What Is a Cervical Biopsy?

What to expect when undergoing this procedure

A cervical biopsy is a minor surgical procedure in which a sample of tissue is taken from the cervix, the cylinder-shaped structure that connects the vagina and the uterus, for diagnostic evaluation. You may need a cervical biopsy if you had an abnormal Pap smear, your doctor felt an abnormality during a routine pelvic exam, or if you are at high risk of cervical cancer.

Cervical Pap smear showing abnormal cells
Spike Walker / The Image Bank / Getty Images

Purpose of Procedure

A cervical biopsy is important for the detection of cancer or precancerous cells. There are three kinds of cervical biopsies:

  • Punch biopsy, in which a small amount of tissue is removed with a device that resembles a paper hole puncher
  • Endocervical curettage (ECC), which involves removing a sample with a scoop-like instrument
  • Cone biopsy, a more involved procedure in which a laser or scalpel is used to remove a cone-shaped tissue sample. A cone biopsy also sometimes is used to remove pre-cancerous cells or early-stage cervical tumors.

Indications for a cervical biopsy include:

  • Abnormal Pap smear (a biopsy is often done during a colposcopy to further evaluate abnormal results)
  • A positive test for high-risk strains of human papillomavirus (HPV)
  • Abnormalities detected during a pelvic examination
  • Abnormal imaging test results, such as a computed tomography (CT) scan, magnetic resonance imaging (MRI), or ultrasound, that suggest cervical cancer
  • Symptoms of cervical cancer, such as vaginal bleeding after sexual intercourse, irregular or heavy menstrual bleeding, pelvic pain, or vaginal discharge
  • Removal of abnormal tissue or to administer treatment to precancerous cells

In addition, a cervical biopsy sometimes is done to diagnose genital warts or cervical polyps. A doctor also may choose to do a cervical biopsy on a woman whose mother took diethylstilbestrol (DES) while pregnant. This drug is a synthetic form of estrogen that prescribed in the 1940s through the early 1970s to prevent miscarriage, premature labor, and related complications. DES was discontinued when it was found to increase the risk of reproductive cancer in the daughters of women who took it during pregnancy.

Risks and Contraindications

A cervical biopsy generally is regarded as safe for most women. The most common complication associated with the procedure is light bleeding. However, complications that may be more serious include:

  • Infection
  • Incompetent cervix (see pregnancy below)
  • Pelvic pain

A cone biopsy in particular, can result in heavy bleeding, and (though rare) infection, injury to tissue, vaginal tears, perforation of the uterus requiring surgical repair, or impaired menstrual flow (cervical stenosis due to scarring).

Pregnancy Related Risks

Some cervical biopsy procedures may be associated with an increased risk of premature birth due to an incompetent cervix. This is primarily a concern when more than 1 centimeter (roughly 1/2 inch) of tissue is excised, and is more common if a woman gives birth within one year of the procedure. If you have a procedure that may raise your risk of preterm labor, your doctor will monitor you closely during pregnancy. In some cases, a procedure (cerclage) is performed in which the cervix is "sewed shut" to reduce the risk of preterm labor.

Uncommonly, a cervical biopsy, particularly a cone biopsy, may result in scarring and narrowing of the cervix. This, in turn, could lead to infertility by preventing sperm from accessing the uterus. If this occurs, the cervix may be dilated with either dilators or a via a surgical procedure in which the area of scar tissue is shaved down to again open the cervix.

Contraindications

Women who have acute pelvic inflammatory disease or inflammation of the cervix will usually need to wait until their condition has subsided before having a cervical biopsy.

Pregnancy-Related Contraindications

A cervical biopsy is generally safe during pregnancy, although more bleeding may occur. That said, the benefits versus risks need to be carefully weighed for each person by looking at Pap smear results, any history of abnormal Pap smears, and history of HPV infections.

Before the Procedure

If possible, schedule your cervical biopsy for about a week after your period so your doctor can get a good cervical tissue sample.

Tell your doctor if you're allergic or sensitive to any medications or to latex. Certain over-the-counter (OTC) and prescription medications cause blood to be thinner than normal, which creates a risk of excess bleeding. These include aspirin, Advil (ibuprofen), and Aleve (naproxen), as well as blood thinners like Coumadin (warfarin). You may be instructed to stop taking these for a day or two before your procedure, especially if you're having a cone biopsy.

Don't use tampons, vaginal creams or medicines, or douche for 24 hours before the procedure and refrain from sexual intercourse for 24 to 48 hours before a cervical biopsy.

