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Cervical biopsy overview

This page was reviewed under our medical and editorial policy by

Ruchi Garg, MD, CTCA Program Director, Gynecologic Oncology.

This page was reviewed on November 17, 2021.

The cervix is located at the lower end of the uterus, where it opens into the vaginal canal. It helps protect the uterus from outside germs, and it makes different types of mucus depending on the stage of the menstrual cycle. It also helps to keep the fetus in the uterus. Before cancer develops, cells in the cervix start to change. Given time, without treatment, these abnormal cells have the potential to turn into cancer, which is why early detection may help provide a better prognosis.

What is a cervical biopsy?

A cervical biopsy is a procedure in which a small sample of tissue is removed from the cervix and the cells are examined under a microscope for abnormalities. Cervical biopsies are used to diagnose cancer or precancerous cervical cells.

The cervix contains two parts: the endocervix and the exocervix.

  • The endocervix is the upper part that leads to the uterus.
  • The exocervix is the lower area that’s exposed to the vaginal canal.

In between these two areas is where cancer cells most often develop—it’s called the “transformation zone.” In order to properly diagnose cervical cancer, doctors perform a biopsy of this tissue if a Pap smear yielded abnormal results.

 

Types of cervical biopsy

Colposcopic biopsy

A colposcope is an instrument that gives doctors extra light and magnification to see the tissues of the vagina and cervix more clearly, but it doesn't go inside the vagina. Instead, your doctor places it just outside of the vagina to get the clearest view possible. If an area of concern is detected using this colposcope, the doctor typically takes a biopsy of the cervical tissue using a different instrument.

Endocervical curettage

Endocervical curettage, also known as endocervical scraping and is performed as part of the colposcopic exam, especially if the cervix appears abnormal. It's also done when the transformation zone isn’t visible with a colposcopy.

Cone biopsy: Also known as conization, this is when a piece of tissue shaped like a cone is removed from the cervix for testing. The cone may include tissue from both the endocervix, as the point of the cone, and the exocervix, as the base. The sample may also include the transformation zone. This type of biopsy is used to remove precancers completely and even treat cancer if it's in an early stage. Cone biopsies are performed using either a scalpel or laser.

How to prepare

For any type of cervical biopsy, doctors may provide instructions on how to best prepare.

For a colposcopic biopsy, patients are urged to:

  • Refrain from using any medications, creams or powders in or around the vagina for 24 to 48 hours.
  • Avoid vaginal intercourse or tampons for 24-48 hours before and after the procedure.
  • Ask about taking over-the-counter medications for pain before the procedure.
  • Make sure not to schedule a biopsy during the menstrual cycle because it may skew results.
  • Inform the doctor in the event of pregnancy.

What to expect during the procedure

The process for a cervical biopsy depends on what type your doctor recommends.

Colposcopic biopsy: The doctor looks for abnormal areas in the cervix through a colposcope. Using forceps meant for biopsies, the doctor removes a small area on the surface of the cervix for testing. A colposcopic biopsy may cause some cramping and possibly brief pain. Afterward, you may experience a small amount of bleeding or discharge.

Endocervical curettage: The doctor inserts a small, thin tool—either a curette (which looks like a narrow spoon) or a brush— into the endocervical area. This tool is then gently scraped against the walls of the cervical canal, removing some of the tissue. Similar to a colposcopic biopsy, this may cause light cramping and bleeding.

Cone biopsy: A colposcope is used to help guide the instruments to retrieve the sample. A cone biopsy may be performed in one of three ways:

  • LEEP: During this procedure, the doctor removes the tissue sample with a heated wire loop that acts as a knife. It may be done under local anesthetic in your doctor's office. This may also be called large loop excision of the transformation zone (LLETZ).
  • Cold knife cone biopsy: This procedure is done in a hospital, and instead of a heated wire, the tissue sample is taken with a scalpel, similar to those used during surgical procedures. Because of this, you may receive stronger anesthesia, such as general anesthesia that puts you to sleep, or spinal or epidural anesthesia.
  • Laser: During this procedure, your doctor will use laser energy to remove the cervical tissue.

You may be given a local anesthetic, either through an intravenous (IV) line in your arm or by mouth. With general anesthesia, you stay in a recovery room after the procedure until it's safe for you to go home.

Does a cervical biopsy hurt?

You may experience some pain during and after your cervical biopsy. Pain will vary based on the type of procedure that you undergo. During a colposcopy, for example, the doctor applies a vinegar or iodine solution to your cervix, and this may cause burning or stinging. During LEEP or LLETZ, local anesthesia is used to minimize any discomfort.

Cervical biopsy side effects

After a colposcopic biopsy, you may experience side effects such as vaginal discharge that looks dark in color, due to a solution used to help decrease bleeding. You may also experience cramping or slight pain, along with some bleeding.

Complications from a cone biopsy may include bleeding, infection or the cervix becoming scarred. A cone biopsy doesn't necessarily come with an increased risk of fertility problems, but if you've had a larger amount of tissue removed, you may be at a higher risk of premature birth. Of all the methods for a cone biopsy, a LEEP seems to have fewer long-term side effects.

Cold knife excision may have more complications, such as the risk for miscarriage in the second trimester. Make sure to tell your doctor if you’ve had a cone biopsy and are now pregnant.

The cervical scarring could make your menstrual cycles more painful. This procedure also carries a risk of premature birth if you become pregnant.

Cervical biopsy aftercare

Your recovery and the type of care you need after the procedure also vary based on the type of cervical biopsy and whether you received anesthesia. Bleeding is common after most cervical biopsies. You may need to use a sanitary pad.

If you undergo a colposcopy with a biopsy, expect some pain—and possibly vaginal bleeding and/or dark discharge—for a few days after the procedure.

In the recovery room, you’re monitored if you received regional or general anesthesia. You should not drive following this procedure.

In the event you experience cramping, ask your doctor about appropriate pain medications, as some can increase your risk for bleeding. Your doctor may suggest that you limit your activity for a few days. Make sure you are clear about when you can start exercising again.

Other instructions may include not using douches or tampons, and/or not having sex for a period of time.

Some red flags that may indicate a complication requiring medical attention include:

  • Bleeding
  • Foul-smelling vaginal drainage
  • Fever and/or chills
  • Severe pain in your lower abdomen

You should contact your doctor if you experience any of the above.

Cervical biopsy results

After the biopsy, your doctor will share the test result. If no abnormal cells were found, the test result is considered normal.

If it’s abnormal, that means there have been changes in your cervical cells, and further follow-up is necessary. Treatment depends on the severity of these changes. You may need more tests, and your doctor may refer you to a specialist that treats gynecologic cancer. If you're having treatment for cervical precancer or cancer, you may have colposcopies done periodically to see how the treatment is working or whether more abnormal cells develop.

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