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Cited by 0Cervical Cancer and HPV ResearchWomen's cancer prevention and managementReproductive tract infections research

Thermal ablation versus loop electrosurgical excision procedure and cold knife conization for cervical intraepithelial neoplasia: efficacy and HPV clearance in a 5-year cohort of Chinese women

Open access
Yuan, Meiwen, Zhao, Xuelian, Hu, Shangying, Zhao, Shuang, Pan, Qinjing, Zhang, Xun, Duan, Xianzhi, Zhao, Fanghui·2026·Cancer Biology & Medicine
DOI 10.20892/j.issn.2095-3941.2025.0415
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Abstract

Objective: To evaluate the 5-year efficacy of thermal ablation (TA) for cervical intraepithelial neoplasia (CIN) and high-risk HPV (hrHPV) clearance in Chinese women. Methods: A total of 17,202 women aged 20–65 years were recruited to screening cohorts in 2017–2018 from 3 rural counties in Shanxi and Inner Mongolia and an urban area in Shenzhen with follow-up evaluations until 2022. The hrHPV-positive women with ablation-eligible lesions on colposcopy underwent biopsy and TA (n = 228) in one visit. A loop electrosurgical excision procedure (LEEP) or cold knife conization (CKC) was recommended for ineligible women with high-grade CIN on histology (n = 106 and 41, respectively), while untreated hrHPV-positive women served as controls. Treated women had annual hrHPV testing and cytology. Untreated women had annual hrHPV testing. Positive cases were referred for colposcopy, with biopsy performed when indicated. Cure rates and hrHPV clearance rates were analyzed using Kaplan-Meier and competing risk models with sub-distribution hazard ratios (SHRs) assessing treatment effects. Results: The 5-year cure rate for CIN1 regressing to normal was 79.0% after TA treatment and the 5-year cure rate for CIN2 regressing to CIN1/normal was 87.9%, comparable to LEEP (90.3%) and CKC (94.4%) for CIN2 (P = 0.54). The TA cure (66.0%) was significantly lower for CIN3 than LEEP and CKC (97.0% and 94.1%; P = 0.006). TA achieved 98.0% 5-year hrHPV clearance in CIN1/normal cases, which was higher than untreated women (87.7%; SHR = 0.81, 95% CI = 0.73–0.90), particularly for HPV16 (SHR = 0.67), HPV31 (SHR = 0.56), and HPV33 (SHR = 0.65). The 5-year hrHPV clearance after TA was comparable to LEEP and CKC for CIN2/3. Conclusion: TA provides durable efficacy for CIN1 and CIN2 and promotes hrHPV clearance, reducing progression risk. It could complement excisional treatments for CIN2 and enhance treatment accessibility in low-resource settings.

AI snapshot

Written from the paper’s full text.

TL;DR

In a 5-year prospective cohort of Chinese women, thermal ablation (TA) had durable cure for CIN1 and CIN2 and hrHPV clearance comparable to LEEP/CKC in CIN2/3, but lower cure for CIN3. TA also improved hrHPV clearance versus untreated women, especially for HPV16, HPV31, and HPV33.

Key findings

  • Five-year cure rates: CIN1 treated with TA was 79.0%; CIN2 cure was 87.9% with TA, 90.3% with LEEP, and 94.4% with CKC (P = 0.54). For CIN3, TA cure was 66.0% versus 97.0% for LEEP and 94.1% for CKC (P = 0.006).
  • Among women with normal cervix/CIN1, 5-year hrHPV clearance was 98.0% after TA versus 87.7% in untreated women (SHR = 0.81, 95% CI = 0.73–0.90); genotype-specific effects were strongest for HPV16 (SHR = 0.67), HPV31 (SHR = 0.56), and HPV33 (SHR = 0.65).
  • In CIN2/3, 5-year hrHPV clearance after TA was comparable to LEEP and CKC overall; CKC was associated with higher clearance of non-16/18 hrHPV than TA (SHR = 1.46, 95% CI = 1.09–1.96), while LEEP did not differ significantly from TA (SHR = 0.77, 95% CI = 0.58–1.02).
  • A total of 375 hrHPV-positive women were treated: TA n = 228, LEEP n = 106, CKC n = 41; 328 (87.5%) had at least one post-treatment follow-up evaluation.

