LEEP vs. Cold Knife Cone Biopsy

I have high grade dysplasia, not sure if CIN II or III or CIS. My doctor's nurse is extremely difficult to communicate with. Anyway, they basically gave me the choice between LEEP or Cone under general. I have no idea which to choose. I took the cone option because somewhere I think I read it to be preferred for CIN III/CIS. But now I am wondering if I made the right choice. I posted on another thread that I currently have the flu. If I have to postpone my surgery I may consider the LEEP to avoid anesthesia after my illness. Oh I am very confused.

If you were given the choice between the two procedures what would/did you do? and why?

Thank you so much for your input!!

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hello, newhere. i'm sorry to hear you have dysplasia and need a leep or cone biopsy. and, sorry that you've got the flu on top of everything else. :(

first of all, i think you need to take steps to be less confused, and the way to do that is to have a conversation with your doctor which ends with having had your questions answered. if the nurse is not helpful and even seems to be a problem, that emphasizes further that you need to talk with the doctor.

you should know exactly your diagnosis. i'm assuming you've already had a colposcopy and biopsy or biopsies, and the doctor should share with you these results. it shouldn't be a general answer - it should be specifically you diagnosis. in fact, you may want to ask to see your medical records, including the pathology reports. these records are yours, and you are more than entitled to see them.

secondly, the doctor should be providing you with a recommendation on which procedure he or she thinks is best for your situation. he's the one who went to medical school and has experience with this, and should be providing you with all the information so that you can make an informed decision. if your doctor is not providing you with the necessary information to make an educated decision, you should find another doctor. before the procedure is done!

the differences between procedures include whether they can 'read' the margins, how extensive and/or deep the dysplasia appeared via colposcopy exam and from biopsy results, potential impact on future pregnancies, etc.

i've never been given a 'choice' as to procedure; the doctors have always told me what they think i need to have done to treat my situation. if your doctor doesn't give a clear recommendation, ask what he would do if you were his sister.

again, i'm really sorry you're feeling confused. it's scary enough to be dealing with dysplasia, but to feel confused could make things overwhelming. and, we all emphasize that we need to keep our stress levels as low as possible!

please call the doctor on monday to better understand your situation. you need to be your own advocate. let us know how it goes!

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here's what i found about why a cone biopsy would be done rather than a leep:

"A cone biopsy is a treatment for cervical abnormalities. It refers to a surgical procedurewhere a cone-shaped or cylinder-shaped piece of the cervix is removed. This procedure isthe least type used currently since cryocautery, loop electroexcision (LEEP) or lasermethods generally are adequate to treat the more common cervical problems. Thismethod of treatment will result in a definitive diagnosis of the abnormal Pap smear; andwill often be a cure for the problem at the same time with proper follow-up. In a smallnumber of cases, a cone biopsy may interfere with childbearing.There are various reasons for having to undergo a cone biopsy. These include:1. An abnormal Papanicolaou smear that is considered high grade with normalcolposcopy findings.2. Colposcopy findings that extend deep inside the cervical canal so that they cannotbe treated by a loop electroexcision procedure (LEEP) or laser procedure.3. At times, the endocervical curettage can be significantly abnormal, suggesting theneed for a cone biopsy.4. At times, a Papanicolaou smear containing atypical glandular cells requiresfurther biopsy and treatment, which may be a cone biopsy.5. Suspicion of microinvasion.The cold knife diagnostic procedure is generally considered a minor outpatient surgicaloperation. As with any procedure performed under anesthesia, fasting for 6 to 8 hours isrecommended. You will be asked to sign an informed consent form. The procedure isgenerally a same day procedure in which hospitalization is not necessary.The tissue is sent to the pathologist to judge whether all abnormal tissue was likely tohave been removed.Printed with Permission. Wheeless CC. Atlas of Pelvic Surgery, Second Edition, pg. 187Conization of CervixCone Biopsy"

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Hi -

I am sorry to hear you are sick and may need to postpone your surgery! I hope it all works out.

As flowershoplady mentioned, I would speak with yoiur doctor and get his/her opinion and see what procedure they suggest would be best for you. If they can't come to some conculsion, I would look into gettting a second opinion as maybe this doctor isn't providing you with the asnwers and standard of care you need.

I had something similar.Basically, a LEEP is a conization, but it cauterizes as it removes the tissue sample and lesion/tumor. With cold-knife, there is more bleeding and may require more recovery time. LEEP procedures have several advantages, including preservation of the margins for histologic evaluation, and virtual bloodlessness. Moreover, LEEP procedures can be performed in the office or in other outpatient settings.

In my case, the doctor had first opted for a cold-knife, but decided to do the LEEP because I still wanted to have childrern via a vaginal birth. Also, there is a higher chance of preterm labor with a cold-knife vs. a LEEP. Most often with a cold-knife, you must have a c-section if you decided to have children. In my case, I ended up needing a c-section anyway due to other cervical issues (cervical stenosis). I would talk more to your doctor about the future if you want to have kids and make sure that having a cold-knife conization is in-line with your future plans.

I hope this info helps. Either way, I will say a litle prayer that your surgery goes well and you get better quickly.

Let us know what happended!


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Hi. Thank you both for your responses. I wrote a lengthy reply yesterday but for some reason it never showed up.

I saw my gyno today. Well I finally got all my questions answered. I have CIN II, up in the canal. There are no lesions on the exterior portion of my cervix. He said the LEEP and the Cone are both options for me. I am not having anymore children, already have 2 and my husband is fixed! We discussed the pros and cons of each, I chose the cone. For 2 reasons, 1) since the lesion is up in the canal I want to be sure it gets taken out and we can read the margins well and 2) I I have had some traumatic experiences and would prefer not to have someone causing me pain (long story).

I have learned a big lesson. I have to speak up quickly. Alot of my anguish could have been avoided if I just bypassed the nurse and made an appointment.

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glad to hear that you got your questions answered by the doctor, understand the pros and cons of each procedure, and now have a plan to go forwards. do you have it scheduled? let us know when it is.....you'll have a whole group of women across the country as well as in other countries wishing you well!

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My surgery is scheduled for March 14th. Thanks for asking :)

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Dear newhere, I hope everything goes well with your cone biopsy. I just had mine done on 25th of February and have to go for my post-op tomorrow. I am very anxious and scared about the result. I just wanted to let you know that i am praying for you and hopefuly everything will go well. Please do not worry about the surgery. It is not a big deal. I never had any kind of surgery before and was very worried about the whole thing but, it was not bad at all. it took about less than 30 minutes to do my cone biopsy and D&C and after i woke up i just felt some mild cramps which went away by taking some pain killers. I never had pain nor much bleeding after that. I do have dark brown discharge but trust me you will be alright. Good luck and God bless. Simona

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Good Luck with all and keep being your own advocate no matter what! I just had a cone biopsy and a D&C, which as Taylor1 said, took a total of about 30 minutes. I have been extremely surprised at how the recovery is. I had my operation last Thursday, March 19th and just did some spotting like you would at the end of any normal period. My doctor did place some foam material where she had removed the cone shape and other than it falling out, which was very uneventful, I have had no other discharge at all. I go in the morning to get my results, which I think is the scariest part of all! So, don't worry about the procedure just rest and take care of yourself. Remember God can do All Things!

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