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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">urmj</journal-id><journal-title-group><journal-title xml:lang="ru">Уральский медицинский журнал</journal-title><trans-title-group xml:lang="en"><trans-title>Ural Medical Journal</trans-title></trans-title-group></journal-title-group><issn pub-type="epub">2949-4389</issn><publisher><publisher-name>Ural State Medical University</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.52420/umj.25.3.129</article-id><article-id custom-type="edn" pub-id-type="custom">QPOONP</article-id><article-id custom-type="elpub" pub-id-type="custom">urmj-2235</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>Литературные обзоры | Literature reviews</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>Literature reviews</subject></subj-group></article-categories><title-group><article-title>Эволюция представлений о предраковых поражениях шейки матки и возможностях прогнозирования развития цервикальной карциномы: обзор литературы</article-title><trans-title-group xml:lang="en"><trans-title>Evolution of Concepts on Cervical Precancerous Lesions and Methods for Predicting Cervical Carcinoma Risk: A Literature Review</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3268-7981</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Семёнов</surname><given-names>Ю. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Semenov</surname><given-names>Yu. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Юрий Алексеевич Семёнов — доктор медицинских наук, доцент, ректор </p><p>Екатеринбург </p></bio><bio xml:lang="en"><p>Yuri A. Semenov — Doctor of Sciences (Medicine), Associate Professor, Rector </p><p>Ekaterinburg </p></bio><email xlink:type="simple">usirius@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3876-9259</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Сычугов</surname><given-names>А. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Sychugov</surname><given-names>A. G.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Александр Глебович Сычугов — заведующий лабораторией патоморфологии и цитодиагностики </p><p>Екатеринбург </p></bio><bio xml:lang="en"><p>Alexander G. Sychugov — Head of the Laboratory of Pathomorphology and Cytodiagnostics</p><p>Ekaterinburg </p></bio><email xlink:type="simple">sychugovsag@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2008-7671</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Казачков</surname><given-names>Е. Л.</given-names></name><name name-style="western" xml:lang="en"><surname>Kazachkov</surname><given-names>E. L.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Евгений Леонидович Казачков — доктор медицинских наук, профессор, заведующий кафедрой патологической анатомии и судебной медицины имени профессора В. Л. Коваленко, Южно-Уральский государственный медицинский университет; патологоанатом, патологоанатомическое отделение № 2, Челябинское областное патологоанатомическое бюро </p><p>Челябинск </p></bio><bio xml:lang="en"><p>Evgeny L. Kazachkov — Doctor of Sciences (Medicine), Professor, Head of the Department of Pathological Anatomy and Forensic Medicine named after Professor V. L. Kovalenko, South Ural State Medical University; Pathologist, Pathology Department No. 2, Chelyabinsk Regional Pathological Anatomy Bureau </p><p>Chelyabinsk </p></bio><email xlink:type="simple">doctorkel@yandex.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бойко</surname><given-names>И. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Boyko</surname><given-names>I. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Ирина Валерьевна Бойко — кандидат медицинских наук, заведующий консультативно-диагностическим отделением</p><p>Челябинск </p></bio><bio xml:lang="en"><p>Irina V. Boyko — Candidate of Sciences (Medicine), Head of the Consultative and Diagnostic Department</p><p>Chelyabinsk </p></bio><email xlink:type="simple">Irina_boiko_70@mail.ru</email><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3251-6944</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Сычугов</surname><given-names>Г. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Sychugov</surname><given-names>G. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Глеб Вячеславович Сычугов — кандидат медицинских наук, доцент кафедры патологической анатомии и судебной медицины имени профессора В. Л. Коваленко, Южно-Уральский государственный медицинский университет; заместитель главного врача, Челябинское областное патологоанатомическое бюро </p><p>Челябинск </p></bio><bio xml:lang="en"><p>Gleb V. Sychugov — Candidate of Sciences (Medicine), Associate Professor of the Department of Patholog‑ ical Anatomy and Forensic Medicine named after Professor V. L. Kovalenko, South Ural State Medical University; Deputy Chief Physician, Chelyabinsk Regional Pathological Anatomy Bureau</p><p>Chelyabinsk </p></bio><email xlink:type="simple">docsgv@yandex.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0000-3556-9764</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шерстобитов</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Sherstobitov</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Алексей Васильевич Шерстобитов — исполняющий обязанности директора </p><p>Екатеринбург </p></bio><bio xml:lang="en"><p>Alexey V. Sherstobitov — Acting Director, Ural Research Institute of Maternity and Infant Care</p><p>Ekaterinburg </p></bio><email xlink:type="simple">arno1980@yandex.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1175-4479</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Казачкова</surname><given-names>Э. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Kazachkova</surname><given-names>E. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Элла Алексеевна Казачкова — доктор медицинских наук, профессор, профессор кафедры акушерства и гинекологии</p><p>Челябинск </p></bio><bio xml:lang="en"><p>Ella A. Kazachkova — Doctor of Sciences (Medicine), Professor, Professor of the Department of Obstetrics and Gynecology </p><p>Chelyabinsk </p></bio><email xlink:type="simple">kazachkovaea@yandex.ru</email><xref ref-type="aff" rid="aff-5"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Уральский государственный медицинский университет</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Ural State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Уральский научно‑исследовательский институт охраны материнства и младенчества</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Ural Scientific Research Institute of Maternal and Infant Health</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Южно‑Уральский государственный медицинский университет; Областное патологоанатомическое бюро</institution><country>Россия</country></aff><aff xml:lang="en"><institution>South Ural State Medical University; Chelyabinsk Regional Pathology Bureau</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>Областной перинатальный центр</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Regional Perinatal Center</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-5"><aff xml:lang="ru"><institution>Южно‑Уральский государственный медицинский университет</institution><country>Россия</country></aff><aff xml:lang="en"><institution>South Ural State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2026</year></pub-date><pub-date pub-type="epub"><day>02</day><month>07</month><year>2026</year></pub-date><volume>25</volume><issue>3</issue><elocation-id>129–147</elocation-id><permissions><copyright-statement>Copyright &amp;#x00A9; Семёнов Ю.А., Сычугов А.Г., Казачков Е.Л., Бойко И.В., Сычугов Г.В., Шерстобитов А.В., Казачкова Э.А., 2026</copyright-statement><copyright-year>2026</copyright-year><copyright-holder xml:lang="ru">Семёнов Ю.А., Сычугов А.Г., Казачков Е.Л., Бойко И.В., Сычугов Г.В., Шерстобитов А.В., Казачкова Э.А.</copyright-holder><copyright-holder xml:lang="en">Semenov Y.A., Sychugov A.G., Kazachkov E.L., Boyko I.V., Sychugov G.V., Sherstobitov A.V., Kazachkova E.A.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.umjusmu.ru/jour/article/view/2235">https://www.umjusmu.ru/jour/article/view/2235</self-uri><abstract><sec><title>Введение</title><p>Введение. В этом обзоре представлен системный анализ эволюции взглядов на трактовку предраковых поражений шейки матки и методы прогнозирования риска развития цервикальной карциномы. </p></sec><sec><title>Материалы и методы</title><p>Материалы и методы. Прослежен исторический путь от ранних морфологических классификаций, основанных на принципе градации через формирование концепции дисплазии и цервикальной интраэпителиальной неоплазии (CIN) к утверждению системы Bethesda, ориентированной на клинические проявления и тактику ведения пациенток. </p></sec><sec><title>Результаты</title><p>Результаты. Особый акцент сделан на проблемах морфологической диагностики: низкая воспроизводимость диагнозов и высокий уровень спонтанной регрессии диктуют необходимость пересмотра традиционных представлений. Доказанная связь с персистирующей ВПЧ-инфекцией и развитием карциномы легла в основу новой биологической модели. В обзоре описаны ключевые пути вирусной трансформации, включая деградацию белков p53 и pRb под действием онкопротеинов E6 и E7. Решением проблемы субъективности стала стратификация риска на базе молекулярных тестов. Проведена детальная оценка роли иммуногистохимии (p16, p16/Ki-67), генотипирования ВПЧ и маркеров метилирования ДНК (FAM 19A4, miR124-2) в современных схемах скрининговой диагностики. </p></sec><sec><title>Обсуждение</title><p>Обсуждение. Затронуты перспективы изучения регуляторных РНК (miRNA, circRNA), применения искусственного интеллекта и формирования единых платформ для профилактики всей группы ВПЧ-зависимых заболеваний. Делается вывод о том, что эволюция представлений от описательной феноменологии к высокоточной, с оценкой риска малигнизации составляет научную основу для достижения цели глобальной элиминации рака шейки матки. </p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Introduction</title><p>Introduction. This review presents a systematic analysis of the evolution of views on the treatment of precancerous lesions of the cervix and methods for predicting the risk of developing cervical carcinoma.</p></sec><sec><title>Materials and methods</title><p>Materials and methods. The historical path has been traced from the early morphological classifications based on the principle of gradation through the formation of the concept of dysplasia and cervical intraepithelial neoplasia (CIN) to the approval of the Bethesda system focused on clinical manifestations and patient management tactics.</p></sec><sec><title>Results</title><p>Results. Special emphasis is placed on the problems of morphological diagnostics: the low reproducibility of diagnoses, the high level of spontaneous regression call into question traditional fundamental concepts. The proven link with persistent HPV infection and the development of cancer formed the basis of a new biological model. The review describes the key pathways of viral transformation, including the degradation of p53 and pRb proteins under the action of oncoproteins E6 and E7. Objective risk stratification based on molecular tests has become the solution to the problem of subjectivity. We have evaluated in detail the role of immunohistochemistry (p16, p16/Ki-67), HPV genotyping and DNA methylation markers (FAM 19A4, miR124-2) in modern screening diagnostic schemes.</p></sec><sec><title>Discussion</title><p>Discussion. The prospects of studying regulatory RNAs (miRNA, circRNA), the use of artificial intelligence and the formation of unified platforms for the prevention of the entire group of HPV-dependent diseases are discussed. It is concluded that the evolution of ideas from descriptive phenomenology to a highly accurate one, with an assessment of the risk of malignancy, forms the scientific basis for achieving the goal of global elimination of cervical cancer. </p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>рак шейки матки</kwd><kwd>цервикальная интраэпителиальная неоплазия</kwd><kwd>вирус папилломы человека</kwd><kwd>метилирование ДНК</kwd><kwd>биомаркеры</kwd><kwd>стратификация риска</kwd><kwd>микроРНК</kwd></kwd-group><kwd-group xml:lang="en"><kwd>cervical cancer</kwd><kwd>cervical intraepithelial neoplasia</kwd><kwd>human papillomavirus</kwd><kwd>DNA methylation</kwd><kwd>biomarkers</kwd><kwd>risk stratification</kwd><kwd>microRNA</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Vu M, Yu J, Awolude OA, Chuang L. Cervical cancer worldwide. 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