CERVICAL BIOPSY

INTRODUCTION
A cervical biopsy is a surgical procedure in
which a small amount of tissue is removed
from the cervix to test for abnormal or
precancerous conditions, or cervical cancer.
 TYPES
 Surface
 Punch

 Wedge

 Ring

 Cone
 PUNCH BIOPSY
 Punch biopsy is done in the outpatient or as an office procedure,
without anesthesia.
 Using cusco’s bivalve speculum, biopsy is taken from the
suspected area or a four quadrant using punch biopsy forceps.
 Alternatively, the biopsy may be taken from the unstained area
(white) when the cervix is painted with Schiller’s iodine or
colposcopic directed.
 Hemostasis is usually achieved by pressure with a gauze piece.
 WEDGE BIOPSY
 This is done when a definite growth is visible.
 Necrotic area is to be avoided.

 An area nearer the edge is the ideal site.

 PROCEDURE:

➢ Posterior vaginal speculum is introduced.

➢ Anterior or posterior lip of the cervix is to be held by Allis

forceps.
➢ With a scalpel, a wedge of tissue is cut from the edge of the
lesion including adjacent healthy tissue for comparative
histologic study.
➢ Hemostasis may be achieved by gauze packing or by sutures.
 RING BIOPSY
 Whole of the squamocolumnar area of the cervix is excised with
a special knife.
 The tissue is subjected to serial section to detect CIN ( Cervical
Intraepithelial Neoplasia ) or early invasive carcinoma.
 This is almost replaced by directed biopsy either Schiller or
colposcopy.
 CONE BIOPSY - CONIZATION
 The operation involves removal of cone of the
cervix which includes entire squamocolumnar
junction, stroma with glands and endocervical
mucous membrane.
 INDICATIONS
 Unsatisfactory colposcopic findings. The entire margins
of the lesion are not visualized.
•
Inconsistent findings—colposcopic, cytology and
directed biopsy.
•Positive endocervical curettage.
•
When biopsy cannot rule out invasive cancer from CIS
or microinvasion.
 PROCEDURE (COLD KNIFE )
 The operation is done under general anesthesia.
 B
lood loss is minimized with prior hemostaticsutures at 3 and 9 O’clock
positions on the cervix by ligating the descending cervical branches.
 •
The cone is cut so as to keep the apex below theinternal os.
 A
fter the cone is removed, a margin suture is placed at 12 O’clock position
for identification of the cone.
 R
•outine endocervical curette above the apex of the cone is performed and
uterine curettage is done, if indicated.
 •
Cone margins are repaired by hemostatic sutures.
 Sturmdorf hemostatic suture should not be used as it interferes with future
colposcopic examination.
 The excised cervical tissue is sent for histological
 examination (serial section–minimum 6).
 If the margins of the cone are involved in neoplasia, hysterectomy should
be seriously considered either within 48 hours or at a later date (6 weeks) to
avoid infection.
ADVANTAGES OF LASER OVER COLD
KNIFE CONIZATION
•
Done in the outpatient under local anesthesia
•
Less tissue damage and less blood loss.
•
Postoperative pain and discharge (morbidity) - less
•
Regeneration of epithelium occurs earlier (3-4 weeks).
•
All types of CIN can be treated.
•
Fertility and pregnancy outcome are not affected adversely.
 COMPLICATIONS
•econdary hemorrhage.
S
•
Cervical stenosis leading to hematometra.
•
Infertility.
•
Diminished cervical mucus.
•
Cervical incompetence leading to recurrent miscarriage.
•
Midtrimester abortion or preterm labor.