Methods

  • Prospective study within community-based cervical cancer screening in three rural counties (Inner Mongolia and Shanxi) and one urban site (Shenzhen); 17,202 women aged 20–65 years were recruited in 2017–2018 with follow-up until 2022.
  • hrHPV-positive women with ablation-eligible lesions underwent biopsy and TA in one visit; LEEP or CKC was recommended for ineligible women or histologically confirmed CIN2/3. Untreated hrHPV-positive women (n = 1,532) served as controls for hrHPV clearance.
  • Outcomes were 5-year cumulative cure and hrHPV clearance, analyzed with Kaplan–Meier and Fine–Gray competing-risk models; subdistribution hazard ratios (SHRs) assessed treatment effects, adjusted for age, marital status, menopausal status, and number of sexual partners.

Limitations

  • Stated: treatment allocation was non-randomized and guided by lesion characteristics (TA for type 1 TZ with fully visible SCJ and lesions <75% of TZ; LEEP/CKC for more extensive or less visible disease), so residual confounding is possible and randomized studies are warranted.
  • Stated: some subgroups had insufficient sample sizes (e.g., CIN3 treated with TA and HPV18 infection), cure definitions differed between CIN1 and CIN2/3 and were not directly comparable, and the study did not systematically capture longitudinal HPV genotype persistence or viral load dynamics.
  • Evident: the observational, non-randomized design means selection bias and confounding cannot be excluded; several genotype-specific estimates had wide confidence intervals due to small numbers.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.20892/j.issn.2095-3941.2025.0415

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 25 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § Abstract

    Thermal ablation was associated with higher hrHPV clearance particularly for HPV16 (SHR = 0.67).

    “TA achieved 98.0% 5-year hrHPV clearance in CIN1/normal cases, which was higher than untreated women (87.7%; SHR = 0.81, 95% CI = 0.73–0.90), particularly for HPV16 (SHR = 0.67), HPV31 (SHR = 0.56), and HPV33 (SHR = 0.65).”
    Quote in the paperSubstantial claim
  • Findingown data
    § Abstract

    The 5-year cure rate for CIN2 treated with CKC was 94.4%.

    “The 5-year cure rate for CIN2 regressing to CIN1/normal was 87.9%, comparable to LEEP (90.3%) and CKC (94.4%) for CIN2 (P = 0.54).”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Abstract

    Untreated women had 87.7% 5-year hrHPV clearance in CIN1/normal cases.

    “TA achieved 98.0% 5-year hrHPV clearance in CIN1/normal cases, which was higher than untreated women (87.7%; SHR = 0.81, 95% CI = 0.73–0.90), particularly for HPV16 (SHR = 0.67), HPV31 (SHR = 0.56), and HPV33 (SHR = 0.65).”
    Quote in the paperSubstantial claim
  • Findingown data
    § Abstract

    Thermal ablation cure for CIN3 was significantly lower than LEEP and CKC (P = 0.006).

    “The TA cure (66.0%) was significantly lower for CIN3 than LEEP and CKC (97.0% and 94.1%; P = 0.006).”
    Quote in the paperSubstantial claim
  • Findingown data
    § Abstract

    The 5-year cure rate for CIN2 treated with LEEP was 90.3%.

    “The 5-year cure rate for CIN2 regressing to CIN1/normal was 87.9%, comparable to LEEP (90.3%) and CKC (94.4%) for CIN2 (P = 0.54).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 49
  • Classified as probably not a substantial claim. 19

  • May combine two claims.

    Findingown data
    § Results

    Women treated by LEEP for CIN2 had a 1-year cure rate of 100%, which decreased to 90.3% (95% CI: 82.5%-98.8%) at 5 years.

    “Women treated by LEEP (n = 66) had a 1-year cure rate of 100%, which decreased slightly to 90.3% (95% CI: 82.5%–98.8%) at 5 years following a single recurrence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    For CIN2, the 1-year cure rate in the thermal ablation group was 87.9% (95% CI: 77.4%-99.8%) and remained stable through 5 years.

