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What Is the Difference between a LEEP and Cone Biopsy?

By Marlene Garcia
Updated Mar 03, 2024
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The difference between a loop electrosurgical excision procedure (LEEP) and cone biopsy centers on the amount of cervical tissue removed and the method of excision. Both surgeries might be done with the same surgical instrument, but LEEP and cone biopsy involve removing tissue from different areas of the cervix. LEEP excises cells from the surface of the cervix, while a cone biopsy removes a wedge-shaped piece of tissue higher in the cervical canal. Another difference between these procedures is that one is done in the office of a medical professional and the other in a hospital.

Both LEEP and cone biopsy, called conization, are used to treat cervical dysplasia, a condition marked by abnormal cells at the bottom part of the uterus. Abnormal cervical cells might change and invade beyond the surface of the cervix, where they can mutate into cancer cells. A cone biopsy removes tissue containing cells that have invaded into the upper regions of the cervix. A LEEP device can be used for this operation, but is more often used for surface dysplasia. Some doctors prefer a scalpel or laser surgery when performing conization.

A woman undergoing a cone biopsy might receive general anesthetic during the procedure or a local anesthesia to numb the vaginal area. LEEP typically requires simple numbing of the cervix. This represents the only difference between the LEEP and cone biopsy during the preparatory phase.

In both instances, the vaginal canal is widened to enable the doctor to see the cervix. A vinegar or iodine solution is applied that turns dysplasia cells white and guides the doctor while removing abnormal tissue. He or she uses a special microscope that sheds strong light and high magnification onto the cervix during both types of surgery. Any excised tissue from either procedure is sent to a laboratory for examination.

An abnormal pap test typically prompts both procedures. This test identifies dysplasia that might appear mild, moderate, or severe before it becomes cancer. Women carrying the human papillomavirus (HPV) causing genital warts face higher risks of developing dysplasia. HPV is a sexually transmitted disease and the most common cause of dysplasia. A higher risk also exists for women with multiple sex partners, women who began having sex before the age of 20, and in smokers.

The recovery period from these procedures is the same. After either surgery, mild cramping and bleeding might occur, and rest is advised for a day or two. Sex and heavy physical activity should be avoided for four to six weeks, along with tampon use. Medical professionals typically recommend more frequent pap tests in the first year after LEEP and cone biopsy to determine if all suspicious cells have been removed.

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