During cervical tissue biopsy, small amount of tissue is removed carefully for examination under a microscope. It is the only test that can help us reach definitive diagnosis. Small cervical lesions are removed during the biopsy.
There are several types of biopsies. Doctor’s usually perform this method in their office using a local anesthesia. It may result in bleeding which can be controlled easily. Commonly an instrument is used to remove small pieces of cervical tissue.
» Colposcopic biopsy
For this type of biopsy, doctor examine the cervix with a colposcope to find the abnormal areas in the cervix. Biopsy forceps are then used to remove any abnormal area on the surface of the cervix. The biopsy procedure may result in mild cramping and bleeding.
» Endocervical curettage (endocervical scraping)
Transformation zone cannot be visualized with the colposcope so doctor takes a sample of an endocervix by inserting a curette into the endocervical canal. Sample is sent to the pathologist for further examination. After this procedure, patient may experience some pain and bleeding. This procedure is called endocervical curettage (ECC). Curette used in this procedure is a spoon-shaped instrument that removes small amount of tissue from inside the cervical opening.
» Cone biopsy
Cone biopsy is done by removing a cone-shaped piece of tissue from the cervix. The base of the cone is normally formed by the exocervix and the point or apex of the cone is from the endocervical canal. This method is used to remove tissue from transformation zone of cervix. This procedure is also called conization.
It is the best method for the treatment of any pre-cancerous conditions and some early stage malignancies. One of the disadvantages of this procedure is that it makes women prone to premature birth.
Most common methods for cone biopsies are the loop electrosurgical excision procedure (LEEP) and the cold knife cone biopsy.
- Loop electrosurgical procedure (LEEP, LLETZ,): In this procedure, the tissue is scraped off with a thin wire loop heated by electricity. A LEEP is very effective in removing precancer or an early-stage cancer. It is also called large loop excision of the transformation zone (LLETZ,).
- Cold knife cone biopsy: A surgical scalpel or a laser is used to remove the cervical tissue. It is more advanced and safe procedure than LLETZ,.
How biopsy results are reported
Biopsy can detect any cancerous or pre-cancerous changes in a biopsy are called cervical intraepithelial neoplasia (CIN). CIN is graded on a scale of 1 to 3 based on extent of abnormal changes.
- In CIN1, mild dysplastic changes can be seen
- CIN2, moderate dysplastic changes can be seen
- In CIN3, severe dysplastic changes can be seen throughout the epithelium. It is also called carcinoma in situ.
- If the biopsy shows presence of cervical cancer, doctor may suggest additional tests to look for metastasis.
Your doctor may also recommend that you get a screening more frequently based on your circumstances.
Certain tests are done if doctor suspect cervical cancer on biopsy:
› X-ray :
An x-ray is done to rule out spread of malignant cells to chest, abdominal region or pelvic region.
› Computed tomography (CT or CAT) scan :
A CT scan can help the doctor in staging the invasive cervical cancer. A CT scan can be used to measure the size of tumor. Lymph node involvement can also be seen in CT scan. Contrast medium is given before the scan to increase the quality and detail of an image.
› Magnetic resonance imaging (MRI) :
An MRI uses magnetic fields to produce images of the body. Size of the tumor can be measured with an MRI. Involvement of organs other than cervix can be seen in an MRI.
› Positron emission tomography (PET) :
A PET scan is usually combined with a CT scan to produce pictures of organs and tissues inside the body. Malignant cells tend to use energy actively so they absorb more of the radioactive substance. Detailed images of high quality are produced.
Any ominous bladder or rectal symptom accompanied with cervical cancer require these procedures
› Cystoscopy :
A cystoscopy is a method that helps the doctor to view the inside of the bladder. A cystoscopy helps in finding out whether cancer has metastasized to the bladder.
› Sigmoidoscopy (also called a proctoscopy) :
A sigmoidoscopy helps the doctor in viewing colon and rectum with a sigmoidoscope. A sigmoidoscopy is used to look for rectal spread of cancer.
» Now, let’s discuss the screening of cervical cancer.