Directed Biopsy of the Cervix at Colposcopy

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Directed Biopsy of the Cervix
at Colposcopy

Colposcopy as an adjunctive diagnostic tool in the assessment of cervical intraepithelial neoplasia is a significant aid to the pelvic surgeon in selecting the appropriate method of therapy in certain cases. Its use is indicated in all patients having abnormal Papanicolaou cytologic smears or gross lesions.

To obtain accurate cytologic specimens for study, the surgeon must be trained not only in performing a colposcopy but also in selecting the proper instruments for the examination.

The purpose of the operation is to visualize the cervix under high magnification and delineate abnormal zones of cervical epithelium. In addition, it is designed to allow precise, accurate biopsies to be obtained from these abnormal zones of epithelium.

Physiologic Changes. None.

Points of Caution. A direct Papanicolaou smear should be taken prior to any manipulation of the cervix.

A detailed survey of the cervix should be performed prior to any surgical manipulation.

Directed biopsies, oriented to prevent tangential cutting, should be placed on small pieces of wet paper towel and sent to the pathologist.

Technique

The patient is placed on an ordinary gynecologic examining table, and a nonlubricated speculum is placed in the vagina. The colposcope is moved into appropriate position and focused. A routine cytologic smear as well as a wet mounted smear for Trichomonas and Monilia are taken. The cervical mucus is then cleared by applying 4% acetic acid to the cervix and removing the solution with either a small suction cannula or a cotton-tipped applicator. The cervix is studied carefully with the green filter lens in place to enhance the appearance of the cervical blood vessels.

Appropriate biopsy instruments, designed for taking crisp, sharp, directed biopsies from zones of abnormal tissue located by the colposcope, are selected.

An endocervical speculum is inserted to appropriately inspect the endocervical canal.

Because there are significant patterns important to the diagnosis of cervical intraepithelial neoplasia, the surgeon searches specific zones for signs of abnormal epithelium.