ОСОБЕННОСТИ ДИФФЕРЕНЦИАЛЬНОЙ ДИАГНОСТИКИ ИНТРАЭПИТЕЛИАЛЬНОЙ НЕОПЛАЗИИ В ПЕРИМЕНОПАУЗЕ
- Авторы:Реймназарова Гулсара Джамаловна
- Дата публикации:July 13, 2026
- Тип:Статья
- DOI: 10.64156/mju.9488 Скопировано
- Том / № Выпуска:Том 1 №4 (2026)
Аннотация
Аннотация. Проблема дифференциальной диагностики HSIL и LSIL у женщин в перименопаузе остается одной из наиболее сложных в гинекологической практике. Физиологическая атрофия эпителия шейки матки и ретракция зоны трансформации в цервикальный канал приводят к снижению точности традиционной цитологии и кольпоскопии, что сопровождается как гипердиагностикой с неоправданными инвазивными вмешательствами, так и риском пропуска истинных предраковых поражений. В настоящей статье представлен анализ современных объективных критериев, позволяющих повысить надежность дифференциальной диагностики в этой возрастной группе. Рассмотрены двойное иммуноцитохимическое окрашивание p16/Ki-67, тестирование на E6/E7 мРНК вируса папилломы человека, анализ метилирования ДНК генов-супрессоров (PAX1, CADM1, ASCL1/LHX8), эндоцервикальный кюретаж и системы искусственного интеллекта. Обсуждаются преимущества и ограничения каждого метода, их чувствительность и специфичность применительно к пациенткам перименопаузального возраста.Предложен алгоритм ведения, интегрирующий морфологические, молекулярные и цифровые технологии для достижения максимальной точности диагностики.
Ключевые слова: HSIL, LSIL, перименопауза, диагностика, p16, Ki-67, E6/E7 мРНК, метилирование ДНК, искусственный интеллект, цервикальная интраэпителиальная неоплазия.
Abstract. The differential diagnosis of high-grade squamous intraepithelial lesions (HSIL) and low-grade squamous intraepithelial lesions (LSIL) in perimenopausal women remains one of the most challenging issues in gynecological practice. Physiological atrophy of the cervical epithelium and retraction of the transformation zone into the endocervical canal reduce the diagnostic accuracy of conventional cytology and colposcopy, resulting in both overdiagnosis with unnecessary invasive procedures and the risk of missing true precancerous lesions. This article presents an analysis of current objective criteria that improve the reliability of differential diagnosis in this age group. The review focuses on dual p16/Ki-67 immunocytochemical staining, human papillomavirus (HPV) E6/E7 mRNA testing, DNA methylation analysis of tumor suppressor genes (PAX1, CADM1, ASCL1/LHX8), endocervical curettage, and artificial intelligence–based diagnostic systems. The advantages and limitations of each method, as well as their sensitivity and specificity in perimenopausal women, are discussed. An integrated diagnostic algorithm combining morphological, molecular, and digital technologies is proposed to achieve maximum diagnostic accuracy.
Keywords: HSIL, LSIL, perimenopause, diagnosis, p16, Ki-67, E6/E7 mRNA, DNA methylation, artificial intelligence, cervical intraepithelial neoplasia.
Annotatsiya. Perimenopauza davridagi ayollarda yuqori darajadagi yassi epiteliy ichki neoplaziyasi (HSIL) va past darajadagi yassi epiteliy ichki neoplaziyasi (LSIL)ning differensial diagnostikasi ginekologik amaliyotdagi eng murakkab muammolardan biri hisoblanadi. Bachadon bo‘yni epiteliysining fiziologik atrofiyasi hamda transformatsiya zonasining servikal kanal ichiga retraksiyasi an’anaviy sitologiya va kolposkopiyaning diagnostik aniqligini pasaytiradi. Natijada, bir tomondan, asossiz invaziv muolajalar bilan kechuvchi ortiqcha tashxis qo‘yish, ikkinchi tomondan esa haqiqiy prekanseroz shikastlanishlarni o‘tkazib yuborish xavfi yuzaga keladi. Ushbu maqolada mazkur yosh guruhida differensial diagnostikaning ishonchliligini oshirishga imkon beruvchi zamonaviy obyektiv mezonlar tahlil qilingan. p16/Ki-67 ikki martalik immunotsitokimyoviy bo‘yash, inson papilloma virusi (HPV) E6/E7 mRNK testlari, o‘sma supressor genlari (PAX1, CADM1, ASCL1/LHX8) DNK metillanishi tahlili, endoservikal kyuretaj hamda sun’iy intellektga asoslangan diagnostik tizimlar ko‘rib chiqilgan. Har bir usulning afzalliklari va cheklovlari, shuningdek, perimenopauza davridagi bemorlarda ularning sezgirligi va spetsifikligi muhokama qilingan. Diagnostik aniqlikni maksimal darajada oshirish maqsadida morfologik, molekulyar va raqamli texnologiyalarni birlashtiruvchi integratsiyalashgan diagnostik algoritm taklif etilgan.
Kalit soʻzlar: HSIL, LSIL, perimenopauza, diagnostika, p16, Ki-67, E6/E7 mRNK, DNK metillanishi, sun’iy intellekt, bachadon bo‘yni intraepitelial neoplaziyasi.
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