An integrated diagnostic algorithm for the detection of HPV-associated precancerous lesions of the cervix for the prevention of cervical cancer

Vollständiger Abstract

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Introduction. Cervical cancer is still one of the pressing problems in medicine and public health in Kazakhstan. Infection with high-risk human papillomavirus (HPV) is a key cause of precancerous changes development, which suggests the need to find new ways of diagnosing and assessing risk factors. Aim. To develop an integrated algorithm for evaluation and diagnosis of the risk of precancerous cervical changes caused by HPV, considering the features of modern diagnostic methods and the healthcare system of Kazakhstan. Methods. According to the WHO recommendations and up-to-date literature, an algorithm has been developed for women aged 18 to 70 years. The algorithm includes initial screening for high-risk HPV infection and cytology, and then stratification of patients based on test results. In cases of abnormal cytology and/or high-risk HPV infection, the algorithm includes colposcopy, targeted biopsy, and histopathological confirmation of the results. In addition, vaginal microflora and sexually transmitted infections are assessed, especially in patients who test positive for human papillomavirus. Results. The described algorithm makes it possible to divide patients into groups with low, medium, and high risk, taking into account the presence of HPV, HPV type, cytological and colposcopic manifestations, as well as the presence of STIs and dysbiosis. High-risk status is determined by the detection of HPV-16, cytological changes, and an abnormal colposcopic pattern. Histopathological examination is used to determine the next steps in the treatment of CIN I-III and in situ cancer. Conclusion. The proposed algorithm combines HPV diagnostics, cytology, colposcopy, histology and microbiological studies. This approach may yield better results in terms of early detection of precancerous changes and optimization of patient referrals. It can also be used to prevent cervical cancer. Further study is required to evaluate the diagnostic performance of the algorithm. Keywords: cervical cancer, diagnostics, HPV, algorithm, cytology.