CO₂ Laser Ablation Versus Conization for Cervical Intraepithelial Neoplasia Grade 2: A Prospective Cohort Study

Objective This study aimed to compare the efficacy of CO₂ laser ablation versus conization for treating cervical intraepithelial neoplasia grade 2 (CIN2) and to identify predictors of treatment failure. Methods A prospective observational cohort study was conducted on 146 women with histologically confirmed CIN2. Participants were allocated to either CO₂ laser ablation (n = 100) or Loop electrosurgical excision procedure (LEEP, n = 46) based on clinical decision. The primary outcome was histopathological treatment response (regression to CIN1/normal) at a 6-month follow-up. Propensity score matching was used to control for baseline confounders. Results The overall treatment response rate was 81.5%, with no statistically significant difference between the conization (89.1%) and laser ablation (78.0%) groups (p = 0.108). This non-significant difference persisted after propensity score matching (OR = 0.66; 95% CI: 0.17 to 2.54; p = 0.548). For the entire cohort, younger age and normal cytology were independent predictors of treatment success. In the laser group specifically, abnormal cytology, older age, and a BMI ≥ 25 were significant predictors of treatment failure. Conclusion CO₂ laser ablation demonstrated comparable short-term efficacy to conization for managing CIN2. It represents a viable fertility-sparing alternative, particularly for younger patients with normal cytology and lower BMI. Careful patient selection is crucial for optimizing outcomes.