Colposcopic magnified scanning-assisted CO2 laser treatment (CMSLT) for vaginal high-grade squamous intraepithelial lesion (VaHSIL): A single-center prospective cohort study

Abstract To evaluate the feasibility of Colposcopic Magnified Scanning Laser Treatments (CMSLT), divided into laser excision (CMSLE) and vaporization (CMSLV), using a scanner-assisted CO 2 laser as a singular outpatient therapeutic modality for patients affected by vaginal high-grade squamous intraepithelial lesion (vaHSIL). vaginal high-grade squamous intraepithelial lesion (vaHSIL) is a rare condition associated with persistent high-risk HPV infection, carrying a concrete potential for progression into invasive carcinoma. Due to diagnostic complexities and the rarity of the disease, its optimal clinical management and treatment standardization remain controversial. This prospective non-randomized cohort study was conducted between January 2022 and June 2024 on 63 patients with histologically confirmed vaHSIL. Based on the 2011 IFCPC colposcopic terminology, patients were assigned to either the CMSLV group ( n = 22) or the CMSLE group ( n = 41). The outpatient protocol utilized a laser system implemented with a computerized surgical scanner-assisted micromanipulator. The two-year follow-up included semi-annual screenings with HPV testing, cytology, and colposcopy. Follow-up adherence was high, with a dropout rate limited to 11.3%. The cumulative recurrence risk for vaHSIL was 14.5%, with no statistically significant difference between the two modalities, although the CMSLE group showed a higher 2-year disease-free survival rate (70% vs. 57%). The progression rate to invasive carcinoma was 1.6% 1 cases in the CMSLE cohort), revealing a 2.4% rate of occult cancer missed at initial colposcopic assignment. Only one major complication occurred (vaginal perforation, 1.6% in a post-hysterectomy patient), with no minor complications or long-term sequelae (dyspareunia or pain) reported. CMSLT may represent feasible approach since it happened to be safe, effective and associated with patient compliance. The precision of the scanner-assisted technology minimizes thermal damage and the risk of undertreating occult cancer, allowing for tailored and efficient therapy.