The incidence and mortality rates of cervical cancer in China are continuously rising, presenting a severe challenge for prevention and control. The integration of HR-HPV genes into the human genomic DNA sequence is the key molecular basis for the occurrence of cervical cancer. With the advancement of precision diagnosis and treatment concepts, the rational application of new high-throughput viral integration testing technologies can achieve precise stratification and risk management of HR-HPV positive patients. This expert consensus aims to standardize the application of HR-HPV gene integration testing in cervical cancer screening. Additionally, this consensus will focus on elucidating the role and molecular mechanisms of HR-HPV gene integration in the occurrence and development of cervical cancer, the methods and processes. It will also focus on providing recommendations on HR-HPV gene integration testing for HR-HPV infected individuals, those with abnormal combined screening results, patients with persistent cervical LSIL(CIN1), follow-up of cervical HSIL(CIN2), and clinical management after treatment of cervical HSIL (CIN2，CIN3). These recommendations aim to provide references for clinicians in decision-making for cervical cancer screening management, with the goal of accelerating the elimination of cervical cancer in China

阴道镜检查是宫颈癌筛查异常者进一步检查的重要工具，高质量的阴道镜检查能够提高风险评估的准确性，进而对检查异常者进行规范管理。因此，保证阴道镜检查的质量至关重要，也关系到宫颈癌筛查的整体效果。为了规范阴道镜检查的实施与操作、高质量开展宫颈癌防控工作，特编写本共识，希望为开展阴道镜检查和管理的相关专业人员提供参考。本共识主要内容围绕阴道镜检查过程中需要进行质量控制的相关环节制订指标，包括阴道镜检查开展前、操作过程中以及阴道镜检查后的管理等。各地区或医疗机构在开展阴道镜检查内部和外部质量评估时可根据实际情况进行参考或在此基础上制定适合本地区或医疗机构的阴道镜检查质量控制指标，最终达到提高宫颈癌筛查质量，促进本机构学科发展的目的。

预防性人乳头瘤病毒（human papilloma virus， HPV）疫苗接种是预防HPV感染的有效方法，可降低HPV 感染相关疾病的发生。目前国内外临床试验及真实世界研究均表明，预防性HPV疫苗是安全的，具有很好的免疫原性、保护效力和保护效果。优先推荐9~26岁女性接种HPV疫苗，重点是9~14岁女孩；同时推荐27~45岁女性和9~26岁男性接种，倡导男女共防。对于HPV感染或细胞学异常人群、HPV相关病变治疗史人群、遗传易感人群、子宫颈癌发病高风险生活方式人群，以及免疫功能低下人群均推荐预防性HPV疫苗接种。接种HPV疫苗后仍应定期进行子宫颈癌筛查。

p16/Ki-67双重染色检测（双染）作为一种相对客观的检测方法，已在多个国家获批应用于临床。本共识基于循证医学证据，对双染样本的取材与制备、检测流程、结果判读及报告规范达成共识，并推荐双染可用于高危人乳头瘤病毒（high-risk human papillomavirus, HR-HPV）初筛不分型阳性或部分分型其他12种（HR 12）阳性人群的分流；也可用于联合筛查时HR-HPV不分型阳性或部分分型HR 12阳性，且细胞学正常或轻度异常时的人群分流；还可用于筛查结果异常（HR-HPV检测或HR-HPV联合细胞学检测）后随访人群的分流。通过本共识的制定，旨在规范双染检测技术的临床应用，实施子宫颈癌精准筛查。

