Robert Wood Johnson University Hospital
 

Cervical Biopsy

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:

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?

Illustration of the anatomy of the female pelvic area
Click Image to Enlarge

The organs and structures of the female pelvis are:

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 positive test for human papillomavirus (HPV), a sexually transmitted infection, may also be a reason for cervical biopsy. Certain types of HPV can cause cervical cancer and other less common types of genital cancers.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:

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:

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:

Before the Procedure

During the Procedure

Illustration of a cervical biopsy procedure
Click Image to Enlarge

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 or an endocervical brush . 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:

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

Online Resources

The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding your condition.

This page contains links to other Web sites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these Web sites, nor do these sites endorse the information contained here.

American Cancer Society

American College of Obstetricians and Gynecologists

American Society for Colposcopy and Cervical Pathology

National Cancer Institute (NCI)

National Institutes of Health (NIH)

National Library of Medicine

National Women's Health Information Center

 

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