Guidelines for Cervical Cancer Screening in China (II)

1Background & Goal

Goal: standardize triage of abnormal results — avoid overdiagnosis AND missed diagnosis.
Burden: 150,700 new & 55,700 deaths in China 2022 (22.7%/16.0% of world).
Context: builds on Screening Guideline (I); WHO elimination strategy.

2Triage Methods Overview

Cytology — main triage for HR-HPV(+) primary screening.

1类

p16/Ki-67 dual stain — HPV(+) no-genotype / 12 HR-HPV; co-test NILM/ASC-US/LSIL.

Methylation — triage of 12 HR-HPV(+) to reduce colposcopy referrals.

HPV integration — HR-HPV(+) triage; positive → colposcopy.

Reagents: all new methods need authoritative approval & validated indications.
Others: extended genotyping / viral load — more evidence needed.

76.6%

HPV16 in SCC

7.9%

HPV18 in SCC

3.2%

HPV31 in SCC

35.1%

HPV16 in adeno

30.6%

HPV18 in adeno

74.5%

hrHPV in adeno

52/58/16

CIN1 common types

16/58/52/33/31

CIN2/3+ types

15.0%

HPV prevalence ≥20 y

Why triage: HPV(+) mostly transient — triage spares low-risk women from colposcopy.
Risk principle: same risk, same management (ASCCP).
Dual stain scope: HPV(+) no-genotype / 12 HR-HPV; co-test NILM/ASC-US/LSIL.
Methylation mechanism: CpG promoter methylation silences suppressors — triage signal.
Integration mechanism: HPV DNA integration into host genome — risk stratifier.
Reagent gate: authoritative approval + clinically validated indications for each method.

Refined triage = precision management: fewer unnecessary colposcopies, fewer missed lesions; cytology remains the workhorse, molecular methods add precision.

3Management Flowcharts (Fig 1–4)

Fig 1 · HPV(+) primary screening

No-genotype → cytology triage or genotyping · 16/18+ → colposcopy · 12 HR-HPV+ → cytology triage.

Fig 2 · Cytology(+) primary screening

ASC-US/LSIL → HPV-based triage · ASC-H/HSIL/AGC → colposcopy · SCC/adeno → immediate referral.

Fig 3 · Co-testing abnormal

Risk-based per ASCCP 2019: combine HPV & cytology strata to decide colposcopy vs follow-up.

Fig 4 · p16/Ki-67 dual stain

DS(+) → colposcopy · DS(−) → 1-yr follow-up (HR-HPV no-genotype / 12 HR-HPV; co-test NILM/ASC-US/LSIL).

Four management flows cover HPV-primary, cytology-primary, co-testing and dual-stain triage pathways.

4Methylation Triage (2B) & HPV Integration

12 HR-HPV+

methylation triage target

colposcopy ↓

referral reduction

recommendation class

Methylation: CpG-island promoter hypermethylation silences tumor suppressors — early lesion signal for triage.
Reagents: approved & clinically validated for 12 HR-HPV(+) triage.
HPV integration: integration(+) → high-risk, full colposcopy & histology; (−) → 1-yr follow-up.