Cervical Biopsy

If abnormal areas are identified on the ectocervix, a correlation for consistency with Pap results is required. A biopsy of the abnormal areas identified by the colposcope can be undertaken using a Kevorkian or Tischler biopsy forceps. To aid in visualization and prevent cross-contamination, biopsies are done on the posterior cervix first, followed by the anterior aspect. The fixed end of the biopsy forceps is usually placed into the cervical os, and biopsies are done in a radial orientation to obtain a sampling of the squamocolumnar transition zone in the area of concern. Samples should be deep enough to include the epithelial surface and a small amount of underlying stroma.

Once biopsies are completed, hemostasis is best achieved with use of a Monsel's paste applied with a cotton applicator or silver nitrate sticks. The vagina is wiped of remaining debris and the speculum withdrawn. The patient is instructed to use analgesics as needed, to abstain from intercourse or tampon use for 10 to 14 days, and to expect some intermittent spotting. Any excessive bleeding, fever, discharge, or significant pelvic pain should warrant a return visit and assessment and treatment of the cause. Confirm a method of contact with the patient and relay the results and treatment recommendations when the pathologic results return.

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