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 to remove the cervical tissue.

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 your 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 they’re not able to gather enough tissue through a punch biopsy. Cold knife cone biopsies let your doctor 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.

Many women undergo cold knife cone biopsy under a general anesthesia, meaning they’re asleep for the procedure. Those who have preexisting health conditions such as heart, lung, or kidney disease might have increased risks while receiving general anesthesia. Be sure to discuss your health history and any previous reactions to anesthesia with your doctor. Risks of general anesthesia can include:

  • infection
  • breathing difficulties
  • stroke

You may be given a regional anesthetic instead. Regional anesthesia numbs you from the waist down, but you remain awake. You won’t 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. Abstain from sexual intercourse for 24 hours before the test. Don’t insert anything into the vagina for 24 hours before your biopsy, including:

  • tampons
  • medicated creams
  • douches

Stop taking aspirin, ibuprofen, and naproxen for up to two weeks 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 entire cold knife cone biopsy takes less than an hour. You’ll lie on an examination table with your feet in stirrups, like a regular gynecological exam. Your doctor will insert an instrument called a speculum into your vagina to push apart the vagina’s walls and keep your vagina open during the biopsy. After you’ve been sedated with either a regional or a general anesthetic, your 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. Your doctor will use one of two options to control bleeding in the cervical. They might cauterize the area with a tool that seals the blood vessels to bring the bleeding under control. Alternately, they might place conventional surgical stitches in your cervix.

The tissue that was removed from your cervix will later be examined under a microscope to determine the presence of cancer. Your doctor 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.

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 are 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.

Recovery from cold knife cone biopsy can span several weeks. You’ll 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 any of the following, as these may be signs of infection:

  • fever
  • chills
  • discharge that smells foul
  • mild-to-moderate cramping, progressing to severe pain

Notify your doctor if you have any of the following symptoms, as they may be signs of a blood clot:

  • chest pain
  • difficulty breathing
  • swelling, redness, or pain in your legs

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 biopsy.

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.


Is there a limit to how many cold knife cone biopsies a woman can have? What are the steps after?

Anonymous patient


The procedure leaves a scar on the cervix that may or may not prevent future cold knife cone biopsies. Your doctor will advise you of options for future testing. The steps after the biopsy depend on the results of the test. For low-grade abnormal cells, a PAP test may be recommended every year to two years. More advanced abnormal cells may be excised (cut out), or they may be destroyed by freezing or heating them.

Cervical cancer is often associated with the Human Papillomavirus (HPV), and your doctor may test for this at the same time as the PAP test.

Deborah Weatherspoon, Ph.D, MSN, RN, CRNAAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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