Atlas of Colposcopy: Principles and Practice

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Colposcopically directed biopsy  

  • Obtain the biopsy after application of Lugol’s iodine.
  • Use low-power magnification, to have a panoramic view of the cervix.
  • The biopsy should always be taken from the part of the lesion that is closest to the SCJ.
  • Obtain multiple biopsies if the lesion is in multiple quadrants or if more severe abnormalities are detected away from the SCJ.
  • Sample the posterior lip of the cervix first, to avoid the vision being obscured because of bleeding from the anterior lip.
  • Position the biopsy forceps directly over the point to be biopsied.
  • Orient the opened biopsy forceps in such a way that the fixed jaw of the forceps is placed close to or within the external os.
  • Hold the handles of the biopsy forceps upside down while taking a biopsy from the posterior lip.
  • To prevent the forceps slipping from the biopsy site, push the cervix backwards with the open biopsy forceps.
  • Quickly squeeze the forceps handles together.
  • Asking the woman to cough while squeezing the handles together may help to obtain a good sample.
  • Lock the jaws of the forceps and pass it to the assistant to collect the tissue and put it into pre-labelled bottles containing formaldehyde solution.
  • Confirm colposcopically that the intended area has been adequately sampled.
  • Secure haemostasis by applying Monsel’s paste or silver nitrate for 30–60 seconds.
  • Gentle pressure with a swab for a few minutes will also stop the bleeding most of the time.

Note: The biopsy sample must be of adequate depth to include some stromal tissue along with the epithelium, otherwise the biopsy will be inadequate. Use of blunt biopsy forceps will lead to inadequate and crushed tissue and will also cause pain to the woman. Some colposcopists prefer to inject 1–2 mL of local anaesthetic at the biopsy site before the procedure. Biopsy forceps should undergo regular sharpening and maintenance.

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