Thermal ablation for visible cervical HSIL or suspected HSIL: a tissue-conserving alternative to excision in selected patients

Background This study evaluates the feasibility and clinical outcomes of squamocolumnar junction (SCJ)-targeted thermal ablation in patients with visible cervical lesions diagnosed as high-grade squamous intraepithelial lesions (HSIL) or suspected HSIL, and explores changes in CK7-positive SCJ cells following treatment. Methods In this prospective cohort study, 226 patients meeting predefined eligibility criteria between June 2017 and December 2024 were managed with either SCJ-targeted thermal ablation (n = 110) or loop electrosurgical excision procedure (LEEP, n = 116), based on clinical assessment and patient preference. Outcomes included operative parameters, complications, cytological abnormalities, high-risk HPV (hrHPV) clearance, lesion persistence or recurrence, and changes in CK7-positive SCJ cells in a subset of patients. Results Baseline clinicopathologic characteristics were broadly comparable between groups, although treatment allocation was non-randomized. SCJ ablation was associated with shorter operative time, minimal intraoperative blood loss, fewer procedure-related complications, and lower treatment cost compared with LEEP ( P < 0.05). During follow-up, rates of cytological abnormalities and lesion recurrence were low in both groups, with no progression to invasive carcinoma observed. A higher rate of hrHPV positivity was noted in the ablation group at 3 months (36.4% vs. 18.1%, P = 0.006), but this difference was not observed at subsequent time points. In a subset analysis, CK7-positive SCJ cells markedly decreased following both treatments, with no residual CK7-positive HSIL or SCJ cells identified post-treatment. Conclusion In carefully selected patients with fully visible transformation zones, SCJ-targeted thermal ablation demonstrated favorable procedural outcomes and similar observed short- to mid-term clinical results compared with LEEP in this observational cohort. These findings support its potential as a tissue-conserving treatment option in selected cases. The reduction in CK7-positive SCJ cells suggests a possible biologic basis for SCJ-targeted therapy, although this remains exploratory. Given the non-randomized design and limited event rates, these findings should be interpreted with caution, and further prospective studies are warranted.