|January 2002 · Vol. 14, No. 1
Cone biopsy: perfecting the procedure
When colposcopy and cervical biopsy are inadequate in evaluating cervical dysplasia, cone biopsy of the cervix often will be both diagnostic and therapeutic.
Dr. Toglia is chief, subdivision of gynecology, at Riddle Memorial Hospital in Media, Pa, and assistant clinical professor, department of OBG, at Thomas Jefferson Medical School in Philadelphia.
Cone biopsy typically includes the removal of the entire squamocolumnar junction of the cervix, generally agreed to be the site of origin of squamous cell carcinoma.
Inject a premixed solution of 2% xylocaine and epinephrine in a concentration of 1:200,000 into the cervical stroma at 12 o’clock outside the intended margin.
For a “cold-knife” cone, use a #11 surgical blade to begin a circular incision starting at 12 o’clock on the face of the cervix.
Cone biopsy of the cervix has been used for more than a century to rule out the presence of invasive carcinoma in women with squamous intraepithelial lesions (SIL). And while less invasive techniques such as colposcopy and loop electrosurgical excision procedures (LEEP) have reduced the need for diagnostic conization dramatically, cervical cone biopsy becomes necessary when these techniques prove inadequate.