A cervical biopsy is a procedure to remove a tissue sample from an area of interest to test for the presence of a precancerous condition or cervical cancer.
The cervix is the lower narrow part of the uterus, is the lower segment of the uterus, its wall is a continuation of the uterine wall. The place where the uterus passes into the cervix is called the isthmus. It forms a channel that opens into the vagina.
A cervical biopsy can be done in several ways. A biopsy can remove a sample of tissue for testing, it can also be used to completely remove abnormal tissue, and it can also treat cells that can turn into cancer.
A cervical biopsy is a procedure that is sometimes performed on women during a study called colposcopy to remove a sample of cervical tissue for examination. This is usually done when the result of a Pap smear is either inconclusive or abnormal, and the doctor wants to continue to look for any pathology.
Cervical biopsy involves several types of procedures.
Puncture biopsy. This procedure uses a circular blade, like a perforator for paper holes, to remove a tissue sample. One or more biopsy tissue captures can be performed in different areas of interest.
Sphenoid biopsy. This procedure uses a laser or scalpel to remove a large cone-shaped piece of tissue from the cervix.
Endocervical curettage. This procedure uses a narrow instrument called a curette to clean the tissue of the endocervical canal. This is an area that is not visible outside the cervix.
You need to schedule a biopsy of the cervix for a week after the menstrual period. This will make it easier for the doctor to get a clean sample. Also, be sure to discuss any medications that a woman takes with a doctor. The doctor may ask you to stop taking medicines that may increase the risk of bleeding, for example, warfarin, ibuprofen, naproxen, aspirin.
It is important to avoid using tampons, vaginal suppositories or medicinal vaginal creams for at least 24 hours before the biopsy. Also a woman should avoid intercourse at this time.
On the day of the procedure, the doctor may suggest taking Acetaminophen, or another pain medication, before proceeding with the procedure. After the procedure, there may be a slight bleeding, so you need to take sanitary pads with you. It is also a good idea to take with you a family member or friend so that they can take the woman home after the procedure, especially if general anesthesia was performed. General anesthesia can cause drowsiness after the procedure, so you can not drive a car until the effects have passed.
The doctor will explain the procedure, and you can ask questions.
It is usually not necessary to stop eating or drinking before a simple cervical biopsy. If the biopsy needs anesthesia, you may need to fast for a certain number of hours before the procedure. This usually happens after midnight. The doctor may prescribe a painkiller 30 minutes before the procedure. Or, medication may be given to help relax before anesthesia begins.
A cervical biopsy can be performed when abnormalities are detected during a gynecological examination. This can also be done if abnormal cells are detected during the PAP test. A positive test for the human papillomavirus (HPV) may also require further cervical biopsy.
HPV is a type of sexually transmitted infection. Some types of virus can cause both the formation of cervical cancer and other less common types of genital cancer. A cervical biopsy is often performed as part of a colposcopy. Colposcopy uses a tool with a special lens to examine the tissues of the cervix.
A cervical biopsy can be performed to find precancerous cells of the cervix. Cells that seem abnormal, but not yet malignant, are called pre-cancerous. These abnormal cells may be the first sign of cancer that can develop years later.
A cervical biopsy can also be used to diagnose and treat these conditions:
- non-tumorous formations (polyps) on the cervix;
- genital warts, which may mean that a woman has an infection with HPV, which is a significant factor contributing to the development of cervical cancer;
Before the patient agrees with the test or procedure, it is important to ensure that you know the answers to the following questions:
- The name of the test or procedure?
- The reason for the test or procedure?
- Risks and benefits of the test or procedure?
- When and where should I take a test or procedure, and who will do it?
- When and how can I get results?
- How much will you have to pay for a test or procedure?
What to expect during the procedure
A biopsy of the cervix may be performed in the doctor’s office at a medical facility, on an outpatient basis, or during a hospital stay. Some biopsy procedures require only local anesthesia. Others need regional or general anesthesia. The method of conducting the test may vary depending on the state and practice of the doctor.
Typically, cervical biopsy follows this process:
- The patient needs to undress completely and wear a hospital gown.
- Before the procedure, you need to empty the bladder.
- A woman lies on a chair, supporting her legs, as during a pelvic examination.
- The doctor will put a tool called a mirror in the vagina. This will expand the vaginal wall to reach the cervix.
- Often a medical professional will use a colposcope. It is a tool with a special lens, such as a microscope, to help see the tissues of the cervix. The doctor will put the colposcope on the opening of the vagina. He will not enter the vagina.
- The doctor will scan the cervix with a colposcope to find any problem areas on the cervix or vagina.
- The doctor can clean and soak the cervix with a solution of vinegar (acetic acid solution). This solution helps to make the abnormal tissues white to make them easier to see. At this time, a woman may feel a slight burning sensation. To cover the cervix, you can use a solution of iodine. This is called Schiller's test.
