Cone Biopsy & LEEP, are they the same?

• By LRose
• Reply 136994
• September 21, 2008 at 9:23 am
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I am wondering the same thing! I am having my 2nd LEEP done on the 26th, and my doc said something about using a cone. So i just assumed the cone was a tool for the LEEP. ???

• By ladyyydee
• Reply 136998 · In reply to 136994 by LRose
• September 21, 2008 at 9:27 am
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I want to kick myself for not asking more questions to these doctors. Now I'm here four days before the procedure and as confused as ever. I'm pretty sure the cone is not the tool they are using but they both have so many things things in common.

• By flowershoplady
• Reply 137015
• September 21, 2008 at 9:57 am
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hello, ladyyydee. it's not too late to talk with your doctor so that you have a better understanding of what your procedure is going to be. it's important you understand what the doctor is doing, what the risks are (bleeding, impact on future pregnancies, etc), the follow up, and so forth. so, please call the doctor's office on monday to get clarification of your procedure!

ok, and i'll try to answer your question....no a leep and cone biopsy are not the same. but, to make things a bit confusing, one can have a cone biopsy using leep technology. that's why you need to talk with the doctor to understand what is going to be done.

ok, so, a cone biopsy refers to a procedure where a cone shaped part of the cervix is removed. this can be done with a scalpel (also called cold knife) or with leep (loop electrosugical excision procedure) or laser. if it's cold knife, then the doctor will use general anesthesia; otherwise it can be done with local anesthetics. the method used will result in differences in risks of bleeding (less with leep and laser), whether or not stitches are needed (just needed for the cold knife), and the anesthesia needed.

a conization removes the cone shaped tissue while the procedure that is generally just called a LEEP (it's the method as well as the procedure itself) removes less cervical tissue. another procedure is a 'top hat' leep, which involves a second pass of the 'loop' to remove a hat shaped (yep....sort of like the cone shape!) section of tissue.

here's a website that describes cervical conization:
http://www.webmd.com/cancer/cervical-cancer/cone-biopsy-conization-for-abno rmal-cervical-cell-changes

and here's one that is for a LEEP:
http://www.webmd.com/cancer/cervical-cancer/loop-electrosurgical-excision-p rocedure-leep-for-abnormal-cervical-cell-changes

hope this helps!

• By ladyyydee
• Reply 137025 · In reply to 137015 by flowershoplady
• September 21, 2008 at 10:11 am
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Thank you for all that. I will definatley call my doctor tomorrow. When I spoke to my GYN on Friday, she was just calling to follow up on my finding an ONC. I filled her in on everything that was going on and then I told her the ONC. wants to do a LEEP, she said quietly under her breath,"I wonder why she's not doing the cone on you" So thats where all my questions starting building up. I have the ONC saying right off the bat to have the LEEP done and then my GYN saying she wanted to do a cone biopsy. I wish these two doctors could disuss my case with each other so I can finally have one straight direction to go to. I'm pretty much driving myself crazy on what to do.

• By flowershoplady
• Reply 137110
• September 21, 2008 at 1:16 pm
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it would be good for you to understand why the gyn/oncologist is following a different approach than the gynecologist....just ask the gyn/oncologist. i know, it sounds easier than it is, but one of their responsibilities is to explain to you why he/she is recommending what he/she's recommending! and the gyn/oncologist is doing the procedure, right? so that means there should be an explanation of the recommendation, why he/she thinks it's best for situation, prognosis, side effects, and so forth. and, you can also get a third opinion. usually, you would be seeing a gyn/oncologist because they've got the expertise needed, more knowledge/experience than the general gynecologist, so you may just need an explanation from him/her. you can also check that your doctors are board certified, the gyn/oncologist is a member of the society of gyn/oncologists, etc.

let us know when you've called the doctor and - hopefull - received a good explanation. you shouldn't get the procedure done until you're feeling more certain that this is the right thing to do.

• By ladyyydee
• Reply 137189
• September 21, 2008 at 5:28 pm
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Thanks flower for your response, tomorrow I'm going to call my GYN & then I'll call my ONC/GYN (I should've mentioned that she was an ONC/GYN.) Because at this point I'm still confused and not sure of which procedure would be right for me. I got somewhat intimidated when I had a consult. with her, I just let her do all the talking, when I should have been asking questions. Thanks so much for all your help.

• By Pirkar
• Reply 137382
• September 22, 2008 at 4:52 am
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Thanks a lot ladyyydee, bringing this subject up. Please let us know what your doctor told you about the differences btw LEEP and cone!

My gyn told me that there is no significant difference btw the different electrosugical excision procedures. The main difference is in size and shape of removed tissue (the bigger it is, the more likley are complications).

The surgeon chooses the tool/method by evaluating the size and location of dysplasia, and she or he can choose btw different methods of conization = cone biopsy:
1. either cold knife conization (done under general by surgeon scalpel, sutures are needed);
2. electrosugical excision procedure (under general or local). This can be done by loop (there are different sizes of loops, depending on the size of the tissue that needs to be removed) and if loop is used, the procedure is called LEEP. It can also be done by electric knife (by this tool the doctor can remove a cone shaped piece of tissue, but no sutures are needed) and I assume it is called also LEEP in that case (but I am not sure).
3. removal of tissue by laser.

