Efficacy of focused ultrasound for HPV clearance and cervical LSIL treatment: a meta-analysis

Persistent high-risk human papillomavirus (hrHPV) infection is a major risk factor for high-grade squamous intraepithelial lesions (HSIL) and cervical cancer. Although HPV vaccines effectively prevent infections with vaccine-covered HPV types, they do not eliminate established infections. Additionally, not all HPV types associated with cervical cancer are covered by the vaccine. Therefore, treatment strategies for HPV-related cervical lesions remain an important clinical challenge. A systematic search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library to identify studies evaluating the efficacy of focused ultrasound in treating HPV and cervical low-grade squamous intraepithelial lesions (LSIL). Ten eligible observational studies were included. Study quality was assessed using the MINORS criteria, and evidence quality was evaluated based on GRADE guidelines. A meta-analysis was performed using Stata 12.0 software. Focused ultrasound treatment led to HPV clearance in 74% of cases (ES = 0.74, 95% CI: 0.64-0.85, P < 0.001). Additionally, 94% of women with LSIL histology before treatment had a normal cervical biopsy at follow-up (ES = 0.94, 95% CI: 0.92-0.97, P < 0.001), and 87% of women with abnormal ThinPrep cytology (TCT) results had normal cytology at follow-up (ES = 0.87, 95% CI: 0.78-0.96, P < 0.001). Compared to the observation group, focused ultrasound treatment was significantly more effective in clearing HPV (OR = 3.58, 95% CI: 2.21-5.81, P < 0.001). Similarly, focused ultrasound was superior to interferon treatment for HPV clearance (OR = 4.22, 95% CI: 1.12-15.96, P = 0.034). The quality of evidence across studies was rated as low to moderate. This meta-analysis demonstrates that focused ultrasound achieves a 74% HPV clearance rate and 94% LSIL resolution in women with cervical LSIL and concurrent hrHPV infection. While superior to observation and interferon, the evidence remains low-to-moderate due to the observational nature and geographic concentration of included studies. Future multicenter RCTs are essential to validate these results and assess long-term outcomes, including recurrence and obstetric safety.