« - 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. ., ., , . « », — . 1 , , . ., . . ., . . « », — . , « », — ., ., - 43 , , . , 2 , , . ., « . . ., , », — . , 1 , , , . « . », — 38 , , . . . ., », — ., ., . . ., « 18 , 20 . « , », — 25 , 28 . ., », — ., ., , », — . « - 37 . ., . . 2 , . . . ., ,— ., ., 35 , , 39 , , , , 42 , , . . ,— 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) . , ( , ). (Biopsy) , — ( .4 3 2 ) (Vaccination) (Vascularisation) (HPV) (Human papillomavirus) , (Hysterectomy) . , (Dysplasia/dyspl asias) , , . CIN I, — CIN II carcinoma in situ — CIN III. CIN II CIN III , a CIN I — (Dysplastic) , (Liquid-based cytology) , , (Incidence/incid ences) , , (Transformation zone) ; , (Keratinisation) . , , , , . (Colposcope) . (Colposcopy) , (Koilocytosis) ; (Cryotherapy) ( , ) ( , .) , (False negative) . , , . , (False positive) . , . , , , . , (Menopause) , (Metaplastic/met aplasia) , — . (Metastasized) , (Neoplastic) , , , . (Low-risk) , , , . (Oncogenesis) ) . (Oncogenic) 99,7% ( ) (Tumour) ( ) ) , , (Pap smear) . (Papanicolaou), , (Primary prevention) (Persistent) . 2 6 . , (Lesions) . , .( . CIN) (LEEP) (Loop electrosurgical excision procedure). , , (Prevalence) (Stages) ; , , . FIGO (International Federation of Gynaecology and Obstetrics) 4 : I, II, III IV (Transient) . , 6 ( (Triage) ) , ( (Cervical screening) ). . , (Epithelial cells/epithelium) , . , -10, , 10- 63.0 N 72 ) [12] . : , , . N74.0 N74.4 , . N 75 N76.1 N76.8 . . . N80.8 N84.1 N84.3 D26.0 N 86.0 N87.0 N 87.1 N 87.2 N87.9 N88 N88.0 N88.1 N 88.2 N 88.4 N89 N89.1 N89.2 N90.4 N90.0 N90.1 N90.2 N90.7 N90.9 D 28.0 D 28.1 . . . . . (CIN II (CIN I .). .). (CIN III .). . . . . . . (VaIN I .). (VaIN II .). (VaIN III .). . (VIN I .). (VIN II .). (VIN III .). . . . 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