Cervical Biopsy

Cervical biopsy is the excision by sharp forceps of a tissue specimen from the cervix for histologic examination. Two types of cervical biopsy are performed to evaluate abnormal lesions of the cervix or abnormalities revealed on a Papanicolaou (Pap) test. One is a cervical biopsy that's performed during colposcopy. The other is a cone biopsy often performed during a loop electrosurgical excision procedure. The biopsy site is selected by direct visualization of the cervix with a colposcope, and the biopsy is performed when the cervix is least vascular, usually 1 week after menses.

Purpose

• To evaluate suspicious cervical lesions
• To diagnose cervical cancer

Patient preparation

• Describe the procedure to the patient, and explain that it provides a cervical tissue specimen for microscopic study.
• Tell her who will perform the biopsy and where.
• Advise the outpatient to have someone accompany her home after the biopsy.
• Make sure the patient or a responsible family member has signed an informed consent form.
• Just before the biopsy, ask the patient to void.

Procedure and posttest care

• Place the patient in the lithotomy position, and tell her to relax as the unlubricated speculum is inserted.
• For direct visualization, the colposcope is inserted through the speculum, the biopsy site is located, and the cervix is cleaned with a swab soaked in 3% acetic acid solution. The biopsy forceps are then inserted through the speculum or the colposcope, and tissue is removed from any lesion or from selected sites, starting from the posterior lip to avoid obscuring other sites with blood. Each specimen is immediately put in 10% formaldehyde solution in a labeled bottle. To control bleeding after biopsy, the cervix is swabbed with 5% silver nitrate solution (cautery or sutures may be used instead). If bleeding persists, the examiner may insert a tampon.
• If a cone biopsy is to be performed, a local anesthetic may be injected into the cervix.
• Record the patient's and doctor's names and the biopsy sites on the laboratory slip.
• Instruct the patient to avoid strenuous exercise for 24 hours after the biopsy. Encourage the outpatient to rest briefly before leaving the office.Tell her to avoid heavy lifting for a few days.
• If a tampon or vaginal packing was inserted after the biopsy, tell the patient to leave it in place for 8 to 24 hours. Inform her that some bleeding may occur, but tell her to report heavy bleeding (heavier than menses). Warn the patient to avoid using tampons, which can irritate the cervix and provoke bleeding.
• Tell the patient to avoid douching and intercourse for 2 weeks, or as directed.
• Inform the patient that a foul-smelling, gray-green vaginal discharge is normal for several days after the biopsy and may persist for 3 weeks.

Precautions

• Send the specimens to the laboratory immediately.

Normal Findings

Normal cervical tissue is composed of columnar and squamous epithelial cells, loose connective tissue, and smooth-muscle fibers with no dysplasia or abnormal cell growth.

Abnormal findings

Histologic examination of a cervical tissue specimen is used to identify abnormal cells and to differentiate the tissue as intraepithelial neoplasia or invasive cancer. If the cause of an abnormal Pap test isn't demonstrated by cervical biopsy or if the specimen shows advanced dysplasia or carcinoma in situ, a cone biopsy is performed under general anesthesia to obtain a larger tissue specimen and to allow a more accurate evaluation of dysplasia.

Interfering factors

• Menses
• Patient's inability to assume the lithotomy position
• Failure to obtain representative specimens or to place them in the preservative immediately