A colposcopy is a specialized procedure conducted to closely examine the cervix, vagina, and vulva after an initial screening test, such as a Pap smear, indicates the presence of abnormal cells. The procedure uses a colposcope, which is a magnifying instrument with a bright light source that remains outside the body. This device allows a healthcare provider to obtain a highly magnified and illuminated view of the tissue surfaces. The primary goal is to investigate concerning results and visually distinguish normal tissue from abnormal areas, which may represent precancerous changes.
Factors Determining the Number of Biopsies
The number of biopsies taken during a colposcopy is determined by the findings of the visual examination. Tissue sampling is highly selective, known as a directed biopsy, meaning the provider targets only the specific areas that appear abnormal under magnification. Before the biopsy, solutions like dilute vinegar (acetic acid) or iodine (Lugol’s or Schiller’s) are applied to the cervix to help identify these areas.
Acetic acid causes areas with abnormal cell density to temporarily turn white (acetowhitening), making them clearly visible against the normal pink tissue. The iodine solution (Schiller’s test) works similarly, staining healthy cells brown while abnormal cells remain unstained. These aids guide the provider to the precise locations requiring sampling.
While some patients may not require any biopsy, most procedures involve the collection of one to three tissue samples. Taking multiple biopsies, especially two or three, significantly increases the sensitivity for detecting high-grade lesions. The objective is to sample the most suspicious area and often multiple distinct sites to confirm the extent of the abnormality.
The Biopsy Process: What to Expect During Tissue Collection
Tissue collection is performed using specialized punch biopsy forceps, which remove a small, circular piece of tissue from the cervix, vagina, or vulva. The colposcope is used throughout this process to ensure the forceps are precisely positioned on the most abnormal-appearing area.
Patients often report feeling a brief, sharp pinch or mild, menstrual-like cramping when the sample is taken. Because the cervix has few nerve endings, local anesthetic is rarely used for standard cervical biopsies. If the biopsy is taken from the vulva or vagina, which have more nerve endings, a local anesthetic is typically applied first.
Immediately after tissue removal, the provider applies a solution to the biopsy site to control minor bleeding. Common agents include Monsel’s paste (a ferric subsulfate solution) or silver nitrate. These solutions act quickly to stop bleeding. Light spotting or a dark, coffee-ground-like vaginal discharge is common for a few days afterward, resulting from the hemostasis solution.
Interpreting the Biopsy Results and Next Steps
The collected tissue samples are sent to a pathology laboratory for microscopic examination, a process that typically takes one to two weeks. The pathologist determines the presence and severity of cellular changes. The most common terminology used to describe abnormal results is Cervical Intraepithelial Neoplasia (CIN).
CIN is graded on a scale of 1 to 3, reflecting the severity and depth of abnormal cell growth, sometimes referred to as dysplasia. CIN 1 indicates a low-grade abnormality where changes are limited to the bottom third of the surface lining. These low-grade changes frequently resolve on their own, and follow-up often involves monitoring with repeat screening tests or colposcopy.
CIN 2 and CIN 3 represent higher-grade changes, extending through two-thirds or more of the lining, respectively. Although CIN 3 is considered a severe pre-cancerous condition, it is not yet cancer. High-grade results (CIN 2 and CIN 3) generally require treatment to remove the abnormal tissue, such as a Loop Electrosurgical Excision Procedure (LEEP), preventing progression to cervical cancer.