๏ Punch biopsy.

This procedure uses a circular

blade, like a paper hole puncher, to remove a
tissue sample. One or more punch biopsies may
be done on different areas of the cervix.
๏ Cone biopsy. This procedure uses a laser or scalpel
to remove a large cone-shaped piece of tissue
from the cervix.
๏ Endocervical curettage (ECC). This procedure uses
a narrow instrument called a curette to scrape the
lining of the endocervical canal. This is an area
that can’t be seen from the outside of the cervix.
1. undress, put hospital gown and drape
2. Patient must empty bladder
3. Patient will lie on an exam table, with feet and
legs supported (lithotomy)
4. A speculum is inserted into the vagina
5. Colposcope is put at the opening of the vagina
6. Acetic acid solution MAY BE applied to the cervix
› This solution helps make the abnormal tissues turn
white so they are easier to see
⦿ For a simple cervical biopsy- one or more
small samples of tissue is removed using
forceps

⦿ Cells from the inside of the cervical canal

is removed with an endocervical curette
or an endocervical brush
⦿ For a cone biopsy- a loop electrosurgical
excision procedure (LEEP) or the cold
knife cone biopsy procedure is used
› needs regional or general anesthesia
› Cervix is packed with a pressure dressing

7. Sample is sent to the lab for testing

⦿ Squamous Intraepithelial Lesions (SIL)
› Low-grade SIL (LSIL)- CIN I and mild dysplasia;
affects a shallow part of the cervical lining.
› High-grade SIL (HSIL)- CIN II and CIN III and
moderate and severe dysplasia; affects a
deeper part of the cervical lining.
⦿ Cervical Intraepithelial Neoplasia (CIN)
› CIN I- mild dysplasia
› CIN II- moderate dysplasia
› CIN III- severe dysplasia and carcinoma in
situ
⦿ Dysplasia
› Mild dysplasia- cells look slightly different
from normal cells
› Moderate dysplasia- cells look quite different
from normal cells.
› Severe dysplasia- cells look very different
from normal cells.
⦿ Adenocarcinoma in situ (AIS)
› cancer has not spread into the deeper tissues
of the cervix or surrounding tissue
⦿ Chroniccervicitis
⦿ Suspected neoplasm
› HPV positive
› Abnormal Pap smear result
› Presence of warts
⦿ Ulcers
⦿ Allergyto latex
⦿ Pregnancy
⦿ Menstruation
A negative (-) test means that everything is normal,
and further action is usually not required.
A positive (+) test means that cancer or
precancerous cells have been found and treatment
may be needed.
• Abnormal uterine bleeding: irregular bleeding, menorrhagia, suspected malignant or
premalignant condition

• Retained material in the endometrial cavity

• Evaluation of intracavitary findings from imaging procedures (abnormal endometrial

appearance due to suspected polyps or fibroids)

• Evaluation and removal of retained fluid from the endometrial cavity (hematometra,
pyometra) in conjunction with evaluating the endometrial cavity and relieving
cervical stenosis

• Office endometrial biopsy insufficient for diagnosis or failed due to cervical stenosis

• Endometrial sampling in conjunction with other procedures

Absolute contraindications to dilation and curettage include the following:
⦿ Viable desired intrauterine pregnancy
⦿ Inability to visualize the cervical os
⦿ Obstructed vagina

Relative contraindications to dilation and curettage include the following:

⦿ Severe cervical stenosis
⦿ Cervical/uterine anomalies
⦿ Prior endometrial ablation
⦿ Bleeding disorder
⦿ Acute pelvic infection (except to remove infected endometrial
contents)
⦿ Obstructing cervical lesion