    “For CIN2, the 1-year cure rate was 87.9% (95% CI: 77.4%–99.8%) and remained stable through 5 years in the TA group (n = 33).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Results

    Untreated women had 44.7% (95% CI: 42.2%-47.2%) hrHPV clearance at 1 year, 64.5% (95% CI: 62.0%-66.9%) at 2 years, and 87.7% (95% CI: 86.0%-89.4%) by 5 years.

    “Untreated women had similar clearance as the TA-treated women at 1 year (44.7%, 95% CI: 42.2%–47.2%) but slower clearance at 2 years (64.5%, 95% CI: 62.0%–66.9%) and 87.7% (95% CI: 86.0%–89.4%) by 5 years.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Results

    The 1-year cure probability in the thermal ablation group for CIN3 was 73.3% (95% CI: 54.1%-99.5%), declining to 66.0% (95% CI: 45.7%-95.4%) by 3 years and remaining stable thereafter.

    “The 1-year cure probability was 73.3% (95% CI: 54.1%–99.5%) in the TA group (n = 15), declining to 66.0% (95% CI: 45.7%–95.4%) by 3 years and remaining stable thereafter.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Results

    In the CKC group for CIN3, the cure rate was 94.1% (95% CI: 83.6%-100.0%) at 1 year and remained unchanged during subsequent follow-up.

    “In contrast, cure rates remained high after excisional treatments, as follows: 97.0% (95% CI: 91.3%–100.0%) at 1 year and sustained through 5 years in the LEEP group (n = 33); and 94.1% (95% CI: 83.6%–100.0%) at 1 year, which remained unchanged during subsequent follow-up in the CKC group (n = 17).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Discussion

    TA demonstrated sustained lesion cure in CIN1 (79.0%) and a comparable cure rate for CIN2 (87.9%) relative to LEEP (90.3%) and CKC (94.4%), but efficacy declined notably in CIN3 (66.0%).

    “TA demonstrated sustained lesion cure in CIN1 (79.0%) and a comparable cure rate for CIN2 (87.9%) relative to LEEP (90.3%) and CKC (94.4%) but the efficacy declined notably in CIN3 (66.0%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Results

    Multiple infections accounted for 31.3% in the CIN2/3 group overall and were comparable across treatment modalities (TA: 29.4%, LEEP: 30.6%, CKC: 35.7%; P = 0.848).

    “Multiple infections accounted for 31.3% in the CIN2/3 group (n = 147) overall and were comparable across treatment modalities (TA: 29.4%, LEEP: 30.6%, CKC: 35.7%; P = 0.848).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    Untreated women had similar hrHPV clearance to TA-treated women at 1 year but slower clearance at 2 and 5 years.

    “Untreated women had similar clearance as the TA-treated women at 1 year (44.7%, 95% CI: 42.2%–47.2%) but slower clearance at 2 years (64.5%, 95% CI: 62.0%–66.9%) and 87.7% (95% CI: 86.0%–89.4%) by 5 years.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning
    § Discussion

    CKC was associated with a significantly higher clearance probability relative to TA in the non-16/18 hrHPV subgroup, whereas LEEP did not differ significantly.

    “However, CKC was associated with a significantly higher clearance probability relative to TA in the non-16/18 hrHPV subgroup, whereas LEEP did not differ significantly.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Results

    Other hrHPV types showed no significant differences except for HPV52 (P = 0.020) and HPV66 (P = 0.013), which were less frequent in the CKC group.

    “Other hrHPV types showed no significant differences except for HPV52 (P = 0.020) and HPV66 (P = 0.013), which were less frequent in the CKC group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    Untreated women had significantly lower clearance rates than TA-treated women for HPV31 (SHR = 0.56, 95% CI: 0.43-0.74; P < 0.001) and HPV33 (SHR = 0.65, 95% CI: 0.49-0.87; P = 0.0032).

    “However, untreated women had significantly lower clearance rates than women receiving TA for HPV31 (SHR = 0.56, 95% CI: 0.43–0.74; P < 0.001) and HPV33 (SHR = 0.65, 95% CI: 0.49–0.87; P = 0.0032).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Results

    HPV16 remained the most prevalent genotype (59.2%), showing significant variation by treatment (TA: 47.1%, LEEP: 57.6%, CKC: 78.6%; P = 0.039).

