What is a Cone Biopsy?

A biopsy is the removal of a small sample of tissue from a living person. This tissue is then examined to determine the cause of disease, illness, or abnormality. A cone biopsy is a specialized procedure used almost exclusively on cervical tissues when a more standard biopsy procedure warrants further examination.

Also called a cold knife biopsy or conization, a cone biopsy is used for both diagnostic and treatment purposes. The steps leading to a need for biopsy begin with an abnormal pap smear. Sometimes the swab of cells taken during a routine gynecological exam will indicate abnormalities in the cervical cells that form the first layer of cervical tissue. This is called dysplasia.

When only a few cells are abnormal it is called mild dysplasia and isn't considered a serious issue, but moderate and severe dysplasia can indicate pre-cancerous and cancerous conditions. When initial biopsies suggest more severe dysplasia, a cone biopsy allows physicians to remove a cone shaped wedge of tissue higher in the cervix than traditional biopsy procedures. The goal is to remove the abnormal cells along with some of the normal cells at the edge of the dysplastic tissue to ensure all the abnormal cells in the region are removed. The tissue is then examined, but if all abnormal cells were removed in the cone biopsy procedure and no other indications of abnormality are suspected, that in itself serves as the treatment.

A cone biopsy does not require a stay in the hospital. It is usually an outpatient procedure and patients are either given anesthesia to keep them unconscious during the procedure, or the area will be completely numbed. Just like a regular gynecological exam, patients will lie back on a table and place feet in stirrups. A speculum will open the vaginal area and allow the physician to use a scalpel to remove the cone of tissue from the cervix. The surrounding tissue is then stitched or cauterized.

Alternatively, another procedure called the loop electrosurgical excision procedure (LEEP) can be used. LEEP uses a very thin, very hot wire to cut through the cervical tissue. This can be done in a physician's office by numbing the cervix with a cervical block and administering intravenous or oral pain medications.

Yet another option for performing a cone biopsy is a carbon dioxide laser (CO₂ Laser). This is an intense beam of light that not only cuts through the tissue, but also sterilizes and seals the tissue as it is removed. Laser procedures may shorten healing time, but only a physician can determine which procedure is more suited to each individual case.