Cervical biopsy for abnormal cervical cell changes

Surgery Overview

A cervical biopsy removes part of the cervix so the tissue can be examined under a microscope. The amount of cervical tissue removed depends on the method used:

• A simple cervical biopsy removes a small piece of tissue from the surface of the cervix.
• An endocervical biopsy (endocervical curettage) removes tissue from high in the cervix by scraping with a scoop-shaped instrument (curet).

How it is done

A cervical biopsy is usually done in your health professional's office, a clinic, or a hospital as an outpatient procedure (you do not have to spend the night in the hospital).

You will need to take off your clothes below the waist and drape a paper or cloth covering around your waist. You will then lie on your back on an examination table with your feet raised and supported by footrests (stirrups). Your health professional will insert an instrument with curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined. A vinegar solution (acetic acid) may be applied to the cervix to show the abnormal areas.

A cervical or endocervical biopsy may be done with an oral pain medication but without an injection of numbing medication (anesthetic) in the cervix (cervical block). Alternately, these procedures may be done with a cervical block as well as oral pain medication. An anesthetic ointment may be applied to your cervix before a biopsy. After the biopsy, a liquid (Monsel's solution) may be applied to stop bleeding.

A cone biopsy (conization) is a more extensive form of a cervical biopsy. It is called a cone biopsy because a cone-shaped wedge of tissue is removed from the cervix. Both normal and abnormal cervical tissues are removed. For more information, see cone biopsy.

A colposcope is used to magnify the tissues during these procedures.

What To Expect After Surgery

Most women are able to return to normal activity the day of or within 1 day after the biopsy.

After cervical biopsy

• Some vaginal bleeding and a small amount of dark brown discharge are normal for about 1 to 2 weeks.
• Sanitary napkins should be used instead of tampons for 1 week.
• Sexual intercourse should be avoided for 1 week.
• Douching should not be done.

When to call your health professional

Call your health professional for any of these symptoms:

• A fever
• Moderate to heavy bleeding (more than you would usually have during a menstrual period)
• Increasing pelvic pain
• Bad-smelling or yellowish vaginal discharge, which may indicate an infection

Why It Is Done

A cervical biopsy should always be done before surgical treatment is considered when abnormal tissue is seen on the vulva, vagina, or cervix, or if abnormal tissue is seen during colposcopy.

How Well It Works

Results of the abnormal Pap test, colposcopy, and cervical biopsy are compared and evaluated.

• Normal. No abnormal tissue is found on the biopsy. Monitoring with Pap tests is done at regular intervals as recommended by your health professional. If the initial abnormal Pap test showed moderate to severe cell changes, additional testing, such as a cone biopsy, may be done to explain the different results found in the cervical biopsy.
• Abnormal. Abnormal tissue is found. Results may indicate:
  • Infection. The infection may be treated with medication if it is caused by bacteria or yeast. Repeat Pap tests may be done to monitor the success of the treatment.
  • Minor cell changes. Abnormal tissue may be monitored without treating it, or treatment may be done to destroy or remove the abnormal cells. Over half of minor cell changes become normal again on their own in 6 to 18 months.
  • Moderate to severe cell changes. Treatment is done to destroy or remove the abnormal cervical cells.
  • Cancer. Treatment is done to destroy or remove the tissue affected by invasive cancer.

If the results of the initial abnormal Pap test, colposcopy, and cervical biopsy do not agree:

• Repeat Pap testing, with or without colposcopy, may be done to monitor the progression of the cell changes.
• A cone biopsy to destroy or remove the abnormal cells may be done if moderate to severe cell changes are indicated in the Pap test.

Risks

Vaginal bleeding can occur for up to 2 weeks after the cervical biopsy.

What To Think About

You should ask your health professional when and how the results of the biopsy will be reported to you. Depending on the results of the biopsy, treatment may or may not be recommended. The timing of follow-up tests can be discussed with your health professional.

If the Pap tests and cervical biopsy results do not agree, further evaluation and a cone biopsy may be necessary before any type of treatment is recommended so that an invasive cancer is not missed.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

Author:	Shannon Erstad, MBA/MPH	Last Updated January 12, 2007
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Barbara S. Apgar, MD, MS - Family Medicine, Women's Health Ross Berkowitz, MD - Obstetrics and Gynecology
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