Cold coagulation revisited: a strategy for high-grade cervical intraepithelial neoplasia in reproductive-age women

Cold coagulation, although less commonly used today, offers a less invasive alternative to excisional procedures for high-grade cervical intraepithelial neoplasia (CIN). This study evaluated post-treatment cytologic and virologic negativity rates among reproductive-age women with high-grade CIN.

This retrospective study analyzed the medical records of 151 reproductive-age women diagnosed with CIN2 or 3 who were treated with cold coagulation at a single tertiary referral hospital between January 2010 and April 2022. Efficacy was assessed using follow-up liquid-based cytology and human papillomavirus (HPV) tests performed 3 months to 3 years after treatment. Statistical analyses included odds ratios and a univariate Cox proportional hazards model to evaluate treatment outcomes and failure rates.

At 6 months, cytologic negativity was achieved in 66.7% of patients and virologic negativity in 50.0%; these rates increased to 81.3% and 70.0%, respectively, by 3 years. Treatment failure occurred in 26.5% of patients. However, no significant differences in negative test rates were observed between CIN2 and CIN3 or between HPV16/18 and other high-risk HPV types. Persistent disease occurred in 25.8% of patients, whereas recurrence was observed in 2.6%. Minimal complications were reported and no cases of progression to cervical cancer were identified.

Cold coagulation demonstrated moderate post-treatment cytologic and virologic negativity rates with minimal immediate complications in this retrospective cohort. However, given the substantial rate of persistent disease and the nonstandard role of ablative treatment in settings where excision is available, these findings should be interpreted with caution.