Thus, in my understanding there are different methods for conization/cone biopsy and the difference comes from the TOOLS that are used. In general, with knife (either scalpel or electric knife) the cut can be done more in depth, while with loop (which is heated wire) the cut is less invasive.

However, as my GYN said, there is no major difference btw using either loop or electric knife, because the doctor who does the surgery, will decide how much she or he removes. The tool will be chosen depending on 1) the size and location of dysplasia 2) whether it extends into cervical canal (in this case more needs to be removed, so doctors may prefef cold knife) 3) preference/experience of the surgeon/doctor.

PS Sometimes doctors use terms cone/LEEP interchangeably, which adds to the confusion.

I would appreciate very much if someone more knowledgeable could confirm or confute this :-)

• By ladyyydee
• Reply 137454
• September 22, 2008 at 9:13 am
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I've also been told there wasn't much of a difference between the LEEP & the Cone Biopsy but apparently with all the research I've been doing and now hearing, there is a difference. I'm going to call both my doctors today and ask them, what was based on their decision, that the GYN said she wanted and suggested the cone and my ONC/GYN saying she wanted to do the LEEP. I and now I know many others need to know that these same answers. With all thats going on in our lives sometimes we take a back seat into asking our questions, but today hopefully I'll have my answers and will update you ladies.

• By ladyyydee
• Reply 137608
• September 22, 2008 at 1:31 pm
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OK here's the latest from my talking with my ONC/GYN. She said from a pathologist standpoint a LEEP and a CONE Biospy are the same thing. She also said a Cone Biospy is old school that they really dont perform those too much and a less experience doctor may choose to do a Cone Biopsy. LEEP is less bleeping and the healing time is quicker for the patient. She also said one uses a "knife" and the other they use corterizing tool. (hope I spelled that right) but she gave me the choice after her explaination, if I wanted to do a CONE she'll be happy to do it but she said in my case she would go with the LEEP. So what do you think of that explaination, I'm a little less confused and I feel confident with her, so I guess that has to count for something. I haven't heard back from my GYN yet.......Stay tuned

• By flowershoplady
• Reply 137701
• September 22, 2008 at 6:15 pm
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ladyydee, an important part of what you want to know from the doctor (in my opinion) is how much cervical tissue is going to be removed, or, more importantly, how much will remain, particularly if you may have a pregnancy in the future. the doctor explained to you the differences in technique (leep/electrosurgical vs scalpel) and i hope that, in addition to the links i posted above, and your other research, helped clarify the method or approaches to the surgery. as she indicated, leep is a newer technique and has less bleeding and quicker recovery than 'cold knife' or scalpel, and if she can use that approach for your situation, it would generally be considered the preferred way to go.

• By ladyyydee
• Reply 137718
• September 22, 2008 at 6:42 pm
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My GYN/ONC said she'll be removing the cancer cells that were on my cervix. She's said she's been going over my pathologist report & the biospy reports and other medical documents my GYN sent her. She did ask me about future pregnanies (I'm 35, a single mother and dont have a partner, so sadly another child is not in my future) She did say she believed for my case a LEEP would be the best option. My GYN never called me back today, even after leaving her two messages. After talking with the GYN/ONC, I do feel a little better about the procedure now. She also mentioned everyone is different in the healing process, So I'll just have to see what happens and hope for the best. The sites you sent me were very helpful and I truly thank you. I've been pouring over every article and medical documents about these procedures. I'll just keep my fingers crossed for now..........

• By flowershoplady
• Reply 137754
• September 22, 2008 at 8:05 pm
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glad to hear you're feeling better about knowing what's going on! good luck this week....i hope all goes smoothly with the leep. remember to take it easy afterwards, and maybe even take the following day off from work, if you can, so your body can get a chance to recover. let us know how you're doing.

• By ladyyydee
• Reply 137767
• September 22, 2008 at 8:23 pm
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Thank you flower for all your wisdom and support. It's so scary to know how many woman, myself included, are misinformed and have so many unanswered questions and have no place to go. This really is a wonderful site. They moved my procedure now till Sept 30th, so I'll have a bit more waiting to do. I hopefully will be going right to work after the LEEP, believe it or not, right now working is keeping me sane. But I'll see how I feel and take it from there. I'll keep you posted.......Thanks a million

• By 2brooke7
• Reply 138427
• September 24, 2008 at 9:56 am
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"She also said a Cone Biospy is old school that they really dont perform those too much and a less experience doctor may choose to do a Cone Biopsy. "

I'm not so sure about that...from the research I've done, a LEEP procedure burns the flesh b/c of the laser, and if they are searching for cancer at the margins it is more difficutlt to tell with a LEEP over cold knife. I am not a doctor, but AM having a cold knife cone biopsy done in 2 wks to determine whether the cancer is invasive. If getting a clean margin takes the cold knife then I'm all for it...I don't want to have to go back b/c a laser burned the margins and it was too close to tell and I have to have it redone. Sometimes slow and steady wins the race.

• By ladyyydee
• Reply 138658
• September 24, 2008 at 5:41 pm
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Hey Brooke, I agree with you slow & steady does win, and you are right about the LEEP, my ONC/GYN explained at great deal about the difference between the 2 procedures. But she still thinks the best way for me to go is having the LEEP done, and the ONC/GYN is the one who said about the cone being "old school", those were her words not mine, just to be clear. I wish you the best of luck, hopefully better days are ahead for all of us.........