    “HPV16 remained the most prevalent genotype (59.2%), showing significant variation by treatment (TA: 47.1%, LEEP: 57.6%, CKC: 78.6%; P = 0.039).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    Premenopausal status was associated with increased clearance of overall hrHPV (SHR = 1.30; 95% CI: 1.13-1.50; P < 0.001) and non-16/18 hrHPV types (SHR = 1.24; 95% CI: 1.12-1.38; P < 0.001).

    “Among covariates, premenopausal status was associated with increased clearance of the overall hrHPV (SHR = 1.30; 95% CI: 1.13–1.50; P < 0.001) and non-16/18 hrHPV types (SHR = 1.24; 95% CI: 1.12–1.38; P < 0.001)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    Thermal ablation reached 41.7% (95% CI: 32.3%-51.0%) hrHPV clearance at 1 year, 82.4% (95% CI: 75.2%-89.6%) at 2 years, and 98.0% (95% CI: 93.5%-100.0%) by 5 years.

    “TA reached 41.7% (95% CI: 32.3%–51.0%) at 1 year, 82.4% (95% CI: 75.2%–89.6%) at 2 years, and 98.0% (95% CI: 93.5%–100.0%) by 5 years for overall hrHPV clearance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Results

    The thermal ablation group for CIN2/3 had a 1-year cure rate of 83.3% (95% CI: 73.4%-94.6%), which declined to 80.4% (95% CI: 69.5%-92.9%) by 3 years and remained stable through 5 years.

    “The TA group (n = 33) had a 1-year cure rate of 83.3% (95% CI: 73.4%–94.6%), which declined slightly to 80.4% (95% CI: 69.5%–92.9%) by 3 years, then remained stable through 5 years.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Results

    In the LEEP group for CIN3, the cure rate was 97.0% (95% CI: 91.3%-100.0%) at 1 year and sustained through 5 years.

    “In contrast, cure rates remained high after excisional treatments, as follows: 97.0% (95% CI: 91.3%–100.0%) at 1 year and sustained through 5 years in the LEEP group (n = 33); and 94.1% (95% CI: 83.6%–100.0%) at 1 year, which remained unchanged during subsequent follow-up in the CKC group (n = 17).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Results

    CKC was associated with a significantly higher clearance rate for non-16/18 hrHPV genotypes compared to TA (SHR 1.46, 95% CI: 1.09-1.96, P = 0.012), whereas LEEP showed no significant difference from TA (SHR 0.77, 95% CI: 0.58-1.02, P = 0.068).

    “Notably, CKC was associated with a significantly higher clearance rate for non-16/18 hrHPV genotypes compared to TA (SHR 1.46, 95% CI: 1.09–1.96, P = 0.012), whereas LEEP showed no significant difference from TA (SHR 0.77, 95% CI: 0.58–1.02, P = 0.068).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Results

    Non-16/18 hrHPV types were highly prevalent (>89%) with no difference by treatment (P = 0.414).

    “Non-16/18 hrHPV types were highly prevalent (>89 %) with no difference by treatment (P = 0.414).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    Multiple hrHPV infections were present in 38.0% of women with a normal cervix or CIN1, with no significant difference between TA-treated (32.8%) and untreated women (38.4%; P = 0.259).

    “Multiple hrHPV infections were present in 38.0% of women with a normal cervix or CIN1 (n = 1,654) with no significant difference between TA-treated (32.8%) and untreated women (38.4%; P = 0.259).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    The overall prevalence of non-16/18 hrHPV types was 59.2% with no significant variation by treatment (P = 0.293).

    “The overall prevalence of non-16/18 hrHPV types was 59.2% with no significant variation by treatment (P = 0.293).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    The 1-year cure rate in the CKC group for CIN2 was 94.4% (95% CI: 84.4%-100.0%) and remained unchanged thereafter.

    “The 1-year cure rate was 94.4% (95% CI: 84.4%–100.0%) in the CKC group (n = 18) and remained unchanged thereafter.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Discussion

    When CIN2 and CIN3 were combined, the study showed a 1-year cure rate of 83.2% (95% CI: 73.3%-94.5%), consistent with findings from Honduras (83.1%) and the Zambian trial (74.0%) but substantially higher than HIV-positive cohorts.

