
-
,
,
100
,
600
.
-
,
-
.
2,09
,
40
0,4
.
,
,
[13].
.
,
300—600
20-30
,
.
,
(13).
-,
,
,
,
.
,
,
,
(1 — 12%).
,
.
(Cryotherapy)
,
,
,
.
,
.
,
,
,
,
.
:
,
[33].
,
,
-
.
.
[163].
,
,
,
,
.
,
.
,
.
,
.
10
90
.
,
,
,
,
,
,
,
[82].
,
,
.
,
.
-
,
.
,
,
-
. [45, 50].
,
,
.
,
-
,
,
[50].
,
,
.
«
:
»,
,
.
141»,
«
.
,
,
.
: 1(90%
(50%
+ 10%
), 2), 3-
50%
).
-
.
—«
—«
—«
»
»
» (90%
,
.
)
».
«
«
»(
-
(
),
.
.
,
«
»—
[50].
«
141»
[50].
,
.
«
».
,
.
—
-
,
—
,
,
,
[50].
.
.
-
.
3
.
:
,
,
,
,
,
-
,
,
,
.
,
,
,
.
:
3
,
,
.
,
.
,
.
,
.
,
3
.).
,
) (Photodynamic Therapy)
—
(
,
,
,
,
,
.
,
,
.
«
,
», «
»
.
:
,
[28].
:
,
,
;
,
-
,
.
,
,
.
,
,
[46].
:
,
,
,
-
,
.
,
,
.
,
.
24
(
).
.
-
[28].
:
-
;
—
,
,
,
.
40
97% [179].
11.3.
(SURGICAL THERAPY)
,
,
,
—
-
,
[20, 51].
11.4.
,
,
:
;
—
—
;
,
—
,
;
(
—
—
);
.
,
[193].
.
,
,
.
,
.
[115, 161].
(
,
(3,
,
)
[165].
,
,
,
,
[24, 109].
,
.
-2 ,
(250
10
. ME, 500
.
.
. ME, 1
2
ME)
.
LSIL.
,
-
.
Solanum tuberosum.
—
0,004%
5
.
-
:
200
200
•
•
•
;
;
0,002%
3
30 .
,
.
,
.
,
,
-3
-
.
-3
16
-
,
[16, 133].
,
,
.
—
,
-
,
.
,
-
(
.
.
),
,
,
[78, 172].
,
,
.
.
,
,
-
,
.
.
1.
2.
-
,
.
3.
.
4.
-
.
5.
,
.
12
12.1.
,
,
,
.
(
-
)
,
—
.
,
,
,
,
(
«
—
»)
,
.
,
,
,
.
,
,
.
(guidelines),
.
.
-
,
,
.
:
,
,
,
,
.
,
.
.
12.2.
,
,
.
,
—
,
.
,
,
,
-
,
,
,
.
,
.
.
,
[12].
,
.
,
,
(
.),
-
,
.
-
.
.
,
,
;
.
,
,
.
,
(
,
),
.
,
,
.
.
(
-
)
.
,
,
,
[88,
190].
.
,
,
,
.
,
.
,
2
4—5
.
,
-
.
,
(
.
)
.
-
.
(
)
-
.
,
,
-
.
,
[35].
,
,
.
,
-
.
-
.
.
.
[88, 90].
.
,
—
-
.
,
-
,
[105].
.
-
«
», «
».
«
»
«
».
«
».
,
,
,
,
,
,
-
.
.
,
7—8
[88].
12.3.
,
CIN [61,82, 88]:
CIN.
[9, 10],
;
;
;
;
;
;
.
,
.
SIL
:
CIN II
[110].
1.
CIN II
CIN III
III (HSIL)
:
;
•
•
CIN II
[193].
CIN 1
2.
(LSIL)
.
CIN III
.
3.
-
4.
CIN II
CIN III [193].
(
).
:
)
;
)
Digene-
30
.
LSIL
,
LSIL,
CIN I
,
,
.
(
,
.).
,
.
,
.
.
[33].
LSIL
,
,
,
,
,
-
.
1—2
;
[88, 110].
LSIL
[193]:
;
;
CIN I (>18—24
•
•
•
•
•
35
);
;
.
CIN,
.
in situ
in situ,
.
,
,
-
,
,
.
20% [Luesly, 88].
-
,
:
—
;
—
;
;
—
—
—
—
;
;
.
.
in situ,
,
.
