Colposcopy - directed biopsy

Alternative names
Biopsy - colposcopy-directed

Definition
A colposcopy-directed biopsy uses a colposcope to aid in the viewing of the surface of the cervix. It helps identify areas on the surface that show tissue abnormalities. A colposcope is a low-power microscope that magnifies the surface of the cervix 10 to 40 times its normal size.

How the test is performed

You will lie on a table and place your feet in stirrups to position your pelvis for examination. A speculum (an instrument used to hold open the birth canal in order to view and examine the cervix) will be inserted into your vagina and opened slightly.

The cervix is then swabbed with a chemical solution (acetic acid) to remove the mucus that covers the surface, and to highlight abnormal areas. The colposcope is then positioned at the opening of the vagina, and the area is thoroughly examined. Photographs may be taken.

If any areas look abnormal, a small sample of the tissue will be removed (biopsy) using small biopsy forceps. Many samples may be taken, depending on the size of the area.

How to prepare for the test
There is no special preparation. You may be more comfortable if you empty your bladder and bowel before the procedure. You should not douche or have sexual intercourse for 24 hours before the exam.

How the test will feel

A colposcopy is painless. Some women feel a slight stinging sensation caused by the vinegar solution. The biopsy may feel like a pinch each time a tissue sample is taken, which may cause some cramping.

Any pain or cramping you feel during the biopsy may be eased by relaxing and taking a few slow deep breaths. Some cramping may occur after the biopsy. It is typical for a woman to hold her 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
This procedure is usually performed after a positive Pap smear to identify the abnormality.

Normal Values
A smooth, pink surface of the cervix is normal. A biopsy is only performed when abnormal tissues are seen or suspected because of abnormal Pap smear results.

What abnormal results mean
Abnormalities detected include cervical warts (human papilloma virus), precancerous tissue changes, cervical intraepithelial neoplasia, or invasive carcinoma (cancer). The colposcopy may be used to keep track of precancerous abnormalities and look for recurrent abnormalities after treatment.

Abnormal findings during a colposcopy include abnormal patterns in the blood vessels, whitish patches on the cervix, and areas that are inflamed, eroded, or atrophic (tissue wasting away). Any of these abnormalities may indicate cancerous changes.

Additional conditions under which the test may be performed include Cervical dysplasia (indicated by abnormal Pap smear)

What the risks are

After the biopsy, there may be some bleeding for up to a week. Avoid sexual intercourse, douching, and using tampons, for 2 weeks to allow the biopsy area to heal.

If bleeding is unusually heavy or lasts for longer than 2 weeks, or if you notice any signs of infection (fever, foul odor, or discharge), notify your health care provider.

Special considerations
If the colposcopic examination or biopsy does not show why the Pap smear was abnormal, a more extensive biopsy may be suggested (see Cold knife cone biopsy).

Johns Hopkins patient information

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

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