Comparative Efficacy of Photodynamic Therapy and Cold Knife Conization for Cervical High-Grade Squamous Intraepithelial Lesions

(1) Background: Photodynamic therapy (PDT) using 5-aminolevulinic acid (5-ALA) offers a non-invasive alternative for managing cervical intraepithelial neoplasia. This comparative study assessed the efficacy and safety of 5-ALA PDT versus cervical conization in treating HSIL. (2) Methods: A total of 137 patients with HSIL and HPV infection, confirmed by pathological biopsy, were included. Based on patient preference and gynecological evaluation, participants were allocated into the PDT group and the CKC group. Follow-up assessments were conducted at 6 months post-treatment, involving HPV testing, cytology, and colposcopy. Additionally, any discomfort or side effects experienced during treatment were documented, along with a preliminary analysis of treatment costs and duration. (3) Results: The overall lesion remission rates were 88.0% for the PDT group and 89.6% for the CKC group, while HPV clearance rates were 80.0% and 82.7%, respectively. Although no statistically significant difference in efficacy was observed between the two groups, the PDT group exhibited a notably lower incidence of side effects. Nevertheless, the PDT group was associated with higher costs and longer treatment duration. (4) Conclusions: These findings indicate that 5-ALA PDT achieves comparable efficacy to CKC in the treatment of HSIL. Therefore, PDT may serve as a valuable therapeutic option for patients seeking fertility preservation or less invasive management strategies.