    “When CIN2 and CIN3 were combined, our study showed a 1-year cure rate of 83.2% (95% CI: 73.3%–94.5%), which was consistent with findings from Honduras (83.1% without residual or recurrent disease) and the Zambian trial (74.0%) but substantially higher than HIV-positive cohorts14,15,17”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [14]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [15]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [17]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data
    § Discussion

    TA achieved a long-term cure rate of 87.9% for CIN2 after a median follow-up of 36.4 months, comparable to LEEP (90.3%) and CKC (94.4%).

    “TA achieved a long-term cure rate of 87.9% for CIN2 after a median follow-up of 36.4 months among women with CIN2, which was comparable to LEEP (90.3%) and CKC (94.4%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Results

    HPV18 prevalence was low and consistent (7.5%, P = 0.662).

    “HPV18 prevalence was low and consistent (7.5%, P = 0.662).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    The prevalence of HPV16, HPV18, and other individual hrHPV types was similar between the TA and untreated groups (all P > 0.1).

    “The prevalence of HPV16, HPV18, and other individual hrHPV types was similar between the TA and untreated groups (all P > 0.1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    No significant differences were detected between treatment groups for HPV18 clearance (SHR = 1.04; 95% CI: 0.72-1.51; P = 0.834) or non-16/18 hrHPV types (SHR = 0.92; 95% CI: 0.84-1.00; P = 0.043).

    “In contrast, no significant differences were detected between treatment groups for HPV18 clearance (SHR = 1.04; 95% CI: 0.72–1.51; P = 0.834) or non-16/18 hrHPV types (SHR = 0.92; 95% CI: 0.84–1.00; P = 0.043).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction

    WHO guidance includes thermal ablation among the recommended treatment options for eligible pre-cancerous lesions in LMICs.

    “WHO guidance now includes TA among the recommended treatment options for eligible pre-cancerous lesions in LMICs9.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § Methods

    Variables with statistically significant between-group differences were included as covariates in a multivariable model.

    “In addition to treatment method, variables with statistically significant between-group differences were included as covariates in a multivariable model.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Introduction

    Excisional treatments (LEEP and CKC) provide a histologic specimen and have proven efficacy for CIN2+ but require trained clinicians, surgical equipment, and anesthesia.

    “Excisional treatments include loop electrosurgical excision procedure (LEEP) and cold knife conization (CKC), which provide a histologic specimen and have proven efficacy for CIN2+ but require trained clinicians, surgical equipment, and anesthesia.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Introduction

    Colposcopy-based triage can reduce overtreatment and support risk stratification but requires skilled personnel, multiple clinic visits, and laboratory or pathology capacity, which limit scalability in many LMICs.

    “Colposcopy-based triage can reduce overtreatment and support risk stratification but requires skilled personnel, multiple clinic visits, and laboratory or pathology capacity; these features limit scalability in many LMICs3.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Introduction

    Modified colposcopy-and-treat strategies can reduce loss to follow-up and improve programme efficiency.

    “Modified “colposcopy-and-treat” strategies, in which treatment is offered based on the colposcopic impression without histopathologic confirmation, can reduce loss to follow-up and improve programme efficiency4.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction

    Thermal ablation destroys abnormal tissue by heating the cervical transformation zone for 20-40 s, causing dehydration and coagulative necrosis of the epithelium and superficial stroma.

    “TA destroys abnormal tissue by heating the cervical TZ for 20–40 s, causing dehydration and coagulative necrosis of the epithelium and superficial stroma6.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data
    § Abstract

    Thermal ablation promotes hrHPV clearance, reducing progression risk.

    “TA provides durable efficacy for CIN1 and CIN2 and promotes hrHPV clearance, reducing progression risk.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data
    § Results

    TA-treated women in the HPV clearance analysis were younger, less often married, and less frequently postmenopausal than untreated women (P < 0.001 for each).