- The type of biopsy will depend on the size and shape of the abnormal cells, as well as on where they are located. The doctor may numb the area using a small injection needle. The doctor may use forceps to hold the cervix for biopsy.
- The amount of tissue to be removed and its removal depend on the type of biopsy. For simple cervical biopsy, one or more small tissue samples will be removed using a special type of forceps. When this is done, the patient may feel a slight pressure or cramp. Cells from the inside of the cervical canal can be removed with a special instrument called an endocervical curette or endocervical brush. It can also cause some cramps. The doctor may also use a probe (electrocauterization) or sutures to stop the bleeding.
- After all this, the doctor will send the tissue to the laboratory for testing.
Most women experience little discomfort during a cervical biopsy. However, in the following days, the woman may experience some mild discomfort.
Recovery after the procedure
A cervical biopsy is an outpatient procedure, which means that the patient can return home immediately after surgery. Other procedures may require staying in the hospital overnight.
After the procedure, some mild cramps and blemishes can be expected. A woman may also experience cramps and bleeding for a week, depending on the type of biopsy. Weight lifting, sexual intercourse and the use of tampons are not allowed. You must inform the doctor if available:
- development of fever;
- severe bleeding;
- unpleasant smell from the vagina;
These symptoms may be signs of infection.
Recovery will depend on the type of biopsy performed and whether anesthesia has been performed. If regional or general anesthesia was performed, the patient will be taken to the ward so that it can be observed. As soon as blood pressure, pulse and breathing are stable, a woman can go home. If the procedure was performed on an outpatient basis, you need to plan for someone to drive home after the procedure. After a simple biopsy, you need to rest for a few minutes after the procedure before heading home. You can take an anesthetic for cramps. Aspirin or certain other medicines may increase the chance of bleeding.
You can only take medications recommended by your doctor.
The doctor may be asked not to take a shower, use tampons or not to have sex for 1 week after the biopsy or for a certain period of time recommended by the doctor.
After a wedge-shaped biopsy, you cannot insert anything into the vagina until the cervix is healed. This may take several weeks. There may also be other restrictions on daily activities, including without weight lifting.
After the procedures, the doctor will inform you when to return for further treatment or care. As a rule, women who have undergone a cervical biopsy will need more frequent PAP tests.
What are the risks
Possible complications may include infectious disease and bleeding.
In addition, wedge-shaped biopsies can increase the risk of infertility and miscarriage. This is due to changes and scars on the cervix, which sometimes arise as a result of the procedure.
Before the procedure, you must inform the doctor if the patient is allergic to drugs, iodine or latex, if the patient is pregnant, or thinks that she may be pregnant. Some types of cervical biopsies can be done during the gestation period, and some are not. If possible, a cervical biopsy will be scheduled for 1 week after the menstrual period.
There may be some risks depending on the specific health condition. Be sure to talk with your doctor about any problems that exist before the procedure.
Some things may make cervical biopsy less accurate. These include:
- acute inflammation of the pelvic organs;
- acute inflammatory diseases of the cervix.
Colposcopy and Biopsy
Colposcopy is usually recommended after a Pap smear (or Pap test), or other type of cervical examination, which show inconclusive or abnormal results. Colposcopy is a type of gynecological procedure, which is carried out by a gynecologist specializing in the reproductive health of women, for a deeper examination of the cervix.
During this 10-15 minute exam, the woman lies on her back on the examination table, stripped from the waist, and puts her legs in the stirrups. The doctor inserts a medical instrument called a vaginal speculum and then places the solution on the cervix to make any abnormal areas easier to see. The doctor will then place a large, bright electric microscope (colposcope) approximately 30 centimeters from the vagina to get a better view of the cervix. As soon as the doctor identifies any abnormal areas of the cervix (these areas usually look white in color), he or she will do a biopsy of the cervix, which is a sample of tissue, from the white area (s) and send it to the laboratory for analysis.
Another type of biopsy, called endocervical curettage, may be performed. The doctor removes tissue from the endocervical canal, which is a narrow passage that connects the cervix with the uterus.
Understanding the results
Cervical biopsy results are usually returned within two weeks.
Abnormal results obtained after cervical biopsy indicate a low degree of dysplasia (mild), or a high degree of dysplasia (moderate to severe). Many times the doctor will monitor the condition, observe whether the dysplasia persists, because it may take many years for cervical cancer to develop. If the condition worsens, some outpatient procedures can be done to heal or remove cells before they turn into cancer.
Cervical dysplasia does not usually cause any symptoms, so it is important to regularly screen with a doctor.
Abnormal results, which were obtained as a result, may indicate, in particular, cancer. In early stage cervical cancer, the survival rate is 93%.
The doctor will contact the patient about the results of the biopsy. A negative test means that everything is normal, and no further action is usually required. A positive test means that a pathology has been detected, and the patient will need further examination and treatment.