Cold Knife Cone Biopsy

Written by Erica Roth | Published on August 7, 2012
Medically Reviewed by George Krucik, MD

What is a Cold Knife Cone Biopsy?

Cold knife cone biopsy is a surgical procedure used to remove tissue from the cervix. The cervix is the narrow part of the lower end of the uterus and terminates in the vagina. Cold knife cone biopsy is also called “conization.” This procedure removes a large, cone-shaped piece of the cervix to look for precancerous cells or cancerous material.

Cold knife cone biopsy is performed under a general or regional anesthetic. The surgeon uses a scalpel or a laser to remove the cervical tissue.

Reasons for Cold Knife Cone Biopsy

Cervical biopsies are used as both a diagnostic tool and a treatment for cervical precancer and cancer. Abnormal cells that appear on a Pap test may require further examination. Your doctor will remove the abnormal cells from the cervix to determine if you have cancer, or if the cells are precancerous.

There are different types of cervical biopsies. Punch biopsy is a less invasive kind of cervical biopsy that removes small areas of tissue. Your doctor may choose a cold knife cone biopsy if he or she is not able to gather enough tissue through a punch biopsy. Cold knife cone biopsies let the surgeon take a larger amount of tissue. This is especially important if you have already been diagnosed with cervical precancer or cancer. Sometimes all of the cancerous material can be removed during one cold knife cone biopsy.

Preparing for Cold Knife Cone Biopsy

Many women undergo cold knife cone biopsy under a general anesthetic, meaning they are asleep for the procedure. Those who have pre-existing health conditions such as heart, lung, or kidney disease might have increased risks while receiving general anesthesia. Risks can include infection, breathing difficulties, and stroke. Discuss your health history and any previous reactions to anesthesia with your doctor.

You may also be given a regional anesthetic. Regional anesthesia numbs you from the waist down, but you remain awake. You will not feel any pain under either general or regional anesthesia.

Fasting for six to eight hours before the biopsy can help prevent nausea. Nausea and an upset stomach are common reactions to anesthesia. Don’t insert anything into the vagina for 24 hours before your biopsy, including tampons, medicated creams, or douches. Also, abstain from sexual intercourse for 24 hours before the test.

Your doctor may advise you to stop using medications that can increase your risk of bleeding. Stop taking aspirin, ibuprofen, and naproxen for up to a week before the biopsy as directed by your doctor. You might also need to stop taking heparin, warfarin, or other blood thinners.

Bring sanitary pads with you to wear after the biopsy. Ask a family member or friend to accompany you so they can drive you home.

The Cold Knife Cone Biopsy Procedure

The entire cold knife cone biopsy takes less than an hour. You will lie on an examination table with your feet in stirrups, like a regular gynecological exam. The doctor will insert a speculum (an instrument that pushes apart the vagina’s walls) into your vagina to hold it open during the biopsy. After you have been sedated with either a regional or general anesthetic, the doctor will complete the biopsy.

Your doctor will use either a surgical knife or a laser to remove a cone-shaped piece of cervical tissue. The doctor will control bleeding in the cervical canal through a couple of options. They might cauterize the area with tool that seals the blood vessels to bring the bleeding under control. Alternately, conventional surgical stitches might be placed in the cervix.

Once the tissue is removed from the cervix, it is examined under a microscope to determine the presence of cancer. Your healthcare provider will notify you of the results as soon as possible.

Cold knife cone biopsies are usually performed as an outpatient procedure. The anesthesia wears off within a few hours. You can go home the same day.

Risks of Cold Knife Cone Biopsy

The risks associated with cold knife cone biopsy are minimal. Infection is a possibility as with all surgical procedures. Minimize the risk of infection by taking care of yourself after the biopsy:

  • wash your hands before and after using the bathroom
  • avoid using tampons for four weeks after your biopsy
  • avoid douching
  • change sanitary pads often

Scarring of the cervix and incompetent cervix are rare but potentially serious risks. Cervical scarring can hamper your efforts to become pregnant and may cause difficulties in reading Pap smears. An incompetent cervix occurs when a very large area of the cervix has been removed. The wide area of tissue removal can increase your chance of premature delivery during pregnancy.

Cold Knife Cone Biopsy Recovery

Recovery from cold knife cone biopsy can span several weeks. You will most likely experience cramping and bleeding intermittently during this time. Vaginal discharge can range from red to yellow in color, and it may be heavy at times.

Notify your doctor if you develop fever, chills, or discharge that smells foul. Contact your doctor if mild-to-moderate cramping progresses to severe pain. These can be signs of infection.

Avoid lifting heavy objects or physical strain for four to six weeks after a conization procedure. You should also refrain from having sexual intercourse during this time to allow yourself to heal.

Schedule a follow-up appointment with your doctor six weeks after your cervical biopsy.

Long-Term Outcome and Expectations

Cold knife cone biopsy is a highly effective way of diagnosing abnormalities of the cervix and treating early stages of cervical cancer. Stages 0 and IA1 of cervical cancer are sometimes treated with cold knife cone biopsy. For these very early stages of cancer, the biopsy often is able to remove the cancerous area entirely.

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