Cervical Biopsy

Test Description

Cervical biopsy involves taking samples of tissue from the cervix for examination.
Biopsy typically follows a Pap smear which has indicated significant abnormalities
or when an abnormal area is noted on the cervix during a pelvic examination. Minor
cell changes are usually monitored through frequent Pap testing. There are several
types of cervical biopsies:

• Punch biopsy involves removing a small amount of tissue from an area using a
small, round instrument. Multiple punch biopsies may be done. The punch
biopsy is typically done in conjunction with a colposcopy.

• Endocervical curettage (ECC) involves the curettage, or scraping of the endocervical
canal lining. This is tissue which is not visible from the external cervical os.
• Cone biopsy or cervical conization involves removal of a large cone-shaped section
of tissue from the cervix. Cone biopsy may be done using the cold knife cone biopsy
procedure (using a laser or surgical scalpel) or through use of LEEP. Regional or
general anesthesia is needed for cone biopsy.

• Loop Electrosurgical Excision Procedure (LEEP) uses an electrical current
through a fine wire loop to cut away a thin layer of abnormal tissue. The
amount of tissue removed depends on the whether it is done for biopsy only
or to remove the abnormal tissue to allow healthy tissue to grow. LEEP is
not usually done unless another type of biopsy has shown cervical intraepithelial
neoplasia (CIN).
Due to the risk of scarring in the cervix from removal of tissue and possible future
problems with infertility or miscarriage, the patient needs to discuss with the gynecologist
the advantages and disadvantages of each type of procedure. It is important
to find the best procedure for the patient’s particular problem.
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Normal Values:No abnormal cells

Possible Meanings of Abnormal Values
Cervical intraepithelial neoplasia
Cervical polyps
Genital warts
Invasive carcinoma
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Interventions/Implications

Pretest

• Explain to the patient the purpose of the test. Provide any written teaching materials
available on the subject. Note that cramping may occur during the procedure.
       • Use of an analgesic 30 minutes before the procedure may be ordered.
        • Review deep breathing exercises to encourage relaxation during the procedure.
• The patient must remain still during the procedure.
• No fasting is required before the test (unless general anesthesia is to be used).
• No douching, use of tampons or vaginal creams, or sexual intercourse for 24 hours prior
to the procedure.
• Pregnancy testing may be done.
• Obtain a signed informed consent.
• If the procedure is done in an outpatient clinic under anesthesia, the patient will need to
have someone drive her home after the procedure.

Procedure

• The procedure may be performed with or without anesthesia.
• The patient is instructed to empty the bladder prior to the procedure.
• The patient is assisted into a lithotomy position.
• A speculum is inserted into the vagina.
• The cervix is visualized using a colposcope.
• The cervix is cleaned and covered with acetic acid solution. This causes abnormal tissues
to turn white and become more visible.
• The area to be biopsied may be given local anesthetic.
• The biopsy is performed using one of the procedures described previously.
       • If LEEP is performed, a tenaculum (forceps) may be used to the grasp and hold the
cervix steady during the procedure.
• Bleeding from the biopsy site may be treated with a paste-like topical medication.
Electrocauterization or sutures may be needed.
• If a cone biopsy is done, the cervix may be packed with a pressure dressing to be removed
by the patient after a specified period of time.

Posttest

• The specimen is placed in preservative, labeled, and transported to the laboratory.
• A sanitary pad will need to be worn for bleeding. The discharge will be dark/black for
several days.
• An analgesic will be prescribed for discomfort. Over-the-counter pain relievers should
not be taken without checking with the health-care provider due to the risk of bleeding
with some such preparations.
• The patient should avoid sexual intercourse, douching, or using tampons for a week to
allow the cervix to heal. If a cone biopsy was done, this time will be extended to several
weeks. No strenuous activity or heavy lifting is allowed.

• Report abnormal findings to the primary care provider.
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Clinical Alerts             
• Possible complications include: bleeding, infection, and changes or scarring in
  the cervix from removal of tissue with possibility of future infertility or
  miscarriage.
• Instruct the patient to report any signs of infection (fever, foul odor, or discharge),
  or if bleeding continues for more than 2 weeks. Severe lower abdominal pain
    needs to be reported immediately.
• Following a positive biopsy and treatment for carcinoma, Pap testing is done frequently
  (every 3 to 4 months) to ensure no abnormal tissue remains or returns.
  Colposcopy may also be done.
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CONTRAINDICATIONS!
• Pregnancy
• Current menstruation
• Patients with clotting disorders
• Patients with acute pelvic inflammatory disease
• Patients with acute inflammation of the cervix