ABSTRACT
The cone biopsy—removal of a cone-shaped portion of the cervix—has been performed by gynecologists for decades. Several methods exist for obtaining this specimen. These include an electrosurgical techniques, laser, or scalpel method of excision. The electrosurgical techniques referred to as the loop electrosurgical excision procedure (LEEP) or loop excision of the transformation zone (LETZ) have gained popularity. They have several advantages over the other methods, including less immediate bleeding and discomfort. It is therefore possible to perform LEEP in the office without general anesthesia. The technique of needle excision of the transformation zone (NETZ) can also be used in place of cold knife cone biopsy. Although the surgical margins are cauterized for all electrosurgical methods, they still provide reasonable specimens for pathologic interpretation, with no clinically significant limitations. The scalpel and LEEP techniques are also generally equivalent in their clinically significant outcomes (i.e., cure rates). However, the scalpel cone tends to be larger, which is of no particular advantage except perhaps when used in patients with adenocarcinoma of the endocervix. Since this histology may be multifocal, a larger specimen may be more likely to remove all of the lesions. As there may still occasionally be the need to perform a scalpel cone biopsy, all gynecologists should be familiar with both techniques.
