Definition and Overview

A gynaecologic biopsy refers to the collection of tissue samples from certain parts of the female reproductive system for microscopic analysis.

Biopsies are generally performed to examine abnormal cells, which may be detected by screening tests such as a Pap test (Pap smear). In a pap smear, the gynaecologist obtains cells from the lining and the wall of the cervix. These samples are sent to the lab where the structures of the cells are analysed to determine if there’s any abnormality, which could be caused by a number of reasons, including cervical cancer.

However, biopsies can also be carried out for other reasons such as to diagnose autoimmune, sexually transmitted and inflammatory disorders.

Who Should Undergo and Expected Results

A gynaecologic biopsy is performed when:

  • Certain gynaecologic results reveal cellular abnormalities – Not all types of cellular abnormalities immediately mean cancer. For example, a woman may have atypical squamous cell or glandular cells, which may be hard to determine whether they are precancerous or not. To ensure, however, more tests such as colposcopy may be conducted, after which a biopsy is performed for confirmation.

  • The result of the HPV test confirms the presence of a virus – HPV stands for human papillomavirus. It comes in many different strains, and while some of them may not cause serious health problems, HPV 16 and 18 can cause all reported cases of gynaecological cancers, such as cervical and vaginal cancer. HPV is also one of the causes of throat cancer. Usually, HPV tests are performed when the gynaecologist detects genital warts or when the pap test reveals suspicious cells.

  • If certain symptoms warrant further investigation – Aside from tests, certain symptoms may indicate a serious health problem. For instance, endometrial cancer, which is a malignancy in the endometrium or the lining of the uterus, doesn’t have any screening test. However, women who exhibit certain signs such as pelvic pain, unusual bleeding or discharge particularly when they are already in menopause, weight loss, and pain during intercourse are advised to undergo a biopsy to determine the causes of their symptoms.

How Does the Procedure Work?

A biopsy may be performed on the cervix, endometrium, vagina and the vulva usually after a pap test or a colposcopy. The biopsy can be scheduled on another day or carried out on the same day as the other tests.

Rarely a biopsy is performed under general anaesthesia. But if it’s necessary, the patient will be required to meet with an anaesthesiologist, who will then recommend fasting or stopping of certain medications.

During a biopsy, the woman changes in a more comfortable clothing with no underwear and is asked to lie on the table. Both of her feet are then planted on the stirrups while the gynaecologist inserts a speculum to open the vagina and the cervix.

The specific biopsy techniques to be used depend on the body part to be examined. For instance, in the cervical biopsy, a tissue sample is collected using a puncher or a cone-shaped system. A circular blade is used to get tissue samples in different areas of the cervix. Depending on where samples are collected, it may take 15 to 20 minutes before the procedure is completed, after which the patient is wheeled to a recovery room and allowed to rest for a few minutes.

The sample is then sent to the lab, and the result is forwarded to the gynaecologist normally after a week. The gynaecologist then calls the patient back to discuss the results.

Possible Risks and Complications

Usually, the risks and complications of biopsies are minor. One of the most common is bleeding. Thus, women are often advised to bring a sanitary pad during the procedure. Patients may also experience vaginal discharge that doesn't clear out after a few days, low-grade fever and chills, all of which warrant a consultation with the gynaecologist as these may indicate an infection.


Reference:

  • Katz VL. Benign gynecologic lesions. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Mosby Elsevier; 2012:chap 18.
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