[European Quality Standards for the
Treatment of Cervical Intraepithelial Neoplasia (CIN), 2007]
,
,
.
2007
.
—
CIN,
[193].
: www.efc2007.com.
,
,
.
CIN,
.
,
.
.
6
.
1
2
.
,
CIN III
,
— 5,22 ,
+ 3 (99,7%) [61, 66, 68, 88, 116].
,
3,80
CIN
,
:
;
—
—
—
—
;
;
50
.
50
CIN
—
(
-
)
.
.
—
.
(FIGO
;
CIN
Ial)
,
,
.
-
,
CIN,
.
,
-
,
,
.
-
.
.
:
;
—
(
—
)
;
;
—
—
;
—
;
—
.
LSIL
[193].
,
,
.
,
25
3
.
50
5
,
65
[44].
,
,
,
1 —2
.
-
,
[135, 151,
157, 180].
,
,
.
HSIL
:
) [44].
(
.
-
)
.
LSIL
,
ASCUS (
,
LSIL,
11
:
99%
CIN II
14-97%.
ASCUS,
, 6—11%
.
,
,
,
III,
[75, 129, 130, 145].
-
LSIL
LSIL (
CIN I)
.
—
3
6
.
(
, 1—2
.
)
LSIL (
[44, 110].
—
)—
.
(
12
6
)
(
-
,
).
[44].
(
)
-
(
)
.
—
,
6
.
—
.
ASCUS
ASCUS (
,
)
-
[44].
—
3—6
.
6
,
.
ASCUS
.
(
)
—
.
(
,
.
)
12
-
(
)
(
-
)
.
,
,
[110, 135]),
.
—
.
,
12
.
12.4.
.
-
,
,
[195].
,
,
[Lawton E.G., 82].
(
4%).
26,5%
[152].
12.5.
(FOLLOW-UP)
,
,
.
CIN
:
,
1)
,
(residual disease);
2)
;
,
3)
,
,
[88].
,
.
,
V. Kesic
. [116], 26,4%
,
CIN
( =237),
. 18).
(
. 18.
,
,
CIN III
CIN II (
50%
CIN III [138,
)
166].
,
.
,
,
(
,
,
,
.).
,
119
,
CIN
,
[Kiychener ., 88]: 70%
(
)
, 24%
12
—
12
6%
2
.
2—3
.
5
,
.
,
,
6, 12, 24
,
.
3,6, 9, 12, 18, 24
[119].
,
,
-
.
,
,
,
—
(1996—2003
20
3-6
[127].
.), 11
,
,
CIN III,
,
: 98% —
93% —
[34, 64, 76,
195].
53—86%,
96%,
— 83—95%.
—
81%,
99% [195].
,
3
.
(
,
40 , , , ).
,
.
(
,
,
),
—
.
,
,
CIN,
—
CIN,
.
,
,
.
.
12.6.
1
., 25
,
.
.
.
.
12
.
.
,
20
,
,
,
—
.
.
17
,
0,
1
,
.
6
,
,
— 5.
.
—
.
1
.
.
16,
,
—
.
.
41 , , .
,
.
.
,
.
.
.
.
.
. LSIL ?
.
.
. 19.
:
LSIL.
:
.
.
:
,
(
,
.
—
,
12
6
,
1
—
:
,
-
.
—
.
),
,
-
2
., 29
,
«
».
.
2
,
,
,
.
-
,
,
—
.
,
.
.
,
,
—
,
,
.
.
16
,
,
,
,
5
0,
2
6
.
.
,
— coitus interruptus.
.
,
,
,
).
—
,
3
—
.
.
.
11.
ASCUS.
42 , , .
,
,
.
—
.
.
.
.
.
.
.
.
.
,
,
,
,
.
. 20.
6
.
.
—
.
3
.
—
.
-
., 39
,
.
.
.
.
.
,
Digene-
: HSIL.
.
.
.
,
2
,
.
1
—
.
.
.
15
.
.
20
,
,
2,
,
2
.
.
2
2
.
,
,
.
.
—
2
Digene-TecT
HSIL.
.
2
—
—
.
-
43 , , , .
,
.
.
.
.
,
.
.
.
3.
.
. HSIL?
.
,
Digene
,
.
.
3
. 21.
: CIN III,
—
.
(
43 , ).
4
., 21
.
,
.
.
2
.
.
.
15
,
,
.
.
.
,
18
,
0,
0.
,
.
1
,
,
.
.
6
1
—
ASCUS.
1 , , .
