Risk-Based Diagnosis and Modern Triage Strategies for Cervical Pathology in HPV-Positive Women
Keywords:
human papillomaviru, HPV, cervical pathology, HPV DNA, risk stratification, cytology, colposcopy, endocervical curettage, p16/Ki-67, genotyping, self-sampling, DNA methylationAbstract
Cervical pathology in HPV-positive women remains one of the most significant challenges in modern gynecology and gynecologic oncology. This is due not only to the high prevalence of human papillomavirus infection, but also to the fact that this group represents a major area of clinical uncertainty: some patients experience transient infection without significant morphological consequences, while others develop clinically significant lesions requiring timely diagnosis and active intervention. In recent years, universal screening and routing schemes have increasingly given way to risk-based and personalized management models. The aim of this review article was to analyze current literature data on the diagnosis of cervical pathology in HPV-positive women, focusing on the clinical heterogeneity of this group, the role of HPV DNA testing, cytology, colposcopy, targeted biopsy, and endocervical curettage, as well as the significance of new biomarkers and triage strategies. The article examines current understanding of the natural history of HPV infection, the differences between transient and persistent infection, the significance of individual highly oncogenic genotypes, and the role of age, immune status, the transformation zone, and reproductive cofactors. The article discusses in detail current approaches to HPV-based screening, the role of cytology as a triage method, the limitations of visual assessment in TZ3, and the importance of expanded genotyping, p16/Ki-67 dual stain, self-sampling, DNA methylation, E6/E7 mRNA, and oncoprotein tests as tools for more accurate risk stratification. It is concluded that modern diagnostics of cervical pathology in HPV-positive women should be built as a multi-level and personalized system, in which clinical decisions are made not based on a single test, but on a comprehensive assessment of viral, morphological, anatomical, and molecular parameters.
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