Cold Knife Cone Biopsy

A cold knife cone biopsy is performed in the operating room with anesthesia. Before your procedure, you will receive specific instructions about when to stop eating and drinking, which medications to take or hold, your arrival time, and what to expect on the day of surgery. Please follow the instructions provided by your surgical and anesthesia teams, even if they differ from general information on this page.

Before your procedure:

• Let us know if you are pregnant or think you could be pregnant. We will typically perform a pregnancy test before surgery if there is any possibility of pregnancy.

• Let us know if you are taking blood thinners or medications that may affect bleeding. Your surgical team will tell you whether and when these medications should be stopped. Do not stop a prescribed blood thinner without specific instructions.

• Follow the fasting instructions provided before surgery. Because you will receive anesthesia, you will need to stop eating and drinking for a period of time before the procedure.

• Follow your instructions about medications on the morning of surgery. Some medications can be taken as usual, while others may need to be held or adjusted.

• Try to avoid scheduling during a heavy period when possible. Light bleeding or spotting may not interfere with the procedure, but please contact our office if you are having significant bleeding before surgery.

• Have pads available for bleeding or discharge afterward.

• Arrange for an adult to drive you home. You will not be able to drive yourself after receiving anesthesia.

• It is also helpful to have someone available to stay with you or check on you after surgery, particularly during the first several hours at home.

A cold knife cone biopsy is performed in the operating room while you are under anesthesia. The procedure itself usually takes less than an hour, although you will spend additional time at the hospital before and after surgery.

During the procedure:

• A speculum is placed in the vagina so your doctor can see the cervix, similar to during a Pap test.

• The cervix is carefully examined to identify the area of abnormal tissue that needs to be removed.

• Using a surgical scalpel, your doctor removes a cone-shaped piece of tissue from the cervix. The specimen includes the abnormal area on the surface of the cervix as well as tissue extending into the cervical canal.

• Bleeding is controlled using techniques such as cautery, medication applied to the cervix, or stitches when needed.

• The tissue that was removed is sent to a pathologist for detailed examination. This allows us to determine the severity and extent of the abnormal cells and whether the edges (margins) of the specimen are clear.

A cold knife cone biopsy can be both diagnostic and therapeutic. It removes abnormal cervical tissue while also providing a larger, intact specimen for the pathologist to examine.

Benefits may include:

• Removing precancerous or abnormal cervical cells, which can help prevent cervical cancer.

• Providing a larger and deeper tissue sample than some other cervical procedures.

• Allowing the pathologist to determine the type and severity of abnormal cells and whether they extend into the cervical canal.

• Allowing careful evaluation of the edges (margins) of the removed tissue to see whether abnormal cells may remain.

• In many cases, the procedure completely removes the abnormal area, so no additional treatment is needed.
  
  

Possible risks include:

• Bleeding. Some bleeding is expected afterward, but occasionally heavier bleeding can occur and require additional treatment.

• Infection. Infection of the cervix or uterus is uncommon but possible.

• Injury to nearby structures. Injury to the vagina, uterus, bladder, or other surrounding structures is rare.

• Cervical stenosis. Scar tissue can occasionally cause the opening of the cervix to become narrowed, which may affect menstrual flow or make future cervical procedures more difficult.

• Changes in future pregnancies. Removing cervical tissue can slightly increase the risk of cervical insufficiency or preterm birth in a future pregnancy. The amount of tissue removed and whether you have had more than one excisional procedure can affect this risk.

• Abnormal cells may remain or return. Even when the procedure is successful, continued cervical cancer screening and follow-up are important.

Planning a future pregnancy?
Let your doctor know if you hope to become pregnant in the future. We try to remove enough tissue to safely evaluate and treat the abnormal area while preserving as much healthy cervical tissue as possible.

Most patients go home the same day after recovering from anesthesia. You may feel tired or groggy for the rest of the day, so plan to take it easy and have someone drive you home.

During the first few days:

• Mild to moderate cramping, similar to menstrual cramps, is common.

• You may have light bleeding or spotting.

• A watery, pink, brown, or dark-colored discharge is common while the cervix heals. If medication is applied to the cervix to control bleeding, the discharge may look dark brown or even black.

• You may use ibuprofen (Motrin/Advil) or acetaminophen (Tylenol) for discomfort if you normally take these medications safely.

• Most patients can gradually return to their usual daily activities over the next few days, depending on how they feel and the instructions provided by their surgeon.
  
  

While your cervix heals:

• Use pads or panty liners rather than tampons for bleeding or discharge.

• Avoid vaginal intercourse and placing anything in the vagina until your cervix has healed and your doctor has cleared you, typically about 4 weeks.

• Avoid strenuous exercise and heavy lifting for 4 weeks.

• Avoid swimming, hot tubs, or soaking in a bathtub for 4 weeks. Showering is fine.

• You may notice a temporary increase in bleeding around 2 weeks after the procedure. This can happen when the scab over the healing cervix falls off and is usually part of the normal healing process. Please call us if the bleeding becomes heavy.

The tissue removed during your cold knife cone biopsy is sent to a pathologist for examination. Results are usually available within 3–5 days. The pathology report helps us confirm the type and severity of the abnormal cells and determine whether the abnormal area appears to have been completely removed.

One important part of the report is the margins, or edges of the tissue that was removed:

• Negative (clear) margins mean that abnormal cells were not seen at the edges of the specimen. This is reassuring and suggests that the abnormal area was completely removed.

• Positive margins mean that abnormal cells extend to one or more edges of the specimen. This does not necessarily mean that another procedure is needed. Depending on your results and individual circumstances, we may recommend closer follow-up, additional testing, or occasionally further treatment.

Your pathology report may also provide additional information about how far the abnormal cells extend into the cervixand whether there are any findings that change the recommended next steps. We will review your results with you and discuss whether any additional evaluation or treatment is needed.

Even when the abnormal cells appear to have been completely removed, continued cervical cancer screening is important. Having a history of high-grade cervical dysplasia means that you will need closer follow-up than someone who has never had an abnormal result.

Your exact follow-up plan will depend on your pathology results and previous cervical screening history. We will review this with you and make sure you know when your next Pap and/or HPV test should be performed.