,
,
—
.
.
.
.
. 22.
.
.
.
.
.
.
.
6
.
:
.
1.
,
.
HSIL
2.
(
-
).
3.
LSIL, (
CIN I
)
,
,
.
CIN
4.
-
.
5.
.
,
13
13.1.
2
:
.
:
,
(
).
:
,
.
:
,
,
;
.
;
;
;
.
13.2.
,
,
-
,
,
,
,
,
.
[73].
—
,
,
,
.
.
,
,
,
,
.
,
,
.
,
,
-
—
[44, 168].
13.3.
-
,
).
,
16,
,
(
18,31,45).
,
.
,
,
82%
2
[69],
[63, 67, 188].
20%
,
-
.
,
,
,
,
.
,
.
.
,
50—80%
,
,
,
-
[70, 100].
,
,
,
(
11),
6
,
,
[47, 93, 99].
.
,
6
,
.
7
,
.
.
.
,
,
,
,
,
.
,
,
,
10—11
,
-
,
.
,
,
[40, 44].
100
(
MSD — «
16, 18, 6, 11,
,
»),
,—
,
(CIN I—III,VIN II—III, VaIN II—III)
.
,
-16
20
—
20
18.
-
,
—
-6, 40
.
.
.
—
225
-11, 40
—
—
3
2
6
(0-2-6).
5
3
[40, 188].
,
100%
.
3
5
,
[182], ,
5
[147].
-
.
,
,
-
,
.
,
8.5
,
100%
CIN2+,
16
86%
(Rowhani A., et al.
25th International Papillomavirus Conference, Abstract 0-01.03, 2009).
,
.
.
,
—
-
.
.
9
26
.
45
.
96
(
GSK — «
7,3
20
HPV-16, 20
(
.
(
HPV-18.
16
»,
18
)
[44, 106].
6
2009 .),
L1)
.
AS04 ( 1 + MPL®)
GSK,
,
(Einstein
., 25th International Papillomavirus
Conference, Abstract 0-01.02, 2009).
: 0, 1, 6
.
7
,
100%
98%
5
.
,
7.3
(De Carvalho N. et al.,
25th International Papillomavirus Conference, Abstract P-29.15, 2009).
,
98%
CIN2+
16 18
[148].
SkinnerS.R. etal. (25th International Papillomavirus Conference, Abstract
0-29.01, 2009)
100%
CIN2+,
45 31.
26
45
,
(Schwarz T.F., et al. J Clin Oncol 2006; 24 (Suppl
18).
:
.
,
,
HPV-
.
[101].
( ,
,
).
10
,
[108, 112].
,
,
,
25
,
,
,
.
,
,
,
-
,
,
,
.
.
,
,
,
,
.
13.4.
,
.
.
(
,
)
,
40—50
-
80—90%.
10—15
,
—
.
90%
,
,
[94, 95, 110, 135, 162].
:
[85].
-
,
[75,
186].
,
,
.
[88, 112, 135].
,
,
.
.
[44].
.
.
.
,
(
,
.) [75, 183].
,
,
[64, 66, 76, 80,
119, 137].
,
1.
(
),
,
.
2.
,
,
,
,
,
,
.
3.
,
,
.
,
4.
,
.
14
14.1.
,
.
.).
«
»
,
.
,
.
.
.
.
,
,
,
[88].
,
.
,
,
,
.
.
,
-
,
.
14.2.
,
,
,
,
-
,
,
.
,
,
,
.
.
,
.
-
,
.
,
.
CIN,
.
,
1—2-
-
,
.
.
.
,
,
,
.
,
(
,
).
,
.
.
,
,
.
,
.
,
.
-
.
?
-
,
.
.
,
.
:
(
•
)
,
;
,
•
,
;
,
•
CIN
,
;
,
•
;
-
•
,
.
,
,
;
•
.
,
,
.
;
.
•
.
,
,
,
-
,
,
,
,
.
,
.
,
.
.
,
-
,
.
,
1.
-
,
.
,
2.
,
,
.
-
3.
,
.
-
4.
,
,
.
,
5.
.
6.
.
.
.
,
,—
,
.
,
,
,
,
.
.
,
,
,
,
.
,
,
,
.
,
,
,
.
—
,
-
.
,
.
-
ASCUS
(Atypical squamous cells of undetermined
significance),
,
,
.
CIN (
)
(Cervical Intraepithelial Neoplasia) —
.