 In response to the incidence of cervical intraepithelial neoplasia and cervical cancer in China and global screening strategies, a collaborative effort was undertaken by seven Chinese medical societies to develop this guidelineⅡfor cervical cancer screening. This guide focuses on standardizing methods for triaging abnormal cervical cancer screening results, with the aim of reducing overdiagnosis and missed diagnosis through refined management. Cervical cytology is currently the main triage method for individuals with positive high-risk human papillomavirus (HR-HPV) detection. Primary screening with cytology is managed based on the different risks of their results. In addition, p16/Ki-67 dual stain (DS) is acceptable for triage HPV-positive test results without genotyping or those positive for other (non-16/18) HR-HPV types (12 HR-HPV). It can also be used for triage in co-testing with HPV-positive results (no genotyping or 12HR-HPV) when the cytology result shows NILM, ASC-US and LSIL. Methylation is acceptable for triage of individuals testing 12 HR-HPV-positive. HPV gene integration testing could be used for the triage of HR-HPV positive individuals based on current research results in China. All these new testing methods must utilize reagents that have been approved by authoritative institutions and clinically validated for relevant indications. Additional clinical evidence is required for other methods such as HPV extended genotyping or HPV viral load, etc.

Human papillomavirus (HPV) vaccination is an effective method to prevent HPV infection and the related diseases, and is a primary preventive measure for HPV infection related diseases. The vaccination effect of young women is better, and the immune efficacy of vaccination for teenagers before sexual exposure is the best. HPV vaccine is not only suitable for the general population, but also recommended for high-risk and special groups. HPV vaccination should be recommended for women in appropriate age with genetic susceptibility, high-risk lifestyle and human immunodeficiency virus infection. No matter whether they have HPV infection or abnormal cytology, suitable-age women can be vaccinated. Women with pregnancy plan in the near future, or pregnant and lactating women should not be vaccinated. Cervical cancer screening recommendations should be carried out after HPV vaccination.

Objective To investigate the clinical applicability of human papillomavirus (HPV) point-of-care testing (POCT) in screening cervical intraepithelial lesions in high-risk populations. Methods In 499 patients with colposcopic referral indication, HPV POCT method and Sanger sequencing were used for HPV detection, and the consistency of HPV POCT rapid detection method was compared to evaluate the accuracy of HPV detection. Combined with the pathological results of patients, the clinical prediction performance of cervical intraepithelial lesions in high-risk population was analyzed. Results Among 499 patients, the overall HPV infection rate was 82.57% (412/499). The overall coincidence rate between HPV POCT method and Sanger sequencing technology was 90.49% (1 094/1 209). Taking Sanger sequencing detection results as a reference, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of HPV POCT method were higher than 90.00%, and the Kappa consistency coefficient was greater than 0.90 (P<0.001). The sensitivity and specificity of HPV POCT for screening of cervical intraepithelial neoplasia (CIN) 2+ and CIN 3 is comparable to that of Sanger sequencing. Conclusions HPV POCT method demonstrated high consistency with Sanger sequencing in terms of HPV detection and CIN 2+prediction.

Human papilloma virus (HPV) is a double-stranded DNA virus that causes almost all cervical cancers due to high-risk HPV infection. More than 400 different HPV subtypes have been identified in recent years, and most HPV infections are asymptomatic and resolve spontaneously. Women with a normal immune system, starting with high-risk HPV infection, usually take 15 to 20 years to develop cervical cancer, but for immunocompromised women, such as untreated women living with HIV (WLHIV), cervical cancer may progress more quickly (5 to 10 years). In 2006, prophylactic HPV vaccine was developed and marketed, but it has no therapeutic effect on patients who have been infected with HPV or precancerous lesions. The development of therapeutic HPV vaccine may provide an important complement to the current methods for the prevention and treatment of cervical cancer. Currently, the therapeutic HPV vaccine is in the early clinical trials, which is different from the existing HPV prophylactic vaccine to prevent new HPV infection, therapeutic HPV vaccine will be designed to clear or treat existing HPV infections, their associated precancerous lesions and invasive cervical cancer as well. Therefore, a reasonable therapeutic HPV vaccine development strategy will not only allow the therapeutic HPV vaccine product development enterprises to avoid detours and improve the transformation efficiency, but also benefit patients with HPV infection, related lesions and even cancer as soon as possible. With the goal of clearing infection and treating cervical precancerous lesions. The expert concensus focus on the clinical development direction, target population, characteristic and vaccination programme of therapeutic HPV vaccine, aiming to accelerate and promote the research and development of therapeutic HPV vaccine, and will provide reference for the development of therapeutic HPV vaccine products and the formulation of national policies related to therapeutic HPV vaccine.