    “TA-treated women were younger (median age: 43.5 years, IQR: 38.0–48.0 years) than untreated women (median age: 48.0 years, IQR: 42.0–54.0 years; P < 0.001), less often married (82.8% vs. 93.9%; P < 0.001), and less frequently postmenopausal (13.9% vs. 35.4%; P < 0.001).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data
    § Results

    Among women with CIN2/3, age differed significantly by treatment (P = 0.022), with CKC-treated women oldest and TA-treated women youngest.

    “Among women with CIN2/3 (44.8 ± 8.4 years of age), age differed significantly by treatment (P = 0.022) with CKC-treated women were the oldest (48.0 years) and TA-treated women were the youngest (42.9 years).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction

    Population-based studies in rural areas of China have confirmed the effectiveness of HPV self-sampling combined with thermal ablation treatment.

    “Population-based studies in rural areas of China have confirmed the effectiveness of HPV self-sampling combined with TA treatment8.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § Methods

    Histologic findings were reviewed centrally at NCC/CHCAMS with p16INK4a immunohistochemistry applied to resolve equivocal cases.

    “The histologic findings were reviewed centrally at NCC/CHCAMS with p16INK4a immunohistochemistry applied to resolve equivocal cases.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Introduction

    Thermal ablation is safe and acceptable to patients.

    “Evidence to date indicates that TA is safe and acceptable to patients11.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning
    § Abstract

    Thermal ablation could enhance treatment accessibility in low-resource settings.

    “It could complement excisional treatments for CIN2 and enhance treatment accessibility in low-resource settings.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Introduction

    Most published data on thermal ablation are limited to short or intermediate follow-up, and robust evidence on long-term (>2 years) lesion outcomes remains sparse.

    “However, most published data are limited to short or intermediate follow-up and robust evidence on long-term (>2 years) lesion outcomes remains sparse12.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Results

    A slightly higher proportion of TA-treated women reported ≥2 sexual partners in the past 3 years compared to untreated women (4.9% vs. 1.8%; P = 0.048).

    “A slightly higher proportion reported ≥2 sexual partners in the past 3 years (4.9% vs. 1.8%; P = 0.048), while education and parity were similar between the groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data
    § Results

    In the CIN2/3 subgroup, median age did not differ significantly by treatment (P = 0.109), and marital status, education, menopausal status, parity, and sexual history were comparable across groups (all P > 0.05).

    “The median age was 45.0 years in the CIN2/3 subgroup (n = 147; TA: 34, LEEP: 85, CKC: 28) and did not differ significantly by treatment (P = 0.109). Marital status, education, menopausal status, parity, and sexual history were also comparable across groups (all P > 0.05).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data
    § Results

    Education and parity were similar between TA-treated and untreated women.

    “A slightly higher proportion reported ≥2 sexual partners in the past 3 years (4.9% vs. 1.8%; P = 0.048), while education and parity were similar between the groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Introduction

    Thermal ablation is portable, simple to perform, generally does not require anesthesia, uses no consumable supplies, and is relatively low cost compared to excisional methods, while demonstrating favorable short-term efficacy.

    “TA is portable, simple to perform, generally does not require anesthesia, uses no consumable supplies, and is relatively low cost compared to excisional methods, while demonstrating favorable short-term efficacy9,10.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [9]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [10]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Results

    In sensitivity analysis, the 5-year cumulative cure rates from the Fine-Gray competing risk model were highly consistent with the Kaplan-Meier estimates across treatment groups.

    “In the sensitivity analysis, the 5-year cumulative cure rates from the Fine–Gray competing risk model were highly consistent with the Kaplan–Meier estimates across treatment groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Discussion

    TA applied for 40 s typically achieves a tissue destruction depth of approximately 4.7 mm, whereas Peruvian data indicated that 6.5% of CIN3 excisional specimens extend to ≥5 mm.

    “TA applied for 40 s typically achieves a tissue destruction depth of approximately 4.7 mm19, whereas the Peruvian data indicated that 6.5% of CIN3 excisional specimens extend to ≥5 mm20.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [19]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [20]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § Discussion

    The definitions of cure rates differ between CIN1 and CIN2/3, and therefore the cure rates for these groups were not directly comparable.

