Cervical Biopsy

(Biopsy-Cervix, Cervical Punch Biopsy, Cone Biopsy, Conization)

Procedure Overview

What is a cervical biopsy?

A cervical biopsy is a procedure performed to remove tissue from the cervix to test for abnormal or precancerous conditions, or cervical cancer.

The cervix is the lower, narrow part of the uterus (womb) located between the bladder and the rectum. It forms a canal that opens into the vagina, which leads to the outside of the body.

Types of cervical biopsies:

There are several types of cervical biopsies. In addition to removing tissue for testing, some of these procedures may be used to completely remove areas of abnormal tissue and may also be used for treatment of precancerous lesions.

Types of cervical biopsies include:

• punch biopsy - a surgical procedure to remove a small piece of tissue from the cervix. One or more punch biopsies may be performed on different areas of the cervix.
• cone biopsy or conization - a surgical procedure that uses a laser or scalpel to remove a large cone-shaped piece of tissue from the cervix
• endocervical curettage (ECC) - a surgical procedure in which a narrow instrument called a curette is used to scrape the lining of the endocervical canal, an area that cannot be seen from the outside of the cervix

Other related procedures that may be used to help diagnose and treat abnormal or cancerous cervical cells include loop electrosurgical excision procedure (LEEP), colposcopy, and Pap test. Please see these procedures for additional information.

What are female pelvic organs?

The organs and structures of the female pelvis are:

• endometrium - the lining of the uterus
• uterus - also called the womb, the uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. The uterus sheds it’s lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.
• ovaries - two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored and where the female sex hormones estrogen and progesterone are produced
• cervix - the lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body
• vagina - the passageway through which fluid passes out of the body during menstrual periods. Also called the "birth canal," the vagina connects the cervix and the vulva (the external genitalia)
• vulva - the external portion of the female genital organs

Reasons for the Procedure

A cervical biopsy may be performed when cervical abnormalities are found during a pelvic examination, or abnormal cells are found during a Pap test. A cervical biopsy is often performed as part of a colposcopy procedure, also called a colposcopy-guided cervical biopsy. A colposcopy is a procedure that uses a colposcope, an instrument with a special lens to magnify the cervical tissues.

A cervical biopsy may be performed to detect cancer of the cervix or precancerous lesions of the cervix. Cells that appear to be abnormal, but are not cancerous at the present time, are identified as precancerous. The appearance of these abnormal cells may be the first evidence of cancer that may develop years later.

A cervical biopsy may also be used to diagnose and assist in the treatment of the following conditions:

• polyps (benign growths) on the cervix
• genital warts, which may indicate infection with human papilloma virus (HPV), a risk factor for developing cervical cancer
• diethylstilbestrol (DES) exposure in women whose mothers took DES during pregnancy, as DES exposure increases the risk for cancer of the reproductive system

There may be other reasons for your physician to recommend a cervical biopsy.

Risks of the Procedure

As with any surgical procedure, complications may occur. Some possible complications may include, but are not limited to, the following:

• infection
• bleeding

In addition, cone biopsies may increase the risk for infertility (the inability to become pregnant) and miscarriage because of the changes and scarring in the cervix that may occur as a result of the procedure.

Patients who are allergic to or sensitive to medications, iodine, or latex should notify their physician.

If you are pregnant or suspect that you may be pregnant, you should notify your physician. Some types of cervical biopsies can be done during pregnancy, while others cannot.