复发性宫颈癌患者缺少有效的治疗方案，盆腔中心性复发的宫颈癌患者经盆腔廓清手术后，部分患者可以延长无疾病生存期，但需要面对手术创伤大、围手术期并发症严重、术后的器官功能改变以及生活质量下降等巨大风险。因而，对于复发性宫颈癌患者的治疗方案选择需要经过多学科团队合作，制定个体化的治疗方案。经过术前充分评估，提高手术切缘阴性，降低围手术期并发症的发生，采用脏器功能重建的手术方案的优化，从而达到盆腔廓清术在治疗肿瘤的同时，改善患者生活质量的目的。本共识是在总结国内外研究以及专家经验的基础上形成，其主要针对复发性宫颈癌实施盆腔廓清术的分类、不同廓清术类型的定义、适应证、禁忌证、术前评估、手术要点、围手术期管理及并发症防治、术后辅助治疗、预后及随访等问题进行归纳整理，旨在为复发性宫颈癌患者实施盆腔廓清手术提供指导性意见。

In response to the incidence of cervical intraepithelial neoplasia and cervical cancer in China and global screening strategies, a collaborative effort was undertaken by seven Chinese medical societies to develop this guideline for cervical cancer screening. The guideline recommends high-risk human papillomavirus (hr-HPV) nucleic acid detection as the preferred method for primary screening, which should have been approved by authoritative institutions and clinically validated for primary screening. In areas without access to HPV nucleic acid testing, cytology can be used as an alternative. However, it is recommended to replace cytology with HPV-based screening as conditions permit. Cotesting (HPV testing in combination with cytology) is recommended for areas with sufficient medical resources, opportunistic screening populations, and partial special populations. The guideline recommends that individuals with a cervix initiate cervical cancer screening at age 25 years and undergo HPV testing alone or cotesting every five years, or cytology alone every three years. Women over the age of 65 who have had documented adequate negative prior screening in the past may discontinue screening. Corresponding screening programs are proposed for different special populations. The development of these guidelines is an important step in the effort to eliminate cervical cancer in China.

Anal intraepithelial neoplasia (AIN) is a precancerous condition that precedes anal squamous cell carcinoma. Diagnosis often involves the use of high-resolution anoscopy (HRA) and anal HPV examination. Unlike the well-established cervical cancer screening system, AIN research and clinical practice worldwide are relatively new, resulting in a lack of unified diagnostic and treatment standards for anal precancerous lesions. In recent years, international, American, and European institutions have introduced consensus guidelines on the diagnosis and treatment of HPV-related anal diseases, including HRA screening. However, misconceptions regarding the diagnosis and treatment of AIN still persist in clinical practice, leading to a significant number of missed diagnoses and misdiagnoses. This evidence-based consensus, based on existing international guidelines and the current situation in China, aims to summarize the terminology, epidemiology, etiology, clinical manifestations, diagnosis, treatment, and follow-up management of AIN. The goal is to comprehensively standardize the management of AIN, ultimately reducing the incidence of anal cancer.

出血性疾病所致的异常子宫出血是指由先天性及获得性因素导致血管、血小板、凝血、抗凝及纤维蛋白溶解等止血机制缺陷或异常而引起的女性月经过多、经期延长及经间期出血，可发生危及生命的阴道大出血。根据国内外研究结果和相关指南，结合临床实践经验，制定了本共识，共识中阐释出血性疾病所致的异常子宫出血的病因、分类、诊断、治疗、长期管理及其他需关注的问题，以便对临床医师起到指导作用。