    “Third, it should be noted that the definitions of cure rates differ between CIN1 and CIN2/3, and therefore the cure rates for these groups were not directly comparable.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning
    § Discussion

    The pattern of CKC having higher clearance for non-16/18 hrHPV may reflect the greater tissue depth or extent removed by excisional conization, potentially capturing occult infection beyond the ablation zone, though differences in case selection, lesion volume, or detection thresholds may also contribute.

    “This pattern may reflect the greater tissue depth or extent removed by excisional conization, potentially capturing occult infection beyond the ablation zone, though differences in case selection, lesion volume, or detection thresholds may also contribute.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationown data
    § Conclusions

    Overall, TA represents a viable alternative in resource-constrained settings where excisional treatments are unavailable, potentially expanding treatment coverage, reducing progression risk, and facilitating integration of screening and treatment.

    “Overall, TA represents a viable alternative in resource-constrained settings where excisional treatments are unavailable, potentially expanding treatment coverage, reducing progression risk, and facilitating integration of screening and treatment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning
    § Discussion

    Because there is currently no targeted therapy to promote HPV clearance, the findings indicate that TA may offer an additional advantage in facilitating hrHPV elimination, particularly for high-risk genotypes.

    “Furthermore, because there is currently no targeted therapy to promote HPV clearance, our findings indicated that TA may offer an additional advantage in facilitating hrHPV elimination, particularly for high-risk genotypes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given
    § Discussion

    This study was the first study to provide 5-year follow-up evidence supporting the long-term effectiveness of TA.

    “This study was the first study to provide 5-year follow-up evidence supporting the long-term effectiveness of TA.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning
    § Discussion

    The study was designed to evaluate the long-term outcomes of TA within a real-world clinical setting as a supplement method to conventional excisional treatments, so the findings predominantly reflected the effectiveness of TA under routine practice conditions.

    “Nevertheless, our study was designed to evaluate the long-term outcomes of TA within a real-world clinical setting as a supplement method to conventional excisional treatments.”
    • Also stated in: § Discussion · plain
      “Consequently, the findings predominantly reflected the effectiveness of TA under routine practice conditions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data
    § Discussion

    Overall, TA appears to enhance hrHPV clearance and lower the risk of persistent infection, showing particularly favorable outcomes in women with lower-grade lesions and infections with HPV16, HPV31, or HPV33.

    “Overall, TA appears to enhance hrHPV clearance and lower the risk of persistent infection, showing particularly favorable outcomes in women with lower-grade lesions and infections with HPV16, HPV31, or HPV33.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given
    § Discussion

    Treatment allocation was non-randomized and guided by lesion characteristics: TA was applied to type 1 TZ with a fully visible SCJ and lesions involving <75% of the TZ, whereas LEEP and CKC were used for more extensive disease or less fully visible zones.

    “First, treatment allocation was non-randomized and guided by lesion characteristics.”
    • Also stated in: § Discussion · plain
      “Specifically, TA was applied to type 1 TZ with a fully visible SCJ and lesions involving <75% of the TZ, whereas LEEP and CKC were used for more extensive disease or less fully visible zones.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data
    § Conclusions

    In this multicenter 5-year evaluation, TA had comparable performance to excisional methods (LEEP and CKC) for hrHPV clearance in CIN2/3 and achieved durable cure in CIN2 (>87%), despite limited effectiveness in CIN3.

    “In this multicenter 5-year evaluation across histologic grades of pre-cancerous cervical lesions, TA had comparable performance to excisional methods (LEEP and CKC) for hrHPV clearance in CIN2/3 and achieved durable cure in CIN2 (>87%), despite limited effectiveness in CIN3.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § Discussion

    Previous studies have shown that HPV16 and HPV33 are particularly difficult to clear, and among cytology-negative women, HPV16 and HPV31 carried the highest risk, followed by HPV18, HPV33, HPV58, and HPV52.

    “Previous studies have shown that HPV16 and HPV33 are particularly difficult to clear22,23 and among cytology-negative women, HPV16 and HPV31 carried the highest risk, followed by HPV18, HPV33, HPV58, and HPV5224.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [22]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [23]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [24]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data
    § Discussion

    hrHPV clearance was broadly comparable to that achieved by excisional methods among patients with CIN2/3, supporting the notion that TA may contribute to reducing recurrence and progression risk.