CIN 1
, CIN II —
—
CIN II
CIS
HSIL
CIN III
carcinoma in situ.
CIN III
, a CIN 1
—
Carcinoma in situ.
in situ
High-grade squamous intraepithelial lesion
).
. CIN II
CIN III
, a CIN 1
—
LSIL
Low-grade squamous intraepithelial lesion
).
CIN 1
,
,
.
,
(Adenocarcinom
a)
3-5%
(Acetowhite
epithelium)
.
,
(
,
).
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,
—
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)
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(Vascularisation)
(HPV)
(Human papillomavirus)
,
(Hysterectomy)
.
,
(Dysplasia/dyspl
asias)
,
,
.
CIN I,
— CIN II
carcinoma in situ — CIN III. CIN II
CIN III
, a CIN I
—
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,
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cytology)
,
,
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ences)
,
,
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zone)
;
,
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.
,
,
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.
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.
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,
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(
,
)
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,
.)
,
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negative)
.
,
,
.
,
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.
,
.
,
,
,
.
,
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,
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—
.
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.
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,
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.
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99,7%
(
)
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(
)
)
,
,
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.
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,
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prevention)
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.
2
6
.
,
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.
,
.(
. CIN)
(LEEP)
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electrosurgical excision procedure).
,
,
(Prevalence)
(Stages)
;
,
,
.
FIGO (International
Federation of Gynaecology and Obstetrics)
4
: I, II, III IV
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.
,
6
(
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)
,
(
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screening)
).
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,
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cells/epithelium)
,
.
,
-10,
, 10-
63.0
N 72
) [12]
.
:
,
,
.
N74.0
N74.4
,
.
N 75
N76.1
N76.8
.
.
.
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N84.1
N84.3
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N 86.0
N87.0
N 87.1
N 87.2
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N88
N88.0
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.
.
.
.
.
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.).
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.
.
.
.
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.
.
.
'
.
,
1A1
1A2
:
( FIGO)
(Staging of early squamous cervical carcinoma, 1994)
(Stage) 0 CIN,
in situ
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(Stage)
lesion)
(Depth) <3 mm,
(length) <7
mm
(Micro-invasive
(Stage)
lesion)
(Depth) 3-5 mm,
(length)
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(Stage)
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1B1
(Stage)
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(Clinical lesion) >4 cm
1.
2.
3.
.,
. .
:
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.,
.,
.
.//
.
. - 2000. — . 6. 2. — . 175-179.
.
.
.
2008. — 340 .
5.
.
2008. — . 300.
6.
.,
.
. ...
4.
.
.
.—
.—
.
.—
., 2006.
.:
,
.:
,
.
//
. — 2001. — . 3. —
3. —
. 77—81.
7.
. .
:
.—
8.
9.
.
.
.
.
.
.
.,
.—
.
.,
., 1989.
.—
, 1987.
.,
, 1986.
.
10.
11.
.
, 2005.
.
.:
.—
.:
//
. — 2007. - . 56. 12.
.
. 2. - . 91-96.
. — .:
,
2008.
13.
14.
.
.
15.
.—
. .
.—
.:
, 2003.
.
//
16.
//
. 2. - . 53-57.
.
., 1999. — . 254-258.
..—
., 2003.
., 2008. -
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
/
.
.
.—
.:
, 2005.
.
.
:
/
.
.
,
.
. — .:
,
1998. — . 224-247.
.
//
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.
//
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— . 2. — 2. - . 2-4.
.,
.,
.
.
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.
., 2008. - 168 .
.,
.
.
.
—
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.
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,
2008. — 334 .
.,
.
//
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.
— .,
1997.
.
.,
.
.—
1.
, 8—12
27.
.,
28.
. — 2003. —
.,
.
2006 .
.,
.
//
1.
.,
.,
.,
.
(7—9
2006 .,
).
29.
30.
.
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.,
.,
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, 1964.
.
.:
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303.
31.
.X
,
32.
..,
:
.—
.,
33.
.:
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.
/
.:
.,
, 2001.
.
.
, 2001.
.
.—
34.
.
//
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.:
-
, 2008. — . 48-52.
35.
.
:
.—
36.
.
.
37.
.
.
.—
.,
.,
, 2004.
.,
-
.
38.
.,
....
.
.
.
//
3. — . 36-41.
. — 2007. — . 32. —
,
-
.
,
39.
40.
:
.
, 2005.
.,
.—
.
16
.
.
., 1997.
. .
.
.
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., 1996.
.
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(
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