1.
Cervical Biopsy
Apoorva Kottary

2.
Contents
• Anatomy
• Cervical Biopsy
• Types
• Punch Biopsy
• Wedge Biopsy
• Ring Biopsy
• Cone Biopsy
• Complications

3.
Basic Anatomy
• It is lowermost part of
the uterus.
• Cylindrical in shape and
measures about 2.5 cm
• It lies between the
histological internal os
and the vagina.
• Mainly composed of
fibrous connective
tissue. With average of
10-15 % smooth muscle
fibers.

4.
• Transitional zone - also
known as squamo-
columnar junction or
tranformation zone, where
the squamous epithlium of
the vagina merges with the
columnar epithelium of the
endocervix and is around 1-
10 mm.
• It is not static and changes
with hormone level of
oestrogen.

5.
Squamo-Columnar Junction
• The constant cellular activity of the cells
makes the cell highly sensitive to irritants
mutagens and viral agents such as papilloma
virus 16,18
• These nuclear changes eventually lead to
dysplasia and carcinoma cervix.

6.
Cervical Biopsy
Removal of a small
sample of tissue of
the cervix for
examination under a
microscope; used for
the diagnosis and
treatment of cervical
cancer and
precancerous
conditions.

7.
Types of Cervical Biopsy
1. Punch Biopsy
2. Wedge Biopsy
3. Ring Biopsy
4. Cone Biopsy – Conization
5. Surface Biopsy – Pap Smear for cytology

8.
Punch Biopsy
• An out patient procedure without anesthesia
• Using Cusco’s Bivalve Speculum biopsy is taken
from the suspected area or a 4-quadrant using
Punch Biopsy forceps.
• It can be also Colposcopic directed or stained
with Schiller’s iodine or Acetic acid

9.
Iodine staining
revealing saffron-
colored abnormal
area.
Acetowhite lesion
after washing with
acetic acid.

10.
A: Graves or Pederson speculum, B: Endocervical curette, C: Tischler punch
biopsy forceps, D: Fixative for histology (formalin), E: Cytobrush, F: Proto
swabs/“pom-pom” vaginal swabs, G: Monsel’s solution (ferrous subsulfate), H: Silver
nitrate sticks, I: Lugol’s iodine solution, J: 3% acetic acid, K: Cervical speculum.

11.
Wedge Biopsy
• It is done when definite growth is visible
• An area near the edge is the ideal site
• Steps:
a) Posterior vaginal speculum is introduced.
b) Anterior and the posterior lip of the cervix is
held by Alley’s forceps.
c) With a scalpel, a wedge of tissues is cut from the
edge of the lesion including the healthy tissue
for comparative histological study.

12.
Ring Biopsy
• Whole of squamo-columnar junction
area of the cervix is excised with a special
knife.
• The tissue is subjected to serial section to
detect cervical intraepithelial neoplasia
(CIN) or early invasive carcinoma.

13.
Cone Biopsy - Conization
• Both diagnostic and therapeutic purpose
• Removal of cone of the cervix which includes entire
Squamocolumnar junction, stroma with glands and
endocervical mucous membrane.
• Methods: Cold knife, CO₂ laser, Laser diathermy loop

14.
• Indication:
– Unsatisfactory Colposcopic findings
– Inconsistent findings - Colposcopic, Cytology
and directed biopsy
– Positive endocervical curettage for CIN II and III
– When biopsy cannot rule out invasive cancer
from carcinoma in-situ
– Biopsy shows microinvasion – to exclude gross
invasive carcinoma

15.
Steps in Cold Knife
• Under general anesthesia
• Blood loss is minimized with prior haemostatic
sutures at 3 o'clock 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 the
internal os.
• After the cone is removed, a margin suture is
placed at 12 o'clock for identification of the cone.

16.
• Routine endocervical curette above the apex of
the cone is performed and uterine curettage is
done if indicated
• Cone margins are repaired by haemostatic
sutures.
• 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 considered
either before 48 hours or before 6 weeks to
prevent infection.

17.
Advantages of Laser over Cold Knife
• Done in the out patient under local anesthesia
• Less tissue damage and less blood loss
• Less post operative pain and morbidity
• All types of CIN can be treated
• Fertility and pregnancy outcomes are not
affected adversely

18.
Complications
• Secondary Hemorrhage
• Cervical stenosis leading to Haematometra
• Infertility
• Diminished cervical mucus
• Cervical incompetence leading to recurrent
miscarriage

19.
Bibliography
• Howkins & Bourne Shaw’s Textbook of
Gynaecology – 16th edition
• D. C. Dutta’s Textbook of Gynaecology –
Hiralal Konar – 8th edition

20.
Thank you