Timing

A cervical biopsy is not a lengthy procedure. A punch biopsy or ECC typically takes between 10 minutes and 30 minutes. However, you'll want to allow more time than that when scheduling your day. Factor in travel time to the site of the test, time spent filling out forms and waiting your turn, recovery time if you have a cone biopsy, and travel time home. If you experience bleeding, your doctor may have you wait for it to slow before sending you home.

Location

The place a cervical biopsy is performed may vary, depending on your condition and your doctor's practices. Usually it is done in the doctor's exam room or in an outpatient facility. In rare instances, a biopsy may be scheduled in an operating room if surgery is anticipated due to any further complications.

What to Wear

You will need to remove your clothing from the waist down and put on a hospital gown for your biopsy, so choose a skirt or trousers with a comfortable top rather than a dress or other one-piece garment.

Exam rooms can be chilly, so it's advisable to wear or bring socks to keep your feet warm during the procedure.

Food and Drink

You do not have to make any special changes regarding food or drink before a cervical biopsy. However, if you will be having a cone biopsy, in which general anethesia is necessary, you likely will be instructed to not eat or drink for at least eight hours before your procedure.

Cost and Health Insurance

Most health insurance plans cover the cost of a cervical biopsy. Confirm that this is the case with your insurance company, and find out if you will need to bring a copay with you to your appointment.

If you are paying for your procedure out of pocket, expect the cost to be between $2,500 and $5,000, depending on the type of biopsy you're having and your geographic location.

What To Bring

You may experience light bleeding after the procedure. The doctor's office or clinic will probably have sanitary napkins to give you but it's a good idea to bring your own just in case or if you have a particular brand or style you prefer.

If you anticipate a wait, bring along a book, magazine, your knitting, or something to keep your hands and mind busy. It may also be a good idea to bring a family member or friend to chat with before your procedure and to drive you home afterwards. If you're having general anesthesia you will be required to have a ride home.

During the Procedure

When you arrive for your cervical biopsy, you will check in at the front desk. If you're having a cone biopsy, your doctor may come out to greet you.

Pre-Procedure

In the waiting room, you will be asked to fill out paperwork consenting to the biopsy and agreeing to pay, if you haven't done so already. When it's time for your procedure, a nurse will have you empty your bladder and then escort you to the room where it will take place. They will give you a gown and leave the room to give you privacy after instructing you to undress from the waist down. They may check your blood pressure, pulse, and temperature before or after you change.

Your doctor may prescribe a pain reliever 30 minutes before the procedure. Or you may be given medicine to help you relax before the anesthesia is started.

Throughout the Procedure

Here are the steps you will most likely go through for a cervical biopsy:

  • A cervical biopsy begins much like a Pap smear. You will lie down and put your feet in stirrups.
  • You may be given a local anesthetic, but this is not always necessary with small biopsies. If you’re undergoing a cone biopsy, you’ll be given a general anesthetic that will put you to sleep.
  • The doctor will insert a speculum into your vagina to hold it open and provide access to your cervix. The also may use a colposcope, an instrument with a special lens like a microscope, to get a close look at your cervical tissue.
  • Before taking the sample, the doctor will wash your cervix with a solution of vinegar and water. If you have any sensation, this may burn a bit but should not be painful.
  • Next your cervix will be swabbed with iodine for what is called Schiller’s test. The iodine will turn abnormal tissue white-ish so that it's easy to see. It is from the whitest areas that samples will be taken.
  • The amount of tissue removed and where it is removed from depends on the type of biopsy you have. With a simple cervical biopsy, one or more small samples of tissue are removed. When this is done, you may feel a slight pinch or cramp. Cells from the inside of the cervical canal may be removed with a special tool called an endocervical curette or an endocervical brush. This may also cause some cramping.
  • If you have a cone biopsy, your doctor may use a loop electrosurgical excision procedure (LEEP) or the cold knife cone biopsy procedure. With the cold knife cone biopsy, a laser or a surgical scalpel may be used to remove tissue.

Bleeding from the biopsy site may be treated with a paste-like topical medicine. If necessary, your doctor may also use a probe (electrocauterization) or stitches to stop the bleeding. They may pack the cervix with a pressure dressing.

Post Procedure

After the speculum is removed, the doctor or a nurse will provide you with towels to wipe any discharge or blood, and you may need to use the toilet. You may also need a sanitary napkin in case you have discharge or bleeding.

