Cervical Biopsy

A cervical biopsy is a procedure in which a small sample of cervical tissue is obtained for laboratory analysis. The cervix, located at the lower end of the uterus, plays a vital role in reproductive health. Abnormalities in cervical cells, often caused by human papillomavirus (HPV) infection, can lead to precancerous or cancerous changes.

Types of cervical biopsies

There are different types of cervical biopsies, depending on how much tissue needs to be examined:

1. Punch biopsy: A small tool is used to take a tiny piece of tissue from the cervix. This is the most common type of cervical biopsy and is typically done in a doctor's office. It causes minimal discomfort.

2. Cone biopsy: A larger, cone-shaped portion of the cervix is removed for testing. This is done under anesthesia and is used when more tissue is needed, especially if previous tests showed abnormal cells.

3. Endocervical curettage (ECC): This procedure scrapes the lining of the cervical canal to collect tissue. It's done when abnormal cells are found deeper inside the cervix.

Risk & Complications of Cervical biopsies

Cervical biopsies, while generally safe, do carry some risks and possible side effects. These vary depending on the type of biopsy performed and the individual’s overall health. Here's a detailed look at the risks:

1. Bleeding:

• Punch Biopsy: Minor bleeding is common after this procedure, usually lasting a few days.
• Cone Biopsy: This involves removing a larger tissue sample, so heavier bleeding may occur. In some cases, a patient may experience prolonged bleeding, requiring medical attention.

2. Infection: There’s a small risk of infection following any cervical biopsy. Signs include fever, foul-smelling discharge, or severe abdominal pain. Infections can be treated with antibiotics.

3. Pain or Discomfort: Mild cramping or discomfort is common after a cervical biopsy, especially with a punch biopsy. For cone biopsies, cramping may last longer due to the more invasive nature of the procedure.

4. Scarring: After a cone biopsy, there is a small risk of scarring on the cervix. This is known as cervical stenosis, which can cause complications like difficulty getting pregnant or problems during labor.

5. Premature Birth Risk: In rare cases, having a cone biopsy can increase the risk of premature birth in future pregnancies due to the weakening of the cervix.

6. Fainting: Some patients experience lightheadedness or fainting during or after the procedure, especially if they’re sensitive to pain or anxious about the procedure.

Post-Procedure Care:

• After the biopsy, patients are advised to avoid strenuous activities, sexual intercourse, and tampon use for a few days to reduce the risk of complications.
• It's also important to follow up with the doctor for results and further treatment if any abnormal cells are detected.

Who performs a colposcopy?

A colposcopy is performed by a healthcare professional known as a gynecologist. Gynecologists specialize in women's reproductive health and are trained to perform this procedure. Sometimes, an experienced nurse practitioner or a doctor with training in women’s health may also conduct a colposcopy. The procedure is typically recommended after an abnormal Pap test result, to examine the cervix, vagina, and vulva more closely for signs of disease. During the procedure, the healthcare provider uses a special magnifying instrument called a colposcope to get a detailed view of the tissue and detect abnormalities.

What happens after the colposcopy?

The procedure for cervical biopsy typically involves the following steps:

1. Preparation: Before the procedure, the patient may be instructed to empty their bladder. It is essential to inform the healthcare provider about any allergies or medications being taken.

2. Positioning: The patient is positioned on a gynecological exam table, similar to a pelvic exam. The feet are placed in stirrups, allowing the healthcare provider clear access to the cervix.

3. Speculum Insertion: A speculum is gently inserted into the vagina to visualize and access the cervix. This may cause a sensation of pressure but should not be overly painful.

4. Local Anesthesia (optional): Depending on the healthcare provider's preference and the patient's comfort, a local anesthetic may be applied to the cervix to numb the area. This is typically done using a numbing spray or injection.

5. Tissue Sample Collection: Different techniques may be used to obtain a tissue sample from the cervix:
   a. Punch Biopsy: A small instrument called a biopsy punch or forceps is used to remove a small piece of cervical tissue. This may cause a brief pinch or cramp-like sensation.
   b. Endocervical Curettage (ECC): A narrow instrument called a curette is gently inserted into the cervical canal to scrape and collect cells from the endocervical area.

6. Hemostasis and Care: After the tissue sample is obtained, any bleeding is usually controlled using a specialized solution or a small electric probe. The speculum is then removed, and the patient is provided with instructions for post-biopsy care.

7. Laboratory Analysis: The tissue sample is sent to a laboratory for microscopic examination by a pathologist. The results are typically available within a few days to a week.