Case Report: Sequential high-intensity focused ultrasound and focused ultrasound for cervical and vaginal low-grade squamous intraepithelial lesions

Abstract

Background Low-grade squamous intraepithelial lesions (LSIL) of the cervix and vagina are generally low-risk with a high likelihood of spontaneous regression, for which conservative management is preferred. However, treatment becomes challenging when patients exhibit persistent symptoms and imaging findings suggestive of malignancy, despite repeated biopsies confirming LSIL. This report describes the use of high-intensity focused ultrasound (HIFU) and focused ultrasound as non-invasive therapeutic strategies for complex cervical and vaginal lesions under such clinicopathologic discordance. Case presentation This report presents the case of a 55-year-old postmenopausal woman with a 3-year history of intermittent postcoital bleeding and a 6-month history of vulvar itching. Serial MRI and PET/CT showed increased metabolic activity in the cervix and vagina, suspicious for malignancy, while multiple biopsies confirmed LSIL. The patient sequentially underwent treatment with HIFU and focused ultrasound using two different ultrasound therapeutic systems. Both procedures were well tolerated under conscious sedation, without intraoperative or postoperative complications. Symptoms improved markedly after the first treatment, and MRI confirmed effective ablation; focused ultrasound was subsequently applied to residual lesions. During clinical follow-up through 20 months, the patient remained symptom-free, and imaging, colposcopy, and targeted histopathology demonstrated regression of the cervical and vaginal lesions, with no visible evidence of recurrence. Baseline qualitative HPV DNA genotyping detected HPV56, whereas HPV16 and HPV18 were not detected. Extended HPV surveillance through May 2026 showed fluctuating genotype-specific results: HPV56 was no longer detected at the latest assessment, whereas HPV39 was intermittently detected. Sustained clearance of all high-risk HPV types was not demonstrated. Conclusion In this selected patient with clinicopathologic discordance, sequential HIFU and focused ultrasound achieved symptom relief and complete lesion regressionthrough 20 months of follow-up, supporting that this approach may represent a potential option for patients with complex cervical and vaginal lesions who are not candidates for or decline conventional surgical intervention.