If possible, a cervical biopsy will be scheduled approximately one week after your menstrual period.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Certain factors or conditions may interfere with a cervical biopsy. These factors include, but are not limited to, the following:

• menstruation
• acute pelvic inflammatory disease
• acute inflammation of the cervix

Before the Procedure

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• Generally, no prior preparation, such as fasting or sedation, is required for a simple cervical biopsy. If your biopsy requires regional or general anesthesia, you may need to fast for a certain number of hours before the procedure, generally after midnight.
• If you are pregnant or suspect that you are pregnant, you should notify your physician.
• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, iodine, and anesthetic agents (local and general).
• Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• You should not use tampons, vaginal creams or medications, douche, or have sexual relations for 24 hours before the procedure.
• Your physician may recommend that you take a pain reliever 30 minutes before the procedure, or you may be given a sedative before the anesthesia is started. You will need someone to drive you home afterwards.
• You may want to bring a sanitary napkin to wear home after the procedure.
• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

A cervical biopsy may be performed in a physician’s office, on an outpatient basis, or as part of your stay in a hospital. Some biopsy procedures only require local anesthesia, while others require a regional or general anesthesia. Procedures may vary depending on your condition and your physician’s practices.

Generally, a cervical biopsy follows this process:

1. You will be asked to undress completely or from the waist down and put on a hospital gown.
2. You will be instructed to empty your bladder prior to the procedure.
3. You will lie on an examination table, with your feet and legs supported as for a pelvic examination.
4. Your physician will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
5. Often, the physician will use a colposcope, an instrument with a special lens similar to a microscope, to magnify the cervical tissues. The colposcope will be placed at the opening of your vagina but does not enter your vagina.
6. Your physician will look through the colposcope to locate any problem areas on the cervix or in the vagina. Photographs with the colposcope or sketches of the areas on your cervix may be made for your healthcare record.
7. Your cervix may be cleansed and soaked with a vinegar solution, also called an acetic acid solution. This solution helps make the abnormal tissues turn white and become more visible. You may feel a mild burning sensation. An iodine solution may be used to coat the cervix, called the Schiller test.
8. The type of biopsy performed will be determined by the size, shape, location, and other characteristics of the abnormalities.
9. The physician may numb the area using a small needle to inject medication.
10. A type of forceps called a tenaculum may be used to hold the cervix steady for the biopsy. You may feel some cramping when the tenaculum is applied.
11. The amount and location of tissue removed depends on the type of biopsy. For a simple cervical biopsy, sometimes called a punch biopsy, one or more small samples of tissue will be removed using a special type of forceps. When this is performed, you may feel a slight pinch or cramp. Cells from the inside of the cervical canal may be sampled with a special instrument called an endocervical curette. This may also cause some cramping.
12. For a cone biopsy, in which a larger cone-shaped piece of tissue is removed from the cervix, the loop electrosurgical excision procedure (LEEP) or the cold knife cone biopsy procedure may be used. With the cold knife cone biopsy, a laser or a surgical scalpel may be used to remove tissue. This procedure requires the use of regional or general anesthesia.
13. Bleeding from the biopsy site may be treated with a paste-like topical medication. Electrocauterization (use of a probe with high frequency electrical signals to stop bleeding) or sutures may be used in some cases.
14. After a cone biopsy, the cervix may be packed with a pressure dressing. Your physician will instruct you on removal of this packing.
15. The tissue will be sent to a lab for examination.

After the Procedure

The recovery process will vary depending upon the type of biopsy performed and if anesthesia was administered.

If you received regional or general anesthesia, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. If this procedure was performed on an outpatient basis, you should plan to have another person drive you home.

After a simple biopsy, you may rest for a few minutes after the procedure before going home.

You may want to wear a sanitary pad for bleeding. It is normal to have some mild cramping, spotting, and dark or black-colored discharge for several days. The dark discharge is from the medication applied to your cervix to control bleeding.

Take a pain reliever for cramping as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

You may be instructed not to douche, use tampons, or have intercourse for one week after a biopsy procedure, or for a period of time recommended by your physician.

After a cone biopsy, you should not insert anything into your vagina until your cervix has healed, which may take several weeks. You may also have other restrictions on your activity, including no heavy lifting.

You may resume your normal diet unless your physician advises you differently.

Your physician will advise you on when to return for further treatment or care. Generally, women who have had a cervical biopsy will need more frequent Pap tests.

Notify your physician if you have any of the following:

• bleeding
• foul-smelling drainage from your vagina
• fever and/or chills
• severe lower abdominal pain

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.