Cone Biopsy & Leep - Differences in Procedures, Uses and Results

What is cone biopsy (conization)?

Cone biopsy, also known as conization, is a procedure where a cone-shaped section of the cervix is removed for diagnosis or treatment of cancer. The "cone" in its name refers to the shape of the tissue extracted. 

This cone shaped tissue is usually extracted from the transformation zone which lies at the opening of the cervix where the endocervix (inner part) and ectocervix (outer part) come together. The transformation zone is where cervical cancer most often begins. Cone biopsy is used as a means to both to diagnose and treat cervical abnormalities, particularly when other tests like Pap smears or colposcopy indicate the presence of abnormal cells (cervical dysplasia) or early cervical cancer.

When is cone biopsy used?

• Abnormal Pap smear or colposcopy: 

  • If tests indicate high-grade cervical dysplasia (such as CIN 2 or CIN 3), a cone biopsy is often necessary to confirm the diagnosis and remove the abnormal cells.

• Suspected early cervical cancer: 

  • When early-stage cervical cancer is suspected based on prior biopsy results, a cone biopsy can both diagnose and remove the cancerous tissue.

• Inconclusive biopsy results: 

  • If previous biopsy results are unclear or contradictory, a cone biopsy can provide a larger, more comprehensive tissue sample for examination.

• Fertility preservation: 

  • For women with early-stage cervical cancer who wish to preserve fertility, a cone biopsy can serve as a fertility-sparing treatment, removing only part of the cervix while leaving the uterus intact.

Have you noticed any abnormal biopsy results or been recommended for further cervical examination? Request for an appointment with our women health specialists at Thomson Medical for a thorough assessment today.

How is cone biopsy performed?

• Preoperative preparation: 

  • Prior to the procedure, patients may need to avoid eating or drinking for a few hours, especially if general anesthesia is used. 

  • Doctors may also request that patients stop taking blood-thinning medications temporarily to reduce the risk of bleeding.

• Anesthesia: 

  • Cone biopsy can be done under local anesthesia, where the cervix is numbed, or under general anesthesia, where the patient is asleep during the procedure.

• Cone biopsy procedure:

1. The patient is positioned on the examination table with her legs situated in the stirrups, similar to a Pap smear. 

2. A speculum is inserted into the vagina to allow access to the cervix.

3. The doctor removes a cone-shaped section of tissue from the cervix, targeting the area of abnormal cells.

4. The extracted cone-shaped tissue is sent to a lab for pathological examination to determine if it is precancerous, cancerous or normal.

5. If bleeding occurs during the procedure, it may be controlled with stitches or cauterization.

• Duration: 

  • The procedure generally lasts about 15-30 minutes, and the patient can usually go home the same day as it is an outpatient procedure.

Methods used in cone biopsy

There are many different techniques that can be used to excise the cone-shaped tissue during a cone biopsy. The specific method chosen depends on the patient's condition and the doctor's preference. The three most common methods are:

1. Loop Electrosurgical Excision Procedure (LEEP)

   • LEEP is a minor surgical procedure used to remove abnormal tissue from the cervix. It involves using a thin, electrically charged wire loop to excise a small section of cervical tissue, which is then examined to check for precancerous or cancerous cells. Learn more about LEEP here.

2. Cold knife cone biopsy (CKC)

   • This technique uses a surgical scalpel (cold knife) to excise the tissue. It is more often used when a larger tissue sample is needed, or when more precise tissue removal is required. This is typically done under general or regional anesthesia.

3. Laser conization

   • A laser is used to cut away the abnormal tissue. It is less commonly used but can be helpful in certain cases.

What are the potential complications of cone biopsy?

While cone biopsy is generally considered safe, like any surgical procedure, it carries potential risks and complications, including:

• Infection: 

  • There is a risk of developing a uterine or cervical infection following the procedure.

• Bleeding: 

  • Some light bleeding is normal after the procedure, but heavy or prolonged bleeding requires additional medical intervention.

• Cervical stenosis: 

  • The cervix can become narrowed due to scarring (cervical stenosis), which can lead to menstrual problems or fertility issues.

• Preterm birth: 

  • The removal of a large portion of the cervix during cone biopsy may weaken it, increasing the risk of preterm birth or cervical insufficiency in future pregnancies.

• Discomfort and cramping: 

  • Mild to moderate pelvic discomfort and cramping may occur after the procedure, typically resolving within a few days.

Want to know more about the above procedures? Feel free to contact us here.

Is LEEP the same as cone biopsy?

No, LEEP is not the same as a cone biopsy. Cone biopsy, refers to the broader surgical technique used to remove a cone-shaped section of cervical tissue, with multiple methods available to perform it. LEEP can be used as a method in performing a cone biopsy alongside cold knife cone biopsy (CKC) and laser conization. However, LEEP can also be a standalone procedure used to treat or diagnose abnormal cervical tissue. 

Differences between LEEP and cone biopsy

The main distinction between LEEP as a standalone procedure and cone biopsy lies in the tools used and their application. LEEP uses a thin wire loop with an electric current to excise tissue whereas cone biopsy can involve different methods such as a scalpel (CKC), laser, or LEEP.

Application wise, LEEP is often used as a first-line treatment to remove abnormal tissue and is effective for high-grade cervical dysplasia (CIN 2 or CIN 3). It is less invasive and usually performed in outpatient settings. Cone biopsy is typically used when there is a need for a more precise excision, such as when margins need to be clear of abnormal cells, or if there is a suspicion of invasive cancer. 

FAQ

Is cone biopsy painful?

The procedure itself is usually not painful as it is performed under local or general anesthesia. However, mild discomfort or cramping can occur during recovery, which can be managed with over-the-counter pain medications.

How long does it take to recover from a cone biopsy?

Recovery time varies depending on the type of procedure performed. Most patients can return to normal activities within a few days, but sexual intercourse, tampon use, and heavy lifting should be avoided for 4-6 weeks to allow the cervix to heal.

Will a cone biopsy affect my fertility?

In most cases, a cone biopsy does not affect fertility. However, in rare instances, complications such as cervical stenosis or cervical insufficiency can occur, which may impact future pregnancies. Women who plan to become pregnant should discuss this with their doctor before the procedure.

What are the signs of complications after a cone biopsy?

Seek medical attention if you experience:

• Heavy vaginal bleeding (soaking more than one pad per hour)

• Severe pelvic pain or cramping

• Foul-smelling discharge

• Fever or chills (possible signs of infection)

Does cone biopsy remove HPV?

Cone biopsy is both a diagnostic and therapeutic procedure that can effectively treat HR-HPV infection and CIN. However, the HPV infection can still persist in some cases even with the removal of the entire lesion by cone biopsy with negative margins.

Does the cervix grow back after conization?

After a cone biopsy (conization), the cervix can heal and partially regenerate, though it may not return to its exact original shape. The extent of regrowth depends on how much tissue was removed. In most cases, the cervix heals well, and its normal function is preserved. However, if a large portion of the cervix was taken out, it may become shorter or narrower, potentially affecting future pregnancies or increasing the risk of cervical insufficiency. 

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist by requesting an appointment with Thomson Medical today.