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.

Abstract

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.