Background Information:

What are the other Names for the Procedure?

• Cervical Biopsy
• Cone Biopsy
• Endocervical Curettage (ECC)

What is Biopsy of Cervix surgical procedure?

• A Biopsy of Cervix procedure involves the removal of (complete, or a portion of) any abnormal tissue within the cervix
• The tissue that is removed, is sent for a laboratory examination, in order to identify any precancerous abnormalities or to check for cervical cancer

What part of the Body does the Procedure involve?

A Biopsy of Cervix involves the cervix and vagina.

Why is the Biopsy of Cervix surgical procedure Performed?

A Cervical Biopsy is performed for the following reasons:

• To investigate suspected disorders associated with the cervix
• Removal of abnormal cervical tissue, which is then sent to a pathologist for further examination
• Cervical abnormalities found following a pelvic examination, or cell abnormalities found following a pap smear
• This procedure may be performed for investigative reasons, such as to diagnose female infertility
• Occasionally performed on women who have at one time been treated for cervical cancer, or dysplasia within the cervix

What are some Alternative Choices for the Procedure?

The Biopsy of Cervix remains a gold standard technique to obtain samples from the cervix, if any abnormality is suspected.

What are the Recent Advances in the Procedure?

Cervical Biopsy remains a very useful procedure for obtaining tissue samples from the cervix.

What is the Cost of performing the Biopsy of Cervix surgical procedure?

The cost of Biopsy of Cervix procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Biopsy of Cervix and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gynecology/cervical_biopsy_92,P07767/

http://www.nlm.nih.gov/medlineplus/ency/article/003913.htm

http://www.health.harvard.edu/diagnostic-tests/colposcopy-and-cervical-biopsy.htm

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

Prior to Biopsy of Cervix surgical procedure:

How is the Biopsy of Cervix surgical procedure Performed?

• The individual is placed in a lithotomy position. The patient lies flat on the back (supine), with feet raised and supported by foot rests, called stirrups
• An instrument called a speculum, is inserted into the vagina
• The speculum gently spreads the vaginal walls, following which the inside of the vagina and the cervix can be seen
• Another instrument called a colposcope (a special magnifying device) is used to look at the vagina and cervix
• Sometimes, special solutions may be used to make abnormal areas visible on the cervix
• After detection of abnormal areas, several samples are taken using a biopsy forceps, and sent to the pathologist
• In order to take samples from inside the opening of the cervix (the endocervical canal), a procedure called Endocervical Curettage (ECC) is performed. In this procedure a small sharp instrument, called a curette, is gently advanced into the endocervical canal and samples obtained.

Where is the Procedure Performed?

A Biopsy of Cervix is usually performed in an out-patient surgery center facility or a physician’s clinic/office. Normally, the person can go home once the procedure is completed.

Who Performs the Procedure?

The Biopsy of Cervix is performed either by an obstetrician, a gynecologist, a qualified physician, or by any trained personnel (like the nurse practitioners).

How long will the Procedure take?

A Biopsy of Cervix procedure, usually takes about 20-30 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Normally local anesthesia is not used. However, do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
• A physician will request your consent for Biopsy of Cervix procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for Biopsy of Cervix procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Biopsy of Cervix surgical procedure?

Before a Cervical Biopsy procedure, the patient may need to undergo certain tests (as directed by the physician) such as:

• Routine blood and urine analysis
• Pelvic examination
• Pap smear

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Biopsy of Cervix procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• What are the alternatives to the procedure?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Biopsy of Cervix surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia may be administered for this procedure.

How much Blood will you lose, during the Procedure?

Since Biopsy of Cervix is a minimally invasive procedure, there is little or no blood loss involved.

What are the possible Risks and Complications during Biopsy of Cervix surgical procedure?

There are general factors that increase the risk of getting complications during the procedure, which include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes
• Taking some prescription or non-prescription medication: It is very important to inform your healthcare provider the complete list of all such medications. This will help assess the surgical risk for complications

The possible risks or complications that may arise during the surgery are:

• Excessive bleeding
• Infection
• Anesthetic complications
• Accidental injury to the neighboring tissue

What Post-Operative Care is needed at the Healthcare Facility after Biopsy of Cervix surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise. 

After the Biopsy of Cervix surgical procedure:

What are the possible Risks and Complications after Biopsy of Cervix surgical procedure?

Post Biopsy of Cervix, the following complications may arise:

• Excessive bleeding
• Signs of infection
• Narrowing of the spinal canal (cervical stenosis)
• Sometimes, using the procedure, it is not possible to completely remove the cervical dysplasia

What is the Prognosis after the Surgery?

• The prognosis is mainly dependent on the pathology report
• Benign conditions have a better prognosis when compared to cancers
• If cancer is confirmed, then prognosis is based on the stage of cancer, at the time of diagnosis

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain around the surgical wound
• Bleeding or fluid drainage around the spot
• Fever
• Dizziness
• Signs of an infection
• Feeling sick
• Abnormal vaginal bleeding or swelling

What Post-Operative Care is needed at Home after Biopsy of Cervix surgical procedure?

At home, the following post-operative care is recommended, after a Biopsy of Cervix procedure:

• Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
• Avoid all activities that are physically strenuous for 2-3 weeks
• Wear cotton underwear
• It may be required to use sanitary napkins (for bleeding) for about a week (or more)
• Avoid douching, unless advised by your physician
• Resume driving, only 24 hours after the procedure
• Avoid tampons, which may cause an infection, unless your physician recommends them
• Use heat pad or warm compress to relieve pain
• Keep the wound clean and dry. While bathing, wash the wound using an unscented soap
• Avoid sex till complete healing has taken place (under advice by the physician)
• Complete the course of prescribed medication (under advice of the physician)

How long does it normally take to fully recover, from the Procedure?

A complete recovery from this procedure usually takes less than a week.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Biopsy of Cervix surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility, physician’s office or hospital
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)
• An obstetrician, a gynecologist, a family physician or a general surgeon

The patient is advised to inquire and confirm the type of billing, before a Biopsy of Cervix procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA