What Is a Cone Biopsy?

A cone biopsy, also called conization, is a surgical procedure to remove a cone-shaped piece of tissue from the cervix and cervical canal. Cone biopsy is useful when diagnosing or treating cervical intraepithelial neoplasia (CIN), a precancerous condition, or cervical cancer.

Purpose of Test

There are a few reasons why your healthcare provider may order a cone biopsy. In some cases, the procedure is recommended if a person receives abnormal Pap smear results. In other cases, a cone biopsy may be used to treat precancerous lesions or evaluate the extent of cervical cancer already diagnosed.

A cone biopsy is also considered a potential treatment for the following:

• Cervical intraepithelial neoplasia (CIN)
• Carcinoma in situ (CIS)
• Earliest stages of cervical cancer (IA1, IA2) for women who want to preserve their fertility after cancer treatment

There are three ways to perform a cone biopsy and the approach is determined by where cancer or precancerous cells are located in the cervix:

• Laser surgery, which uses a laser beam to excise a portion of tissue
• Loop electrosurgical excision (LEEP), which employs a thin wire loop attached to a generator to electrically remove a piece of tissue
• Cold knife conization (CKC) in which a surgical scalpel is used to remove tissue
  

If the edges of the biopsy have cancer cells, the cone biopsy may need to be repeated or a radical trachelectomy (removal of the cervix as well as upper vagina and nearby tissue) may be considered.

Risks and Contraindications

The cone biopsy procedure is usually well tolerated. Your healthcare provider will explain the short-term and long-term risks associated with the procedure, but it can be helpful to have an idea of what those might be so that you can be prepared to ask any specific questions.

Short-Term Risks

Potential short-term risks include:

• Infection is characterized by a yellow or green discharge with a foul smell.
• Bleeding, including vaginal bleeding and bloody discharge, is common. Excessive bleeding rarely occurs.
• Blood clots are a major complication that can occur after any surgery. While this is uncommon with a cone biopsy, it's important to be aware of it if you have an increased risk for blood clots.

If the cone biopsy did not remove all of the abnormal tissue, a repeat cone biopsy may be performed, or additional treatments may be recommended.

Long-Term Risks

Long-term risks after the procedure may include:

• Persistence of human papillomavirus (HPV) infection: HPV infection, associated with cervical cancer, may persist, especially in women who have high-risk HPV strains (particularly type 16) as well as high HPV viral loads. In a review of studies, the incidence of persistent HPV infection was found to be 42% with LEEP and 7% with CKC.
• Recurrence of abnormal cervical cells (dysplasia): The risk tends to be lowest for cold knife conization (less than 2%) when compared to LEEP and cryosurgery (use of cold to destroy abnormal tissue).
• Preterm delivery: This is uncommon but can happen as a result of a cone biopsy. A 2016 study suggested that the risk following cold knife conization was higher than LEEP or cryosurgery. It's important to note that untreated dysplasia (such as CIN 2 or CIN 3) is also associated with premature delivery. If an incompetent cervix occurs, a procedure called a cerclage is sometimes used, in which the cervix is essentially "sewn shut."
• Inconclusive Pap smears: Cone biopsy may make it harder to interpret future Pap smears.
• Cervical stenosis: Scarring and narrowing of the cervix may result in sperm being unable to pass through the cervix, and subsequent infertility.

These factors reinforce the importance of consistent, routine follow-ups with your healthcare provider and ensuring that any obstetric or gynecologic specialist knows all the details of your medical history.

Contraindications

Contraindications, or reasons the procedure should not be performed, include severe cervicitis (inflammation of the cervix), or, in the case of LEEP, the presence of a demand cardiac pacemaker.

Relative contraindications (which mean the risks and benefits must be weighed for each person) include pregnancy, a history of bleeding disorders, blood clots, or the use of blood thinners.

Before the Test

At an appointment prior to the surgery, your healthcare provider will explain the procedure and give you a chance to ask any questions. They will discuss which anesthesia will be best for you, whether general, regional, or local.

At that time, tell your healthcare provider if you’re pregnant or think you might be. Also, let your healthcare provider know about any allergies or if you have a bleeding disorder that can affect healing.