Recovery will depend on the type of biopsy done, and if you had anesthesia.

With general anesthesia, you will be taken to the recovery room and monitored until you're fully awake and no longer groggy. Once your blood pressure, pulse, and breathing are stable, you will be taken to a hospital room or discharged. If you had the procedure done at an outpatient facility, you should arrange for someone to pick you up.

After a simple biopsy, you may rest for a few minutes before going home.

After the Procedure

It's normal to have some mild cramping, spotting, and dark or black-colored discharge for several days after a cervical biopsy. The dark discharge is from the medicine applied to your cervix to control bleeding.

If necessary, take a pain reliever for cramping, as recommended by your doctor.

Most doctors recommend avoiding sex or using tampons for up to two weeks after a cervical biopsy. Certain activities may also be restricted. Full recovery from a cone biopsy may take several weeks.

Managing Side Effects

Typically, you should not need to take any pain medication for post-cervical biopsy discomfort. Call your doctor if you experience any of the following signs of infection:

  • Pain
  • Fever
  • Heavy bleeding
  • A foul-smelling vaginal discharge

Interpreting Results

Your doctor will send your cervical sample to a pathology lab immediately after taking it. The results should be available within two weeks. The pathologist will send your doctor a report describing whether the cells are normal or abnormal, and detailing their appearance. The doctor will then call you to share the results.

If they're normal, it most likely means you do not have cervical cancer. Abnormal results can indicate low-grade dysplasia (mild), high-grade dysplasia (moderate to severe), or cervical cancer. Cervical dysplasia means there are precancerous changes to the cervix.

CIN1 (low grade intraepithelial lesion/HGSIL) indicates that milder changes are present, most often due to a persistent HPV infection. Many of these changes regress (go away) on their own.

CIN2 describes a biopsy that shows cells that appear more abnormal than CIN1. For roughly 50% of women, these changes also regress (go away) on their own in time.

CIN3 is considered a direct precursor of cervical cancer, and will often progress if untreated.

Adenocarcinoma in situ (AIS) means that cancer cells are present, but may still be localized to the area where it originated (pre-invasive), and though the cells appear cancerous, they do not yet have the potential to spread (the hallmark of cancer).

Follow-Up

Untreated cervical dysplasia may lead to cervical cancer in some cases. However, having cervical dysplasia does not mean you have cancer or that you will necessarily develop the disease.

It can take years for cervical cancer to develop. Depending on how extensive or advanced the dysplasia is, your doctor may decide that you need surgical resection of the dysplasia before it develops into cancer. Recommendations for follow-up and treatment will depend not only on your biopsy results, but on your history of Pap smears, HPV testing, your age, and biopsies in the past. For example, if you have a biopsy that suggests CIN2 and you have a history of a high-grade intraepithelial lesion (HGSIL) in the past, recommendations may differ from those for someone who has a CIN2 biopsy with no history of Pap smear abnormalities in the past.

With CIN2, treatment is usually recommended, although in some cases (depending on the extent of the biopsy sample) monitoring (observation) may be considered, especially in women who wish to become pregnant in the future. As noted, some of these changes may regress in time on their own, and for women under the age of 25, observation is generally preferred (abnormal changes are more likely to regress in younger women than older women). Treatment options may include cryotherapy, laser therapy, loop electrosurgical procedure (LEEP), or a conization.

With CIN3, treatment is always recommended in women who are not pregnant, but may also be recommended in those who are pregnant. Treatments that remove the abnormal cells (excisional treatments) are preferred over treatments that freeze or burn the abnormal cells (such as cryotherapy).

If AIS (adenocarcinoma in situ) is found, treatment to excise the area (and look for any evidence of invasive cancer) should be done, even if a hysterectomy will be performed. after this procedure. An exception (fertility preservation surgery) may be considered in some women who wish to become pregnant in the future.

It's important to note that there are many factors that physicians consider when recommending treatment, and two biopsies that look the same under the microscope may be treated very differently depending on age, history of Pap smears, pregnancy, and more. Since the terminology and treatment approaches for cervical dysplasia can be very confusing, make sure to talk to your doctor about any and all questions you may have.

A Word From Verywell

Having a biopsy and waiting for the results can be very anxiety-producing. But the procedure may be the best way to stave off cancer or illness before it becomes a serious, full-blown disease. That's why it's important to get regular screenings and, if necessary, a biopsy. When cervical cancer is caught in its earliest stage, there is a 93% five-year survival rate.

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