    “hrHPV clearance was broadly comparable to that achieved by excisional methods among patients with CIN2/3, supporting the notion that TA may contribute to reducing recurrence and progression risk.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given
    § Discussion

    All participants underwent baseline colposcopy-directed biopsy with histologic confirmation prior to treatment and were followed according to a standardized protocol that included colposcopy referral and biopsy when indicated, with cytology and HPV testing at each follow-up visit and histologic evaluation triggered by any abnormal result.

    “Unlike previous investigations, all participants in this study underwent baseline colposcopy-directed biopsy with histologic confirmation prior to treatment and were followed according to a standardized protocol that included colposcopy referral and biopsy when indicated.”
    • Also stated in: § Discussion · plain
      “Cytology and HPV testing were performed at each follow-up visit and any abnormal result triggered histologic evaluation.”
    Quote in the paperSubstantial claim
58 of 58

  • The paper relies on this without support.

    Few studies have reported cumulative hrHPV clearance or persistence rates beyond 2 years following thermal ablation.

    “Few studies have reported cumulative hrHPV clearance or persistence rates beyond 2 years following TA.”

  • The authors state this as an assumption.

    Loss to follow-up is non-informative and censoring is appropriate for the survival analyses.

    “Failure was defined as the event of interest and loss to follow-up was treated as censoring.”

  • The paper relies on this without support.

    No unmeasured confounding affects the comparison between thermal ablation and untreated women after adjustment for measured covariates.

    “In addition to treatment method, variables with statistically significant between-group differences were included as covariates in a multivariable model.”

  • The paper relies on this without support.

    Persistent HPV infection is a major driver of residual or recurrent CIN2/3 after treatment.

    “Persistent HPV infection is a major driver of residual or recurrent CIN2/3 after treatment.”

  • The paper relies on this without support.

    Untreated women with normal cervix or CIN1 are a valid comparator for estimating the effect of TA on hrHPV clearance.

    “TA achieved a higher cumulative hrHPV clearance among women with a normal cervix or CIN1 compared with no treatment (98.0% vs. 87.7%)”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Histologic confirmation is said to precede treatment but TA pathology was reviewed later

    Major

    The discussion states that baseline biopsy provided histologic confirmation before treatment for all participants. The treatment procedure instead says eligible women received immediate TA after biopsy and that histology was reviewed later.

  • Conflicting TA sample sizes for the combined CIN2/3 cure analysis

    Major

    The cure-analysis description includes 48 TA-treated women with CIN2/3, but the combined CIN2/3 cure results give the TA group as 33. That is also the separately reported CIN2 TA sample size, before adding CIN3.

  • Conflicting LEEP sample sizes for the combined CIN2/3 cure analysis

    Major

    The paper describes 99 LEEP-treated women with CIN2/3 in the cure analysis, but gives 84 for the combined CIN2/3 cure results.

  • Follow-up counts exceed the reported total

    Minor

    The reported follow-up counts by baseline histology are 81, 73, 117, and 65, totaling 336 women, not the stated 328 treated women with follow-up.

    Reported 328 · recomputed 336

4 of 4

No citation lists for this paper

Authors
Yuan, M., Zhao, X., Hu, S., Zhao, S., Pan, Q., Zhang, X., Duan, X., & Zhao, F.
Affiliations
  • Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
  • Beijing Tongren Hospital (CN)
ORCID
Venue
Cancer Biology & Medicine
Publisher
China Anti-cancer Association
Published
2026-06-05
Pages
1-18
ISSN
2095-3941 (ISSN-L)
DOI
10.20892/j.issn.2095-3941.2025.0415
OpenAlex
W7163750024
Cited by
0
References
0
FWCI
0.00
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Cancer Biology and Medicine (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Keywords
thermal ablation, cervical intraepithelial neoplasia, loop electrosurgical excision procedure, cold knife conization, HPV16, HPV 31, HPV 33, Chinese women, rural women, cervical cancer screening, treatment efficacy comparison, competing risk analysis, HPV genotyping

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-16.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-16.

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