Cervical biopsy

Alternative names
Cervical punch biopsy; Biopsy - cervical punch; Biopsy of the cervix

Definition
A cervical biopsy is a test in which tissue samples are taken from the cervix (see also colposcopy directed biopsy) and examined for disease or other problems.

How the test is performed
You will be asked to lie on your back with your feet in the stirrups. As in a regular pelvic examination, a speculum (an instrument used to hold the birth canal open in order to examine the interior) will be inserted into the vagina and opened slightly so that the cervix is visible.

The area is then viewed with a colposcope, a small low-power microscope used to magnify the surface of the vagina and cervix (the most accurate method). The cervix is swabbed with a vinegar solution (acetic acid), which removes the mucus to help highlight abnormal areas. The colposcope is then positioned at the opening of the vagina and the area is examined. Photographs may be taken.

An alternative method is the Schiller’s test, which uses an iodine solution to stain the cervix. The stain is inserted through the speculum. The iodine solution stains the normal portions of the cervix, but does not stain abnormal tissues.

When an abnormality is located, a sample (biopsy) may be taken using a small biopsy forceps or a large needle. More than one sample may be taken. When the procedure is completed, all the instruments are removed.

How to prepare for the test
There is no special preparation. Before the procedure, you should empty your bladder and bowel for your comfort. Do not douche or have sexual intercourse for 24 hours before the exam.

How the test will feel

A colposcopy is painless. The biopsy may feel like a pinch each time a tissue sample is taken and may cause some cramping with it. Any pain or cramping occurring during the biopsy may be helped by relaxing and taking a few slow deep breaths.

Some cramping may occur after the biopsy. (Many women have a tendency to hold their breath during pelvic procedures in anticipation of pain. Making an effort to concentrate on slow, regular breathing will help you relax and reduce or eliminate some pain).

Why the test is performed
A cervical biopsy is usually performed when a pap smear indicates significant abnormalities or when an abnormal area is seen on the cervix during a routine pelvic examination. The biopsy identifies the abnormality (When a positive pap smear shows minor cell changes or abnormalities, a biopsy probably will not be done immediately, unless there is a reason to believe you may be in a high-risk category. It is usually recommended that a repeat pap smear be done in 6 months).

Normal Values
The tissue sample from the cervical biopsy will be examined by a pathologist who will report to your doctor whether the cells appear normal or abnormal.

What abnormal results mean
Abnormal results of the biopsy may indicate problems, such as abnormal tissue development or cell growth in the cervix (cervical intraepithelial neoplasia), or an invasive carcinoma (cancer).

Colposcopy may be used to keep track of precancerous abnormalities and look for recurrent abnormalities after treatment. Abnormalities that may be noted and either biopsied or monitored include any abnormal patterns in the blood vessels, whitish patches on the cervix, and areas that are inflamed, eroded, or atrophic (tissue wasting away).

Additional findings may indicate:

     
  • Cervical erosion  
  • Cervical polyps

What the risks are
There may be some bleeding after the biopsy for up to a week. Avoid sexual intercourse, douching, or using tampons for a week to allow the cervix to heal.

Special considerations
When the colposcopic examination or biopsy does not show why the pap smear was abnormal, a more extensive biopsy may be suggested.

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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