In cone biopsy, a cone-shaped piece of tissue is removed from the central portion of the cervix, the cylindrical area at the bottom of the uterus that opens into the vagina. This specimen is sent to a laboratory for examination. A cone biopsy is usually done to obtain a more extensive sample of cervical tissue when less invasive tests, such as colposcopy and cervical punch biopsy, are insufficient to confirm or rule out cervical cancer.
Purpose of the Cone Biopsy
- To detect cervical cancer and determine whether it is invasive when the results of colposcopy and cervical punch biopsy are insufficient for a definitive diagnosis
- To detect or treat abnormal cervical cells
- To evaluate the extent and severity of cervical cancer and guide treatment decisions after cancer is detected with a Pap smear, colposcopy, and cervical punch biopsy
- Used therapeutically to remove abnormal cervical tissue
Who Performs Cone Biopsy
- A gynecological surgeon assisted by a nurse
Special Concerns about Cone Biopsy
- Cone biopsy is usually performed under general anesthesia. However, in some cases only local anesthesia is required.
Before the Cone Biopsy
- Tell your doctor if you regularly take anticoagulants or nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen). You will be instructed to discontinue them for some period before the test. Also mention any other medications, herbs, or supplements that you take.
- You will go to the hospital for certain routine blood and urine tests 1 or 2 days before the procedure.
- If general anesthesia is to be used, do not eat or drink anything for at least 6-8 hours before the test.
- You will be asked to disrobe and put on a hospital gown.
- Empty your bladder before the test.
- If local anesthesia is being used, you will be given a sedative about 30 minutes before the procedure.
- If general anesthesia is being used, the medication is administered through an intravenous (IV) needle or catheter inserted into a vein in your arm. A tube may be inserted through your windpipe to ensure you breathe properly during the procedure.
What You Experience during Cone Biopsy
- You will be positioned on your back with your knees bent and your feet raised and resting in stirrups.
- A speculum—a metal or plastic instrument that pushes apart the walls of the vagina—is inserted to expose the cervix. If local anesthesia is being used, the medication is injected into the cervix.
- The doctor uses a scalpel (called a cold-knife conization), laser or a device called an electrosurgical wire loop to remove a cone-shaped portion of tissue from the center of the cervix. (The widest part of the cone is taken from the opening of the cervix, while the middle and tip of the cone are taken from the cervical canal leading to the uterus.)
- The edges of the cervix are then sutured, or a cautery device is used to seal the blood vessels with an electric current.
- The instruments and speculum are then withdrawn.
- Cone biopsy takes up to 30 minutes.
Risks and Complications of Cone Biopsy
- Possible complications include heavy bleeding and, rarely, infection, injury to tissue, vaginal tear, inadvertent perforation of the uterus (which requires surgical repair), or impaired menstrual flow.
- Cone biopsy may lead to increased risk of miscarriages and possible infertility because the cervix may be weakened by the surgery. Scar tissue may also interfere with dilatation of the cervix during labor and thus reduce the chances for vaginal childbirth.
After the Cone Biopsy
- You will remain in a recovery room until you recover from the effects of sedation or anesthesia. During this time, your vital signs will be monitored and you will be observed for any evidence of complications.
- Arrange for someone to drive you home.
- You may experience mild to moderate cramping. Pain-relieving medication may be prescribed to allay any discomfort.
- You may experience slight bleeding. Use sanitary napkins rather than tampons.
- After 2 or 3 days, you may return to your normal activities. However, avoid sexual intercourse, tampons, active sports, douching and using a vibrator for 46 weeks to allow the cervix to heal adequately.
- Avoid baths and take showers for 2 weeks after your biopsy.
- Avoid lifting anything weighing 25 pounds or more for about 2 weeks.
- Call your doctor immediately if you develop heavy bleeding or discharge or a fever.
Results of Cone Biopsy
- A pathologist examines the tissue sample under a microscope for the presence of unusual cells. Cone biopsy usually results in a definitive diagnosis.
- If no cancer is found, no further tests are necessary.
- If cervical cancer or a precancerous condition is found, further surgery may be scheduled. Additional tests, such as a bone scan, may also be performed to determine if cancer has spread.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media