CO₂ laser ablation versus conization for cervical intraepithelial neoplasia grade 2: a prospective cohort study

This study aimed to compare the efficacy of CO₂ laser ablation versus conization for treating cervical intraepithelial neoplasia grade 2 (CIN2) and to identify predictors of treatment failure. A prospective observational cohort study was conducted on 146 women with histologically confirmed CIN2. Participants were allocated to either CO₂ laser ablation (n = 100) or loop electrosurgical excision procedure (LEEP, n = 46) based on clinical decision. The primary outcome was short-term histopathological treatment response (regression to CIN1 or normal histology) at a 6-month follow-up. Propensity score matching was performed to adjust for baseline differences between groups. The overall treatment response rate was 81.5%, with no statistically significant difference between the conization (89.1%) and laser ablation (78.0%) groups (p = 0.108). This non-significant difference persisted after propensity score matching (OR = 0.66; 95% CI: 0.17-2.54; p = 0.548). For the entire cohort, abnormal cytology was an independent predictor of treatment failure, while younger age was independently associated with treatment success. In the laser group specifically, abnormal cytology, older age, and a BMI ≥ 25 kg/m² were significant predictors of treatment failure. CO₂ laser ablation demonstrated acceptable short-term efficacy for managing CIN2, with no statistically significant difference compared with conization at six months of follow-up. While conization remains the preferred treatment for patients with high-risk features, CO₂ laser ablation may represent a reasonable fertility-sparing option in carefully selected low-risk patients. Careful patient selection remains crucial for optimizing outcomes.