Comparison of Topical 5-Aminolevulinic Acid Photodynamic Therapy With the Loop Electrosurgical Excision Procedure for Patients With Cervical High-Grade Squamous Intraepithelial Neoplasia: A Prospective and Propensity-Matched Analysis

Objective To evaluate the efficacy of 5-aminolevulinic acid photodynamic therapy (PDT) for high-grade squamous intraepithelial lesions of the cervix associated with high-risk human papillomavirus (HPV) infection. Methods In this study, 120 patients who received treatment for high-grade squamous intraepithelial lesions of the cervix from March 2023 to March 2024 were followed up prospectively, which were categorized into the PDT and loop electrosurgical excision procedure (LEEP) groups and matched 1:1 using a propensity score. The regression rate of the lesions and the HPV clearance rate were compared between the groups at 6 and 12 months. Factors affecting the clearance rate were analyzed. Results At the 6- and 12-month follow-ups, no significant difference was observed in the rate of lesion regression between the PDT (86.7%, 91.7%) and LEEP groups (85.0%, 93.3%) (p > 0.05), nor the HPV clearance rate (55.0%, 76.7% vs. 65.0%, 78.3%) (p > 0.05). Neither group had any lesions that progressed to Grade 3 or invasive cervical carcinoma at follow-up. According to regression analysis, thinprep cytology test (TCT) results influenced lesion regression in the PDT group. Conclusion Compared to the LEEP, 5-aminolevulinic acid PDT had a similar rate of lesion regression and HPV clearance for the treatment of high-grade squamous intraepithelial lesions of the cervix; thus, PDT offers an alternative and effective minimally invasive approach.