Cervical conization, often called a cone biopsy, is a surgical procedure that removes a cone-shaped wedge of tissue from the cervix. This procedure addresses abnormal cell changes detected during routine screenings. Conization serves two purposes: diagnosing and treating high-grade precancerous conditions. This technique allows for a comprehensive tissue sample analysis while simultaneously removing the problematic cells.
Why Conization Is Necessary
Conization is typically necessary after abnormal results from a Pap test or a colposcopy. It is frequently indicated when biopsies confirm high-grade precancerous changes, such as Cervical Intraepithelial Neoplasia grade 2 (CIN 2) or grade 3 (CIN 3). These cellular changes are caused by persistent infection with high-risk types of the Human Papillomavirus (HPV).
The procedure is necessary when the abnormal area cannot be clearly seen during a standard colposcopy, particularly if the lesion extends into the endocervical canal. Removing the entire cone of tissue confirms the severity of the cell changes and rules out invasive cancer. The removal of this tissue is often curative, excising the precancerous cells and preventing them from developing into cervical cancer.
What Happens During the Procedure
Cervical conization can be performed using one of two main techniques: the Loop Electrosurgical Excision Procedure (LEEP) or Cold Knife Conization (CKC).
Loop Electrosurgical Excision Procedure (LEEP)
LEEP is the more common technique, utilizing a thin, electrically charged wire loop to cut away the abnormal tissue. It is frequently performed in an outpatient clinic setting under local anesthesia, where the cervix is numbed. Some patients may receive light sedation.
Cold Knife Conization (CKC)
CKC involves using a surgical scalpel to remove the tissue, which results in a specimen with minimal thermal damage to the edges. Because this technique carries a higher risk of bleeding and is more involved, it is usually performed in a hospital or surgical center under general or regional anesthesia.
Regardless of the technique, the goal is to remove a sufficient cone-shaped wedge of tissue that includes the entire transformation zone, where abnormal cells are most likely to develop. The specimen is then sent to a pathology lab for analysis.
Immediate Recovery and Receiving Results
Following conization, patients are monitored in a recovery area for a few hours to ensure there is no excessive bleeding before they are discharged. Mild cramping is normal for several days and can usually be managed with over-the-counter pain medication. A dark or bloody vaginal discharge is also common for up to two weeks, often due to a solution applied to the cervix to control bleeding.
Patients are advised to restrict certain activities for four to six weeks to allow the cervix to heal fully. This commonly includes avoiding sexual intercourse, the use of tampons, and douching, as these can introduce bacteria or irritate the healing wound.
The pathology report determines if the margins, or edges, of the removed cone are clear of abnormal cells. A “clear margin” means the surgeon likely removed all the precancerous tissue. A “positive margin” indicates that some abnormal cells may remain, which often necessitates further monitoring or treatment.
Future Health and Pregnancy Implications
One long-term consideration after conization is the potential for cervical insufficiency, a weakening of the cervix that can affect future pregnancies. The risk of preterm birth may be increased, especially if a large or deep wedge of tissue was removed. This risk is related to the amount of cervical tissue excised, as a shorter cervix may be less able to support a pregnancy.
For women who become pregnant after conization, closer monitoring is typically recommended. In some cases, a procedure called a cervical cerclage may be considered to provide extra support. Beyond pregnancy concerns, the procedure does not eliminate the presence of HPV, so continued surveillance is required.
Patients must adhere to a schedule of regular follow-up Pap tests and HPV testing to monitor for any recurrence of abnormal cells, as the risk, while low, persists over many years.