There are a number of common procedures you may need to have over your lifetime. One of these is a cervical biopsy, a procedure to remove tissue from the cervix.
A cervical biopsy may be required to test for, or treat, a range of conditions and diseases. Let’s take a look at why you might need to have the procedure and what it involves.
What Is The Cervix?
The cervix is the “neck” of tissue that acts as a passage between the vagina and uterus. It’s located in the lower part of the uterus and is roughly 2 cm in length. The cervix is divided into two main parts: the endocervix (the inner part of the canal leading into the uterus, and the ectocervix (the outer part that can be seen in the vagina). The actual passageway is known as the endocervical canal.
Why Might I Need a Cervical Biopsy?
A cervical biopsy may be required to investigate any abnormalities found during a pelvic exam or a Pap test. This may be to diagnose or treat:
• Cervical cancer
• Human papillomavirus (HPV)
• Genital warts
• Diethylstilbestrol (DES) exposure
• Abnormal bleeding
What Kinds of Cervical Biopsy Are There?
There are several types of cervical biopsy:
• Pinch biopsy: This is where a fine instrument is used to nibble off a tiny piece of tissue (usually half the size of the end of a toothpick). During a single procedure, multiple pieces of tissue from different areas of the cervix may be removed for examination. This is a diagnostic biopsy.
• Cone biopsy: This is where a laser or scalpel is used to remove a larger, cone shaped piece of tissue. This may be required to remove any abnormal cells that may be precancerous cells.
• LLETZ biopsy (Large Loop Excision of Transformation Zone): this is an electrosurgical technique, where a wire is heated with an electric current, and used as a scalpel to allow the removal of abnormal cells. As with a cone biopsy, it is usually performed under general anaesthesia.
• Endocervical curettage (ECC): This is where a narrow instrument is used to scrape the lining of the endocervical canal.
What Is The Procedure?
Although it may sound daunting, a cervical biopsy is nothing to be concerned about. The procedure is perfectly standard. You will lie on your back with your feet on stirrups. Your doctor will apply a local anesthetic to numb the area (if you are having a cone biopsy, you’ll be given a general anesthetic), then they will use a speculum to keep the vaginal canal open.
Your doctor will then use a colposcope (an instrument with a lens attached) to look at the cervical tissue. This is not inserted into the vagina, but rather uses a microscope to see inside the cervical canal.
The cervix is then washed with a solution of weak vinegar – this allows your doctor to get the best visual of the tissue (this may cause a little discomfort, but it will not hurt). An iodine solution (Lugol’s Iodine, also known as Aqueous Iodine APF) may also be applied. This is called the Schiller test and it’s used to identify any abnormal tissue.
The amount of tissue removed will depend on why you are having the biopsy. You may feel a slight pinching sensation during the process. Once the tissue has been removed your doctor may dress the cervix with an absorbent material to soak up any bleeding (not always though). Alternatively he may apply Silver Nitrate, which chemically stops the bleeding. Silver Nitrate applicators look like long barbecue matches. The tissue will then be sent away for analysis.
Most biopsies are outpatient procedures, so you’ll be able to go home right away. However, some may require a visit to hospital. Afterwards you can expect some mild cramping and spotting – this is completely normal and may last up to a week. If you experience heavy bleeding (or bleeding for more than 7 days), foul smelling discharge, severe pain in your lower abdomen or fever, get in touch with your doctor immediately. This may indicate an infection.
Your doctor will advise you further on the recovery process.
Dr Bevan Brown is one of the most trusted Gynaecologist in the Hills District. Personalised care and strong relationships with our patients is of utmost importance to us!
If you have any questions regarding cervical biopsies or any other gynaecological concerns, or would like to book an appointment, please don’t hesitate to give us a call. We will strive to offer advice and compassionate care in every way possible.