Therapeutic efficacy of laser vaporization and conization for high-grade cervical intraepithelial neoplasia

Cervical intraepithelial neoplasia (CIN) grades 2 and 3 are precancerous lesions requiring timely treatment to prevent progression to invasive cancer. While conization is the standard therapy, it may negatively impact future fertility. This study evaluated the therapeutic efficacy of cervical laser vaporization compared with laser conization.

This retrospective study included patients with CIN2-3 who underwent laser vaporization or conization at NTT East Sapporo Medical Center between January 2018 and December 2022. Treatment selection was based on colposcopic findings, lesion grade, age, and fertility desire. Human papillomavirus (HPV) testing and cytology were performed before treatment and at 3 months postoperatively. Cytologic follow-up continued biannually for 2 years. The primary outcome was absence of cytologic abnormalities throughout the follow-up period. Patients lost to follow-up were excluded. Fisher's exact test was used for statistical comparisons.

Of 319 patients (93 conization; 226 vaporization), the mean age was 41 in the conization group and 33 in the vaporization group. Despite the age difference, no significant differences were observed in 2-year cytologic cure rates or 3-month HPV clearance in CIN3 cases. HPV16 was the most common genotype, followed by HPV52 and HPV58.

A Laser vaporization showed comparable efficacy to conization in appropriately selected CIN2-3 cases. It may be a fertility-preserving option for younger patients. Strengthening HPV vaccination programs remains essential for reducing high-risk HPV infections.