Cervical Biopsy Procedure and Management

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?

  • 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 (also called the birth canal). The passageway through which fluid passes out of the body during menstrual periods. The vagina connects the cervix and the vulva (the external genitalia).
  • Vulva. The external portion of the female genital organs.
  • Fallopian tubes. Two thin tubes that extend from each side of the uterus, toward the ovaries as a passageway for eggs and sperm.

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:

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 doctor 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 doctor.

If you are pregnant or suspect that you may be pregnant, you should notify your health care provider. 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 on your specific medical condition. Be sure to discuss any concerns with your health care provider 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

Preparing for Cervical Biopsy

Schedule your cervical biopsy for the week following your period. This will make it easier for your doctor to get a clean specimen. Discuss any medication you take with your gynecologist.

You may be asked to stop taking medications that could increase your risk of bleeding, such as:

  • aspirin
  • ibuprofen
  • naproxen
  • warfarin

Avoid using tampons, douches, or medicated vaginal creams for 24 hours before your biopsy. You should also refrain from having sexual intercourse during this time.

If you are undergoing a cone biopsy or another form of cervical biopsy that requires a general anesthetic, you will need to fast after midnight, or at least eight hours before the procedure.

On the day of your appointment, your doctor might suggest you take acetaminophen or another pain reliever before you come to the office. Pack some feminine pads to wear after the biopsy in the event of light bleeding. Bring a family member or friend to drive you home.

Cervical Biopsy Procedure

The appointment will begin as a normal pelvic exam. You’ll lie on an exam table with your feet in stirrups. Your doctor will administer a local anesthetic. In the event of a cone biopsy, a general anesthetic that will put you to sleep.

Then, the doctor will insert a speculum into the vagina to keep the canal open during the procedure. The cervix is first washed with a solution of vinegar and water, and may be swabbed with iodine.

This is called a Schiller test, and is used to help your doctor identify the abnormal tissues. The cleansing process may burn a bit, but should not be painful.

The doctor will remove the abnormal tissues with forceps, a scalpel, or a curette. You might feel a slight pinching sensation as the tissue is removed during a punch biopsy.

After the biopsy is finished, your doctor may pack your cervix with absorbent material to reduce the amount of bleeding you experience. Not every biopsy requires packing.

Recovery from Cervical Biopsy

Expect some mild cramping and spotting as you recover from your cervical biopsy. Cramping and bleeding can run for as long as a week in some cases.

Simple punch biopsies are outpatient procedures, meaning you can go home the same day. Other procedures may require you to remain in the hospital overnight.

Activities may be restricted, depending on the type of biopsy you have undergone. Heavy lifting, sexual intercourse, and the use of tampons and douches are prohibited for several weeks after a cone biopsy.

Adhere to the same restrictions for punch biopsies and ECC procedures, but for only one week.

Let your doctor know if you:

  • feel pain
  • develop a fever
  • experience heavy bleeding
  • foul-smelling vaginal discharge

These symptoms can be signs of infection.

Results

Results of a Cervical Biopsy
Your medical care team will notify you of your biopsy results and discuss next steps with you. Findings of cancer or precancerous cells may require further treatment. A negative test means that everything is normal, and most often no further action is required.

Source & More  Info: John Hopkins Medicine and Healthline

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