Objective To investigate the clinical value of hysteroscopic resection of lesions combined with megestrol acetate (MA) in the treatment of endometrial carcinoma (EC) with fertility preservation. Methods The clinical data ofⅠa EC patients who received fertility preservation therapy from December 2012 to December 2020 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. A total of 53 patients underwent hysteroscopic surgery, including 31 EC patients treated with hysteroscopic resection of lesions combined with MA as the hysteroscopic electrotomy group and 22 EC patients treated with hysteroscopy curettage combined with MA as the hysteroscopic curettage group. Endometrial pathological examination was performed every 3 months to analyze the treatment effect and pregnancy outcome of the two groups, and to evaluate the clinical value of hysteroscopic electrotomy. Results (1) The complete remission rate of hysteroscopic electrotomy group and the hysteroscopic curettage group were 87.1%(27/31) and 72.7%(16/22), the recurrence rate were 22.2%(6/27) and 6/16,the pregnancy rate were 29.6%(8/27) and 3/16, the successful delivery rate were 5/8 and 2/3, and the intrauterine adhesions rate which were mild and moderate were 12.9% (4/31) and 9.1% (2/22).There was no significant difference in them between the two groups (P＞0.05). Logistic regression analysis showed that intrauterine adhesion was not a factor affecting recurrence and pregnancy of EC patients (P＞0.05). (2) The median time of complete response in the hysteroscopic electrotomy group was shorter than that in the hysteroscopic curettage group (3 months: 6 months, P=0.004). After 3 months of treatment, the rate of complete response in the hysteroscopic electrotomy group was significantly higher than that in the hysteroscopic curettage group (58.1%:9.1%, P=0.001). (3) The complete response rate, recurrence rate and pregnancy rate were 85.1% (40/47), 27.5% (11/40) and 25.0% (10/40) in highly differentiated EC patients. Among the six case of moderately differentiated EC patients, 
3 had complete remission, 1 had recurrence, and 1 had full-term pregnancy, and had no significant difference between them (P＞0.05). Three moderately differentiated EC patients showed no pathological remission after 3 months of treatment, and underwent comprehensive staging surgery for endometrial cancer. During conservative treatment, there was no risk of disease progression such as deep muscle invasion and distant metastasis. Conclusions The patients who treated with hysteroscopic electrotomy combined with MA can achieve a higher complete remission rate in a relatively short time, and the probability of postoperative intrauterine adhesion is low and it does not affect the pregnancy of EC patients.

Objective To analyze the effects and influencing factors of acute and severe abnormal uterine bleeding （AUB） patients with thrombocytopenia. Methods The clinical data of 43 patients with acute and severe abnormal uterine bleeding caused by thrombocytopenia in Peking University People's Hospital from January 2014 to January 2019 were collected. The efficacy of acute hemostasis and chronic maintenance were retrospectively analyzed. Results The mean age of 43 patients was (40.56±9.94) years, and the platelet count <50×109/L accounted for 60.4%(26/43). Within one week of hysteroscopic hemostasis, 37.20%(16/43) patients had complete hemostasis, and 62.80%(27/43) patients still had a small amount of bleeding. The follow-up period ranged from 6 months to 5 years, 30.2%(13/43) of AUB symptoms were completely relieved, 39.5% (17/43) of AUB symptoms were partially relieved, and 30.2%(13/43) of AUB symptoms were not relieved. Whether to use drugs to control menstruation after operation had a very significant impact on the long-term improvement of symptoms during maintenance period (χ⊃2;=15.84, P<0.001). Conclusions In patients with acute and severe bleeding who have thrombocytopenia, it is effective on hemostasis by intrauterine surgery. Long-term application of medicine treatment during the chronic maintenance period can effectively prevent recurrence.

卵巢肿瘤不仅危害患者的生存，还可能损害患者的生育能力，尤其对15~39岁处于或即将踏入育龄期的年轻女性而言，大部分患者为早期肿瘤，长期生存率较高、预后较好，在治疗肿瘤的同时需考虑保留生育功能。在妇科肿瘤中，保留生育功能手术（fertility-sparing surgery, FSS）的应用越来越广泛。妇科肿瘤中的FSS主要指保留卵巢和/或子宫，使患者可以自然受孕或通过卵子捐献完成生育。在年轻卵巢肿瘤中，交界性肿瘤、恶性生殖细胞肿瘤、性索间质肿瘤和上皮性癌是常见的病理类型。对于不同病理类型的卵巢肿瘤，FSS的指征、手术范围和术后辅助治疗等有所不同。