Your healthcare provider will also need to know about any medications, either over-the-counter (OTC) or prescription, or herbal supplements you take, in case there are any that you should discontinue until after your cone biopsy.

Preparations for the procedure include the following:

• Check with your health insurance to determine how much of the cost is covered before the procedure.
• Abstain from vaginal sex and using tampons, vaginal creams or medications, and douching for at least 24 hours before the procedure.
• Abstain from eating or drinking for six to eight hours before the procedure if you are due to receive general anesthesia.
• Arrange for someone to drive you home afterward because the anesthesia can make you feel weak and tired after the procedure.
• Bring all medical paperwork and health insurance cards to the hospital.
• Bring a sanitary pad to use after the procedure.

During the Test

Cold knife cone biopsies and laser biopsies are typically performed in a hospital or a surgery center. LEEP biopsies are often performed in a healthcare provider's office or clinic. Usually, these procedures are performed by an obstetrician-gynecologist. A cone biopsy takes about 15 minutes. However, you should plan to be at the hospital for several hours, as you'll need time to fill out forms and for pre-and post-operative care

If your procedure is done in a hospital or surgery center, your healthcare team will likely include a preoperative nurse, an anesthesiologist or nurse anesthetist, an operating room nurse, and your obstetrician-gynecologist. They can answer any questions you may have before the procedure.

Pre-Test

When you get to the hospital, the preoperative nurse will conduct an exam and make sure you’ve had all the needed tests before the procedure. After you change into a hospital gown, you will be given a blanket to keep warm.

An anesthesiologist will talk to you about your medical history. Anesthesia is either given intravenously (through a needle into a vein) or through a mask. You and your healthcare provider will decide beforehand whether you should be given general anesthesia or medicines to help you relax and stay sleepy.

For the procedure, you'll be lying on your back with your feet in stirrups to keep your legs apart to provide access to your cervix. The healthcare provider will insert a lubricated tool called a speculum into your vagina to widen it. If a LEEP biopsy is performed, you may be injected with a medication to numb the cervix.

Throughout the Test

During the procedure, the surgical team will monitor your vital signs to make sure that everything is going smoothly. You may be completely asleep with general anesthesia, or drowsy from anesthesia medications.

Whatever method is used to excise a sample, the amount of tissue collected will likely measure around 1.5 centimeters (cm) wide and 1 centimeter deep. Later, that sample of tissue is analyzed with a microscope to determine whether it has cancerous cells or precancerous cells.

Post-Test

After a cone biopsy, your cervix may be packed with a pressure dressing. Your healthcare provider will give you instructions on when and how to remove it.

Expect to spend three to four hours in the recovery room before you're allowed to leave the hospital or surgery center. Again, you will need to have someone drive you home.

If your procedure is done in the office, the team may only consist of the healthcare provider and a medical assistant. You are often given only local anesthesia and you can return home much more quickly after the procedure. It is still good to have someone drive you home.

After the Test

It will take four to six weeks for your cervix to heal after the procedure. Follow your healthcare provider’s instructions for at-home care, which may include:

• Take showers instead of baths: Don’t soak in water, including in hot tubs and swimming pools.
• Avoid strenuous physical activity: This includes vacuuming, yard work, or carrying heavy groceries and laundry.
• Don't lift anything over 10 pounds: The strain could increase your bleeding.
• Do not use tampons or douches or have sexual intercourse: Any of these could prolong the amount of time it takes your cervix to heal and increase the chance of infection.

Managing Side Effects

Recovery varies from person to person. You may feel tired and have abdominal cramping for a couple of days after having a cone biopsy. You may also have a bloody discharge for two to three weeks after the procedure. You’ll probably need to wear sanitary pads during this time.

Your healthcare provider can advise you about what medicines you can take for pain relief.

While your healthcare provider will likely recommend that someone stay with you for 24 hours following the procedure, you should consider having a friend or family member stay with you for several days if you live alone to help with any heavy lifting and chores.

Seek urgent medical care if you experience any of the following symptoms after a cone biopsy:  

• Persistent pelvic pain
• Heavy bleeding
• Foul-smelling discharge
• Chills
• Fever greater than 101 F
• Pain, redness, or swelling in one or both of your legs

In addition, if you have any sudden symptoms after the cone biopsy that seem alarming to you, it's important to contact your healthcare provider or seek urgent medical attention.

