Cone biopsy

A cone biopsy removes a cone-shaped piece of tissue from the cervix. The cone is formed by removing the part of the cervix closest to the vagina and part of the pathway from the uterus to the vagina (called the endocervical canal). A cone biopsy is also called cervical conization.

Cone Biopsy
Cone Biopsy

Why a cone biopsy is done

A cone biopsy may be done to:

  • try to find out what is causing an abnormal Pap test result
  • diagnose precancerous changes of the cervix and cervical cancer
  • treat precancerous conditions of the cervix, carcinoma in situ in the cervix or stage IA1 cervical cancer

How a cone biopsy is done

A cone biopsy is usually done as an outpatient procedure in the hospital. This means you won’t have to stay overnight. You will have a local anesthetic (freezing) or general anesthetic (you will be unconscious). It depends on how the cone biopsy is done. If you are given a local anesthetic, you may be given pain medicine by mouth or IV (intravenous).

During a cone biopsy, you will be in the same position as you are for a Pap test – lying on your back with your feet up in stirrups. The doctor will place a speculum (the same instrument used during a Pap test) into the vagina to keep it open. The doctor then uses a colposcope (a lighted magnifying instrument) to look at the vagina and cervix and to guide the tools used to do the cone biopsy.

There are 3 ways to do a cone biopsy:

  • Loop electrosurgical excision procedure (LEEP) uses a thin wire loop heated by electricity to remove the cervical tissue.
  • Cold-knife excision uses a surgical knife (scalpel) to remove the cervical tissue.
  • Laser surgery uses a laser (an intense, narrow beam of light) to remove the cervical tissue. Laser surgery is also called laser excision.

The cervical tissue that is removed gets sent to a lab to be looked at under a microscope.

If you have a general anesthetic, you will be taken to the recovery room right after surgery and will stay there until you are ready to go home.

After a cone biopsy, most women are able to return to most of their normal activities within a week. You will be told to avoid sexual intercourse, douching and using tampons for 3 to 4 weeks.

Every 4 to 6 months, you will have a Pap test. After your Pap test results have been normal for a few times, you and your doctor will decide how often you should have the test.

Find out more about loop electrosurgical excision procedure (LEEP) and laser surgery.

Side effects

Side effects can occur with any type of treatment, but not everyone has them or experiences them in the same way.

Common side effects may include:

  • mild menstrual-like cramps
  • some bleeding from the vagina during the first week
  • spotting (small amounts of blood) or dark brown discharge from the vagina during the next 3 weeks

Less common but more serious side effects include:

  • heavy bleeding from the vagina
  • pain that doesn’t go away with pain medicine
  • signs of infection such as increasing pain, fever and discharge from the vagina that is yellowish and smells bad

Long-term side effects

Long-term side effects are different depending on the type of cone biopsy you had.

  • LEEP seems to have fewer long-term side effects than the other types of cone biopsy. Women who become pregnant after LEEP may deliver their babies a little early.
  • Cold-knife excision has been linked to second-trimester miscarriages and premature delivery.
  • Laser surgery has been linked to scarring of the cervix, which may make menstrual periods painful. Women who become pregnant after laser surgery may deliver their babies a little early.

If you become pregnant, tell your doctor that you have had a cone biopsy. Your doctor will talk to you about the best way to manage your pregnancy.

What the results mean

A pathologist will look at the tissue removed during a cone biopsy under a microscope. The pathologist’s report will tell your doctor if the cells of the cervix are normal, precancerous or cancerous.

What happens if the results are abnormal

Your doctor may recommend more tests, procedures, follow-up care or treatment.

Expert review and references