CO <sub>2</sub> laser therapy versus topical imiquimod for the treatment of vulvar high‐grade intraepithelial lesions: A retrospective cohort study
Bibliographic record
Abstract
Abstract Objectives To compare topical imiquimod with CO 2 laser therapy for the treatment of a first episode of vulvar high‐grade squamous intraepithelial lesions (vHSIL), to identify serious adverse effects of both treatment modalities, and to examine risk factors for treatment failure. Methods This retrospective chart‐based cohort study included 47 patients initially treated with topical imiquimod or CO 2 laser therapy between 2017 and 2021. The primary outcome was treatment failure, defined as the need for repeat treatment. Cumulative incidence curves were used to compare the probability of treatment failure over time by treatment group. Potential risk factors for treatment failure, including age, treatment type, lesion focality, and smoking, were examined using Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs). Results Sixty‐six percent (31/47) of patients were initially treated with topical imiquimod and 34% (16/47) with CO 2 laser. Both groups were similar in age, lesion focality, human papillomavirus vaccination, and smoking status. During a follow‐up of 62.3 person‐years, 52% (16/31) of patients treated with imiquimod and 56% (9/16) of patients treated with CO 2 laser experienced treatment failure. Age over 52 years was associated with a higher risk of treatment failure (aHR 3.07, 95% CI 1.25–7.53). The association was positive but not significant for multifocal versus unifocal lesions and for smokers versus non‐smokers. No serious adverse effects were observed with either treatment modality. Conclusion Topical imiquimod has similar efficacy and safety to CO 2 laser therapy for initial the treatment of vHSIL. Older age is associated with an increased risk of treatment failure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".