Timing for Second Cervical Biopsy: When is the Best Option?

When is it most appropriate to perform the second large resection surgery?

Hello Doctor: I am 27 years old, unmarried, and have never given birth.
On June 24, I underwent a Pap smear at a gynecology clinic near my home in Taichung, and the report indicated CIN II.
I returned to the clinic on July 2 for a biopsy, and on July 7, I went back to review the biopsy report, which showed CIN III, with margins not completely clear.
The doctor mentioned that due to my narrow cervix, he was concerned that a larger biopsy could increase the risk of miscarriage in future pregnancies, so he aimed to minimize the biopsy area.
The doctor advised me to return for another Pap smear in 2-3 months and to consider a repeat biopsy based on the results (as he indicated it would be more appropriate to wait for the first biopsy site to heal before performing a second procedure).
Recently, due to work commitments, I need to reside in Taipei for an extended period, so on July 9, I visited National Taiwan University Hospital in Taipei and brought my Pap smear and biopsy reports for the doctor’s reference.
The doctor suggested that I could undergo the biopsy procedure again soon.
I am concerned about the possibility of CIN III worsening, so I scheduled the surgery for early August.
As the surgery date approaches, I feel quite anxious, and I have two questions for you: 1.
When would it be appropriate to perform the second biopsy? Should I wait for 2-3 months, or can I proceed in early August? 2.
I am worried that if the biopsy area is extensive, it may lead to an increased risk of miscarriage in future pregnancies.
(The doctor in Taichung explained that if the biopsy area is too large, the cervix may not be able to support a pregnancy, leading to a higher risk of miscarriage.)

Xiangdang danxin de V, 20~29 year old female. Ask Date: 2004/07/30

Dr. Wu Linting reply Obstetrics and Gynecology

If the last biopsy was performed using electrocautery or diathermy, it is advisable to wait 2-3 months to minimize tissue reaction that could affect interpretation before performing another biopsy.
If the last biopsy did not involve electrocautery or diathermy, there are generally no time restrictions.
After a large cervical biopsy, there is an increased risk of mid-pregnancy cervical incompetence leading to miscarriage.
A cervical cerclage procedure can be performed around 14 weeks of pregnancy to prevent this.

Reply Date: 2004/07/30

More Info

When considering the timing for a second cervical biopsy, especially in the context of your recent diagnosis of CIN III (cervical intraepithelial neoplasia grade 3), it is essential to balance the urgency of treatment with the need for proper healing from the first procedure. Based on the information provided, here are some insights and recommendations regarding your situation.

1. Timing for the Second Biopsy: The general recommendation is to wait 2-3 months after a cervical biopsy if electrosurgical methods (like LEEP) were used, as this allows the cervical tissue to heal adequately and minimizes the risk of complications. However, if the first biopsy did not involve electrosurgery, the waiting period may be less stringent. Since your initial biopsy indicated that the margins were not clear, it is understandable that your healthcare provider is concerned about the potential for progression of the CIN III lesion. Given that your doctor in Taipei has suggested that you can proceed with the biopsy sooner, it may be reasonable to schedule the procedure for early August, as long as you feel comfortable and your healthcare provider agrees that you are sufficiently healed.

2. Concerns About Future Pregnancy: Your concerns regarding the impact of a larger biopsy on future pregnancies are valid. A larger excisional procedure can lead to cervical incompetence, which may increase the risk of miscarriage or preterm labor in subsequent pregnancies. However, the risk is often manageable. If a significant portion of the cervix is removed, a cervical cerclage (a stitch to support the cervix) can be performed around the 14th week of pregnancy to help prevent miscarriage. It is crucial to discuss these concerns with your healthcare provider, who can provide personalized advice based on your specific medical history and the extent of the biopsy.

In summary, while the timing for your second biopsy can be flexible, it is essential to ensure that you are adequately healed from the first procedure. Proceeding with the biopsy in early August seems reasonable, especially given your anxiety about the potential progression of CIN III. Additionally, addressing your concerns about future pregnancies with your healthcare provider will help you understand the risks and management strategies available to you. Regular follow-ups and screenings are vital in monitoring your cervical health, and staying informed will empower you to make the best decisions for your reproductive health.

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