Cold knife cone biopsy

Alternative names
Cone biopsy; Biopsy - cone; Cervical conization

Definition
A cold knife cone biopsy is a procedure to obtain a sample of abnormal tissue from the cervix for further examination. This procedure obtains a larger sample than that obtained by cervical punch biopsy or colposcopy-directed biopsy. An alternative procedure known as LEEP (loop electrocautery excisional procedure) uses electric current instead of a knife to remove the cervical tissue.

How the test is performed

This is a surgical procedure, performed in the hospital under either intravenous sedation or general anesthesia, to diagnose and treat a precancerous change in the cervix.

A small cone-shaped sample of tissue is removed from the cervix and examined under a microscope for any signs of cancer. This biopsy may also serve as the treatment if all of the diseased tissue is removed.

How to prepare for the test
As with any procedure performed under anesthesia, fasting for 6 to 8 hours is recommended. You must sign an informed consent form. The procedure is considered a same day procedure in which hospitalization is usually not necessary.

How the test will feel
After the procedure, there may be some cramping or discomfort for a week or so. Avoid sexual intercourse, douching, and use of tampons for about 4 to 6 weeks. For 2 to 3 weeks after the procedure, you may have heavy, bloody, or a yellow-colored discharge.

Why the test is performed
The test is done when results of a cervical biopsy indicate precancerous cells in the area or cervical cancer. A cold knife biopsy may also be done if the cervical biopsy has not revealed the cause of an abnormal Pap smear.

Normal Values
This procedure is only performed if an abnormality in the cells of the cervix is known or suspected.

What abnormal results mean
Most often, abnormal results indicate an area of precancerous or cancerous cells.

What the risks are
There is a slight risk of extensive bleeding and infection. Cervical scarring may result from the procedure, occasionally causing painful menstrual periods or making it more difficult to evaluate an abnormal Pap smear. This scarring may also make it difficult for a woman to become pregnant. Cold knife cone biopsy may be associated with cervical incompetence, a condition that may result in premature delivery.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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