Cervical Biopsy

What is a cervical biopsy?

A cervical biopsy is a procedure 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. It forms a canal that opens into the vagina.

Cervical biopsies can be done in several ways. The biopsy can remove a sample of tissue for testing. It can also be used to completely take out abnormal tissue. It can also treat cells that may turn into cancer.

Types of cervical biopsies include:

• Punch biopsy. This procedure uses a circular blade, like a paper hole puncher, to remove a tissue sample. One or more punch biopsies may be done on different areas of the cervix.

• Cone biopsy. This procedure uses a laser, electrical loop, or scalpel to remove a large cone-shaped piece of tissue from the cervix.

• Endocervical curettage (ECC). This procedure uses a narrow instrument called a curette to scrape the lining of the endocervical canal. This is an area that can’t be seen from the outside of the cervix.

Why might I need a cervical biopsy?

A cervical biopsy may be done when abnormalities are found during a pelvic exam. It may also be done if abnormal cells are found during a Pap test. A positive test for human papillomavirus (HPV) may also call for cervical biopsy. HPV is a type of sexually transmitted infection (STI). Certain types of HPV can cause cervical cancer and other less common types of genital cancers. A cervical biopsy is often done as part of a colposcopy. This is also called a colposcopy-guided cervical biopsy. A colposcopy uses an instrument with a special lens to look at the cervical tissues.

A cervical biopsy may be done to find cancer or precancer cells on the cervix. Cells that appear to be abnormal, but are not yet cancerous, are called precancerous. These abnormal cells may be the first sign of cancer that may develop years later.

A cervical biopsy may also be used to diagnose and help treat these conditions:

• Noncancerous growth (polyps) on the cervix

• Genital warts. These may mean that you have an infection with HPV. HPV is a risk factor for cervical cancer.

• Diethylstilbestrol (DES) exposure if your mother took DES during pregnancy. DES raises the risk for cancer of the reproductive system.

Your healthcare provider may have other reasons to recommend a cervical biopsy.

What are the risks of a cervical biopsy?

Some possible complications may include:

• Infection

• Bleeding

In addition, cone biopsies may increase the risk for infertility and miscarriage. This is because of the changes and scarring in the cervix that may happen from the procedure.

Tell your healthcare provider if:

• You are allergic to or sensitive to medicines, iodine, or latex.

• You are pregnant or think you could be pregnant. Some types of cervical biopsies can be done during pregnancy, but others can't.

If possible, a cervical biopsy will be scheduled about 1 week after your period.

You may have risks depending on your specific health condition. Be sure to talk with your provider about any concerns you have before the procedure.

Certain things can make a cervical biopsy less accurate. These include:

• Menstruation

• Acute (active) pelvic inflammatory disease

• Acute inflammation of the cervix

How do I get ready for a cervical biopsy?

• Your healthcare provider will explain the procedure and you can ask questions.

• 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.

• You usually don't need to stop eating or drinking before a simple cervical biopsy. If you need anesthesia, you may need to fast for a certain number of hours before the procedure. This is usually after midnight.

• Tell your provider if you are pregnant or think you could be.

• Tell your provider if you are sensitive to or are allergic to any medicines, latex, tape, or anesthetic medicines (local and general).

• Tell your provider about all medicines you are taking. This includes prescriptions, over-the-counter medicines, and herbal supplements.

• Tell your provider if you have had a bleeding disorder. Also tell your provider if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop taking these medicines before the test.

• Don't use tampons, vaginal creams or medicines, or douche for 24 hours before the procedure.

• Don't have sex for 24 hours before the procedure.

• Your healthcare provider may tell you to take a pain reliever 30 minutes before the procedure. Or you may be given medicine to help you relax before the anesthesia is started. You will need someone to drive you home afterward.

• You may want to bring a sanitary pad to wear home after the procedure.

• Follow any other instructions your provider gives you to get ready.

What happens during a cervical biopsy?

You may have a cervical biopsy in a healthcare provider’s office, as an outpatient, or during a hospital stay. Some biopsy procedures only need local anesthesia. Other need regional or general anesthesia. The way the test is done may vary depending on your condition and your healthcare provider's practices.

Generally, a cervical biopsy follows this process:

1. You will need to undress completely or from the waist down and put on a hospital gown.

2. You will be told to empty your bladder before the procedure.

3. You will lie on an exam table, with your feet and legs supported as for a pelvic exam.

4. Your healthcare provider will put an instrument called a speculum into your vagina. This will spread the walls of the vagina apart to reach the cervix.

5. Often the healthcare provider will use a colposcope. This is an instrument with a special lens like a microscope to help see the cervical tissues. The provider will put colposcope at the opening of your vagina. It won't enter your vagina.

6. Your healthcare provider will look through the colposcope to find any problem areas on the cervix or in the vagina.

7. They may clean and soak the cervix with a vinegar solution (acetic acid solution). This solution helps make the abnormal tissues turn white so they are easier to see. You may feel a mild burning sensation. An iodine solution may be used to coat the cervix. This is called the Schiller test.

8. The type of biopsy done will depend on the size and shape of the abnormal cells, as well as where they are.

9. The healthcare provider may numb the area using a small needle to inject medicine.

10. They may use forceps to hold the cervix steady for the biopsy. You may feel some cramping when it's put in place.

11. The amount of tissue removed and where it's removed depend on the type of biopsy. For a simple cervical biopsy, one or more small samples of tissue will be removed using a special type of forceps. When this is done, you may feel a slight pinch or cramp. Cells from the inside of the cervical canal may be removed with a special tool called an endocervical curette or an endocervical brush. This may also cause some cramping.

12. For a cone biopsy, the provider may use a loop electrosurgical excision procedure (LEEP) or the cold knife cone biopsy procedure. With the cold knife cone biopsy, a laser or a surgical scalpel may be used to remove tissue. This procedure needs regional or general anesthesia.

13. Bleeding from the biopsy site may be treated with a paste-like topical medicine. The provider may also use a probe (electrocauterization) or stitches (sutures) to stop the bleeding.

14. After a cone biopsy, the provider may pack the cervix with a pressure dressing. Your provider will tell you how to remove this packing.

15. The provider will send the tissue to a lab for testing.

What happens after a cervical biopsy?

Your recovery will depend on the type of biopsy done and if you had anesthesia.

If you have regional or general anesthesia, you will be taken to the recovery room to be watched. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged home. If you had the procedure done as an outpatient, you should plan to have someone 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's normal to have some mild cramping, spotting, and dark or black-colored discharge for several days. The dark discharge is from the medicine put on your cervix to control bleeding.

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

You may be told not to douche, use tampons, or have sex for 1 week after a biopsy, or for a period advised by your healthcare provider.

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

You may go back to your normal diet unless your healthcare provider tells you otherwise.

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

Tell your healthcare provider if you have:

• Bleeding

• Foul-smelling drainage from your vagina

• Fever or chills

• Severe lower abdominal pain

Your healthcare provider may give you other instructions after the procedure, depending on your situation.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure