Cervix and Vagina

Cervical biopsies are common and nearly always performed for the purpose of evaluating squamous or glandular dysplasia. Usually the patient will have a history of an abnormal Pap test or a prior abnormal biopsy finding. Correlation with cytology is nice, but lesions can be focal and/or transient, so perfect agreement is not required.

There are several types of specimens. The smallest is usually the endocervical curettage. This is meant to be a sampling of the endocervix, and so should contain endocervical (columnar) mucosa. These tissue scrapings may have tiny and maloriented fragments, and the tissue can be spread out over a wide area.

If a lesion is seen by the clinician on colposcopy, there may be a cervical biopsy performed, which is a crescent-shaped chunk taken out of the cervix. This tiny specimen is uninked and unoriented. A high-grade lesion requires a cone biopsy, where the transition zone is taken out in a conical fragment with the goal of completely excising the lesion. The cone biopsy may be done with cautery (loop electrosurgical excision procedure) or blade (cold-knife cone). The endocervical margin should be identified and inked to make sure the lesion is not extending up into the canal where it cannot be seen or sampled. The ectocervical margin is also inked, but a positive ectocervical margin is unusual.