A cervical biopsy is a procedure that involves removing a small sample of tissue from the cervix. This diagnostic step is typically recommended after initial screening tests, such as a Pap smear or Human Papillomavirus (HPV) test, have shown the presence of abnormal or precancerous cells. By analyzing the tissue sample, healthcare providers can definitively diagnose conditions like inflammation, dysplasia, or cervical cancer.
Preparing for the Biopsy
It is advised to schedule the biopsy when the patient is not menstruating, as blood can interfere with sample analysis. For 24 to 48 hours before the appointment, patients must refrain from placing anything into the vagina, including tampons, douches, or creams. Sexual intercourse should also be avoided.
Patients must communicate with their provider about all current medications, especially blood thinners like aspirin or certain non-steroidal anti-inflammatory drugs, as these can increase the chance of bleeding and may need to be temporarily stopped. Patients should also disclose any known allergies, a history of bleeding disorders, and the possibility of pregnancy. To manage potential discomfort, the provider may suggest taking an over-the-counter pain reliever, such as acetaminophen, about 30 minutes before the procedure.
Different Methods of Cervical Biopsy
The method chosen depends on the location and extent of the abnormal cells found. A common technique is the Punch Biopsy, often performed during a colposcopy. This involves using specialized forceps to pinch and remove tiny circular pieces of tissue from the outer surface of the cervix.
Another method is Endocervical Curettage (ECC), which involves scraping tissue from the endocervical canal. A curette or specialized brush is inserted into the canal to gently collect cells that may not be visible externally. ECC is often performed with a punch biopsy, especially if the transformation zone, where most abnormal changes occur, cannot be fully seen.
The most extensive procedure is the Cone Biopsy, also known as conization, which removes a larger, cone-shaped wedge of tissue from the cervix. This method is used when a deeper sample is needed or when prior biopsies were inconclusive. Cone biopsies can be performed using a surgical scalpel (cold knife conization) or an electrically heated wire loop (Loop Electrosurgical Excision Procedure, or LEEP). The cone biopsy can also act as a treatment to fully remove precancerous or early-stage cancerous tissue.
What to Expect During the Appointment
The patient is positioned on an examination table with their feet in stirrups. The provider inserts a speculum to hold the vaginal walls open and allow access to the cervix. If a colposcopy is used, a magnifying instrument is positioned near the opening to provide a magnified view of the cervical surface.
The cervix is typically washed with diluted acetic acid, commonly known as vinegar, which causes abnormal cells to briefly turn white. An iodine solution (Schiller’s test) may also be applied, as healthy tissue stains brown while abnormal areas do not. A local anesthetic may be injected into the cervix to minimize discomfort before the tissue is removed.
When tissue is sampled, the patient may feel pressure or a brief, sharp pinch, accompanied by cramping similar to menstrual cramps. After the sample is taken, a chemical agent like Monsel’s paste or silver nitrate is applied to the site to stop bleeding. While most biopsies are outpatient procedures, a cone biopsy is more involved, often requiring general anesthesia and being carried out in a hospital setting.
Post-Procedure Care and Recovery
Mild cramping, manageable with pain relievers, is a common side effect. Light spotting or bleeding for a few days is typical; patients should use sanitary pads instead of tampons to prevent infection. A dark discharge is also common, resulting from the styptic solution applied to control bleeding.
To allow the cervix time to heal, patients are advised to avoid strenuous exercise, heavy lifting, douching, and swimming for a defined period. Restrictions on placing anything in the vagina, including tampons and sexual intercourse, often last one week for a punch biopsy, but may extend to four to six weeks following a cone biopsy. Patients should seek medical attention if they experience:
- Heavy bleeding that soaks through a pad every hour.
- A fever or chills.
- Severe lower abdominal pain.
- Foul-smelling vaginal discharge.
Receiving and Understanding the Results
The tissue sample is sent to a pathology laboratory for examination under a microscope. Results are typically available within a few days to a week. The pathology report classifies the findings, which may indicate normal cells, inflammation, or varying degrees of abnormal cell changes.
Precancerous changes are often described using the term Cervical Intraepithelial Neoplasia (CIN), which is graded by severity. CIN 1 indicates mild changes that frequently resolve on their own. CIN 2 and CIN 3 represent moderate to severe changes that are more likely to require treatment. These results guide the healthcare provider in determining the appropriate follow-up care or treatment plan.