Эволюция представлений о предраковых поражениях шейки матки и возможностях прогнозирования развития цервикальной карциномы: обзор литературы

Введение. В этом обзоре представлен системный анализ эволюции взглядов на трактовку предраковых поражений шейки матки и методы прогнозирования риска развития цервикальной карциномы.

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.

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.

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. 

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