Focused ultrasound versus LEEP for high-grade squamous intraepithelial lesions: a retrospective cohort study of long-term effectiveness and obstetric outcomes

To compare long-term effectiveness and obstetric outcomes of focused ultrasound (FU) ablation versus loop electrosurgical excision procedure (LEEP) for high-grade squamous intraepithelial lesions (HSIL) in reproductive-aged women. This retrospective cohort included women treated with FU (n = 29) or LEEP (n = 32) for HSIL who subsequently delivered (2017–2023). A control group (n = 61) comprised healthy women with negative preconception HR-HPV/cytology. Outcomes were cumulative HR-HPV clearance, cervical length, pregnancy outcomes. Both FU and LEEP demonstrated comparable long-term effectiveness: cumulative HR-HPV clearance rates did not differ significantly at any time point (p > 0.05). Post-intervention cervical length was significantly shorter in the LEEP group (24.79 ± 3.98 mm) than in both the FU (27.63 ± 2.80 mm) and control (28.26 ± 3.92 mm) groups (p = 0.003). Cervical insufficiency was more frequent in the LEEP group (15.63%) than in the FU (3.45%) and control (1.64%) groups (p = 0.019). The LEEP group also had higher rates of preterm birth (18.75% vs 3.45% in FU and 4.92% in controls; p = 0.039) and lower rates of vaginal delivery (15.63% vs 44.83% in FU; p = 0.025). In this selected cohort of women with successful live births, FU may have comparable long-term effectiveness to LEEP for HSIL while potentially preserving cervical length and reducing adverse obstetric risks. These preliminary findings suggest FU may be a fertility-sparing option for appropriately selected HSIL women who are planning pregnancy.