Definition and Overview
A cervical biopsy is a gynecologic procedure used to obtain a tissue sample from the cervix, which is then examined under the microscope to check for abnormalities and signs of disease. This test is most commonly done to diagnose cancer or to assess a woman’s risk for cervical cancer. This is, however, not a purely diagnostic procedure as it can also be used to remove abnormal tissue from the cervix as well as to administer treatment to precancerous cells.
There are different methods used in performing cervical biopsies, namely, punch biopsy, cone biopsy, or endocervical curettage. Like any other medical procedure, there are certain risks and complications associated with the procedure, but proper planning and preparation can help prevent these from occurring.
Who Should Undergo and Expected Results
A cervical biopsy becomes necessary when some abnormalities are detected by a routine pelvic exam or a Pap smear test. It is often used to confirm a suspected diagnosis by taking a tissue sample from the cervix, thus allowing a closer analysis of the cervical cells, usually to check for pre-cancerous conditions. In some cases, the procedure is performed to treat abnormal cells found in the cervix.
A cervical biopsy is often used in the diagnosis and treatment of several gynecological diseases, such as:
- HPV or human papillomavirus – This is a sexually transmitted infection associated with a heightened risk of cervical cancer and other types of genital cancers
- Cervical polyps
- Genital warts
- Cervical cancer
- Diethylstilbestrol (DES) exposure
The results of a cervical biopsy will not be readily available after the procedure. The patient will be asked to wait for her doctor to contact her about the results, which can be:
- Negative – This means that the patient’s cervix is completely normal.
- Positive – Some cancerous or pre-cancerous cells were found during the biopsy.
Following a positive biopsy result, the patient may begin discussing possible treatment options with her doctor.
How is the Procedure Performed?
A cervical biopsy is usually scheduled about a week before a woman begins her period. This is because menstruation, along with other factors such as acute inflammation of the pelvic or cervix, may negatively affect the accuracy of cervical biopsy results.
During the day of the biopsy, the patient will be asked to put on a hospital gown and empty the bladder prior to the procedure. It is performed in an examination room, where the patient will be asked to lie down on an examination table with special support for the legs and feet. The position is similar to that required for a pelvic exam.
The procedure begins with the doctor inserting a speculum into the vagina; the purpose is to keep the vagina open and to give the doctor access to the cervix.
In many cases, a cervical biopsy is preceded by a colposcopy, in which the doctor will use a colposcope, a special instrument equipped with a special microscope-like lens that is positioned just outside the vaginal opening. This allows the doctor to inspect the cervix prior to performing the actual biopsy.
If necessary, the doctor may also put an acetic acid solution in the cervix. This may cause a burning sensation, but is very helpful in detecting abnormal cells. Once the site of the abnormal cells is known, the doctor will inject a small needle containing an anesthetic to numb the area, then use special instruments to remove one or more tissue samples.
The actual part of the cervix where the sample is taken as well as the type of anesthetic and instrument used will differ depending on what type of cervical biopsy is necessary or more appropriate.
Different Types of Cervical Biopsy
Cone biopsy – In a cone biopsy, the doctor uses a laser instrument or a surgical scalpel to remove the tissue sample from the cervix while the patient is under either regional or general anesthesia. After a cone biopsy, the patient will need to use a pressure dressing in the cervix, and will be instructed on when and how to remove the said dressing.
Punch biopsy – In a punch biopsy, the doctor uses a rounded blade, similar to a paper puncher, to take out some tissue samples. This also allows the doctor to take several samples from different parts of the cervix in a single session.
Endocervical curettage – In this type of biopsy, the doctor scrapes some tissue samples from the inside of the cervical canal, which is a part of the cervix that is not visible from the outside. To do so, a special tool called endocervical curette or brush is used.
After the Procedure
The obtained samples are sent to a laboratory for further analysis. The patient, on the other hand, is taken to a recovery room where her breathing, blood pressure, and pulse rate are monitored prior to being discharged. In a simple, uncomplicated biopsy that did not require anesthetics, the patient may be discharged in less than an hour. However, if the patient received regional or general anesthesia, she may need to stay in the recovery room a bit longer. It is normal for anesthetics to cause drowsiness several hours after they are administered, so it is best for patients to arrange for a ride home. All types of cervical biopsies are outpatient procedures and do not require the patient to stay overnight in the hospital unless there are complications.
It is normal for women to bleed after the procedure. The bleeding typically changes into a darker discharge or mild spotting within the next several days.
Cramping is also normal, but if it is severe or prevents the patient from performing her usual activities, she may take pain relievers prescribed by her doctor. Patients should not take pain relievers without the advice from their doctor, as some pain medications may increase her risk of bleeding.
Possible Risks and Complications
Like other medical procedures, a cervical biopsy comes with certain risks and possible complications, primarily:
Certain types of biopsies, particularly the cone biopsy, may also cause scarring and permanent changes in the cervix that may, in effect, raise a woman’s risk of:
In order to prevent any risks and complications from arising, a patient should cooperate with her doctor in preparing for the procedure. This involves informing her gynecologist about any allergies or sensitivity she may have to any medications as well as whether she is or may be pregnant.
Pregnant women can only undergo some, but not all, types of cervical biopsies. Also, women who are taking NSAIDs such as ibuprofen, aspirin, or naproxen will be asked to stop taking these medications for a certain period before the biopsy is performed, as these drugs are known to increase the risk of bleeding.
Patients should also follow all post-procedural instructions given by their gynecologist. Generally, they are advised to refrain from using tampons, performing strenuous activities, lifting heavy objects, or having sexual intercourse for a week or so following the procedure.
If the patient experiences heavy bleeding, fever, chills, a foul-smelling discharge, and severe pain in the lower abdominal region, she should inform her doctor right away.
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 99: Management of abnormal cervical cytology and histology. Obstet Gynecol. 2008;112(6):1419-1444. PMID: 19037054 http://www.ncbi.nlm.nih.gov/pubmed/19037054
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 131: Screening for cervical cancer. Obstet Gynecol. 2012;120(5):1222-1238. PMID: 23090560 http://www.ncbi.nlm.nih.gov/pubmed/23090560