Interpreting Results

You will likely get the results of your cone biopsy within five to seven business days. A normal result means there are no precancerous or cancerous cells in the cervix.

Abnormal results mean that precancerous or cancerous cells have been detected. Precancerous cells fall into these categories:

• CIN 1: Slightly abnormal cells, also called low-grade or mild dysplasia. These often go away without treatment but can become cancerous in some instances.
• CIN 2: Moderately abnormal cells, also called high-grade or moderate to marked dysplasia. For roughly 50% of women, the changes will regress, while for others, the changes may remain the same or progress without treatment. CIN 2 is not cancer but may become cancer if not treated.
• CIN 3: Highly abnormal cells that may be classified as high-grade or severe dysplasia or carcinoma in situ. CIN 3 is considered a direct precursor to cancer, and if not treated, it may become cancer.

In each case, your healthcare provider will let you know whether the cone biopsy was able to remove all the abnormal tissue.

Follow-Up

You will likely be instructed to schedule a follow-up appointment for around four weeks after your procedure. Further treatment and future monitoring will depend on the results of your cone biopsy.

If the biopsy shows that there may still be abnormal cells, the cone biopsy may need to be repeated, or your healthcare provider may discuss other options, such as a radical trachelectomy or hysterectomy, depending on the degree of the abnormality.

If the cone biopsy removes all of the abnormal tissue, you will still need to be monitored. The frequency of monitoring will depend on your results as well as your age, pregnancy status, whether you have a persistent HPV infection, and your history of previous abnormal Pap smears.

Most often, HPV testing will be recommended in six months, and if normal, will be followed by yearly testing (either HPV testing or a combination of a Pap smear and HPV testing) until you have at least three consecutive negative tests.

Once you have completed the recommended short-term follow-up, long-term monitoring is also important. Long-term monitoring usually includes either HPV testing or a combination of a Pap smear and HPV testing every three years for at least 25 years.

Summary

A cone biopsy takes a small sample from the cervix to potentially diagnose cervical cancer or remove precancerous cells from the cervix. While the test does not last very long, it does need to be performed in a surgery center or at a hospital under anesthesia. Follow-up treatment plans will be based on your biopsy results and risk factors

A Word From Verywell

It’s normal to feel anxious or worried when waiting for or receiving test results. To ease your nervousness, turn to trusted family members, friends, and, of course, your healthcare provider. Don't hesitate to ask them any questions you have before your procedure. And if you're in doubt about needing a cone biopsy, feel free to get a second opinion.

It can also be helpful to reach out to someone else who's had a cone biopsy, but be selective. As with other fields of medicine, cone biopsies are constantly improving. The chance that your procedure will be effective and without complications is higher than for someone who may have had the procedure in the distant past.

Frequently Asked Questions

The cervix can regenerate tissue following a cone biopsy. The amount of tissue that can regenerate depends on how much cervical tissue is removed during the procedure and how much cervical tissue remains after the biopsy. The goal is to leave behind as much healthy tissue as possible to allow for the regeneration of the cervical cells.

If you have one cone biopsy and it is determined there are more cancer cells left behind, you may have a repeat procedure. There are risks to having repeated biopsies of the cervix, including pre-term labor for reproductive-age women, but risks and benefits are weighed by the OB/GYN before repeating the test in the future.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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• Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin. 2020. doi:10.3322/caac.21628
• Kindinger L, Kyrgiou M, MacIntyre D, et al. Preterm birth prevention post-conization: a model of cervical length screening with targeted cerclage. PLoS One. 2016;11(11):e0163793. doi:10.1371/journal.pone.0163793
• Kyrgiou M, Mitra, A, Arbyn, M, et al. Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis. BMJ. 2014; 349:g6192. doi:10.1136/bmj.g6192
• Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier
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By Blyss Splane
Blyss Splane is a certified operating room nurse working as a freelance content writer and former travel nurse. She works as a freelance content writer for healthcare blogs when she's not spending time with her husband and dog.

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