Cervical morphology and elasticity following treatment of cervical squamous intraepithelial lesions with focused ultrasound vs. loop electrosurgical excision procedure: a prospective non-randomized controlled study.

OBJECTIVE

To compare the effects of focused ultrasound (FUS) and loop electrosurgical excision procedure (LEEP) on cervical morphology and elasticity after treatment of cervical squamous intraepithelial lesions (SILs).

METHODS

Eighty-one patients with histologically confirmed SILs (42 FUS vs. 39 LEEP) were prospectively evaluated. FUS ablation was performed using the CZF-2 device (Haifu® Medical, 3.5 MHz). LEEP followed ASCCP guidelines with resection margins ≥5 mm beyond lesions. Serial transvaginal ultrasound measurements (cervical length/width/volume) were conducted at baseline and 3/6 months postoperatively.

RESULTS

At 3-6 months after surgery, the high-risk human papilloma virus (HR-HPV) clearance rate and high-grade SIL cure rate were similar in the FUS and LEEP groups (p > 0.05). Cervical length, width, anterior-posterior diameter, and volume did not significantly change after FUS (p > 0.003125). All 4 dimensions were significantly reduced after LEEP (p < 0.003125). These morphological alterations were greater in the LEEP group (p < 0.05). Strain rates at the internal and external os, and anterior-posterior lips did not significantly change after FUS (p > 0.05). After LEEP, strain rates slightly decreased at the internal and external os (1.02 ± 1.00 vs. 0.79 ± 0.69, p > 0.05) and significantly decreased at the anterior-posterior lips (1.43 ± 1.34 vs. 0.97 ± 0.93; p < 0.05).

CONCLUSION

FUS and LEEP demonstrate comparable efficacy in treating HR-HPV-associated SILs. Initial observations suggest that FUS impacts cervical morphology and elasticity less than does LEEP, implying an advantage of FUS for fertility preservation, although the long-term fertility outcomes require further investigation.