Cervical biopsy

This page was reviewed under our medical and editorial policy by

Ruchi Garg, MD, Chair, Gynecologic Oncology, City of Hope Atlanta, Chicago and Phoenix

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. During pregnancy, 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 a biopsy may lead to early detection and a better prognosis.

This article will cover:

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.

Cancer cells most often develop in between these two areas in what'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, the 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 (ECC)

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.

Punch biopsy

This occurs when a circular piece of tissue is removed from the cervix for evaluation. To perform the procedure, the care team uses a specialized tool that looks like a hollow pen but has a circular scalpel on the end so the sample can be removed with a single movement.

How to prepare for a cervical biopsy

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 the doctor recommends.

Colposcopic biopsy procedure: 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, the patient may experience a small amount of bleeding or discharge.

Endocervical curettage procedure: 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 procedure: 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 a loop electrosurgical excision procedure (LEEP), the doctor removes the tissue sample with a heated wire loop that acts as a knife. It may be done under local anesthetic in the 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 doctor takes a tissue sample with a scalpel, similar to what is used during surgical procedures. Because of this, the patient may receive stronger anesthesia, such as general anesthesia that puts her to sleep, or spinal or epidural anesthesia.

Laser: During this procedure, the doctor uses laser energy to remove the cervical tissue.

Punch biopsy procedure: The doctor may use a dye to highlight areas of concern on the cervix. He or she then uses a small tool called punch biopsy forceps, which is hollow with a sharp, circular tip. The doctor turns the tool to the left and right so the tool will lower approximately 4 millimeters deep into the skin. The biopsy instrument is then removed with the sample inside of it. 

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

Does a cervical biopsy hurt?

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

Cervical biopsy side effects

Colposcopic and punch biopsy side effects: After a colposcopic or punch biopsy, the patient may experience side effects such as vaginal discharge that looks dark in color, due to a solution used to help decrease bleeding. She may also experience cramping or slight pain, along with some bleeding.

Cone biopsy side effects: Complications from a cone biopsy may include bleeding, infection or the cervix becoming scarred. A cone biopsy doesn't necessarily increase risk for developing fertility problems, but if the patient has had a larger amount of tissue removed, she may be at a higher risk of premature birth in a future pregnancy. Of all the methods for a cone biopsy, a LEEP seems to have fewer long-term side effects.

Cold knife excision side effects: This type of biopsy may have more complications, such as the risk for later miscarriage in the second trimester. The patient should make sure to tell the care team if she's had a cone biopsy and later becomes pregnant.

The cervical scarring may make menstrual cycles more painful. This procedure also carries a risk of premature birth if the patient becomes pregnant.

Cervical biopsy aftercare

The patient's recovery and the type of aftercare she needs will vary based on the type of cervical biopsy performed and whether she received anesthesia. Bleeding is common after most cervical biopsies. The patient may need to use a sanitary pad.

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

In the recovery room, the patient will be monitored if she received regional or general anesthesia. The patient should not drive following this procedure.

In the event that a patient experiences cramping, she should ask her doctor about appropriate pain medications, as some can increase the risk for bleeding. The doctor may suggest that the patient limits activity for a few days. Make sure to get a clear understanding about when it's safe to 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 discharge 
  • Fever and/or chills
  • Severe pain in the lower abdomen

Contact the care team if any of the above occur.

Cervical biopsy results

After the biopsy, the care team will share the test result. If no abnormal cells are found, the test result is considered normal. Cervical biopsy results may be back one to two days after the procedure, but in some instances, they may take longer. The care team may give the patient a clear idea of when to expect the results.

If it’s abnormal, changes in the patient's cervical cells have been found, and further follow-up is necessary. Treatment depends on the severity of these changes. The patient may need more tests, and the care team may provide a referral to a specialist that treats gynecologic cancer. If the patient is having treatment for cervical precancer or cancer, she may have colposcopies done periodically to see how the treatment is working or whether more abnormal cells develop.

What percentage of cervical biopsies are cancer?

Most cervical biopsies do not result in a cancer diagnosis. One study found that only 4.11 percent of cervical biopsies performed at a specific institution over a one-year period were cancerous. Talk to the care team to get specific information tailored to the patient’s symptoms, diagnosis and treatment.

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Show references
  • Canadian Cancer Society. Cone biopsy.
  • American College of Obstetricians and Gynecologists (2023, April). Loop Electrosurgical Excision Procedure (LEEP).
  • American Academy of Family Physicians (2022, August). Colposcopy.
  • American College of Obstetricians and Gynecologists (2022, August). Colposcopy.
  • Johns Hopkins Medicine. Cervical Biopsy.