Editing Cervical cancer (section)

===Biopsy===
The [[Pap test]] can be used as a [[Screening (medicine)|screening test]] but produces a [[False positives and false negatives#False negative error|false negative]] in up to 50% of cases of cervical cancer.<ref>Cecil Medicine: Expert Consult Premium Edition. {{ISBN|1-4377-3608-4}}, 9781437736083. Page 1317.</ref><ref>Berek and Hacker's Gynecologic Oncology. {{ISBN|0-7817-9512-5}}, 9780781795128. Page 342</ref> Another concern is the cost of doing Pap tests, which makes them unaffordable in many areas of the world.<ref>{{cite journal | vauthors = Cronjé HS | title = Screening for cervical cancer in developing countries | journal = International Journal of Gynaecology and Obstetrics | volume = 84 | issue = 2 | pages = 101–108 | date = February 2004 | pmid = 14871510 | doi = 10.1016/j.ijgo.2003.09.009 | s2cid = 21356776 }}</ref>

Confirmation of the diagnosis of cervical cancer or precancer requires a biopsy of the cervix. This is often done through [[colposcopy]], a magnified visual inspection of the cervix aided by using a dilute [[acetic acid]] (e.g. [[vinegar]]) solution to highlight abnormal cells on the surface of the cervix,<ref name=Robbins/> with visual contrast provided by staining the normal tissues a mahogany brown with Lugol's iodine.<ref>{{cite book | vauthors = Sellors JW |title=Colposcopy and treatment of cervical intraepithelial neoplasia: a beginners' manual |date=2003 |isbn=978-92-832-0412-1 |chapter-url=http://screening.iarc.fr/colpochap.php?lang=1&chap=4 |chapter=Chapter 4: An introduction to colposcopy: indications for colposcopy, instrumentation, principles and documentation of results|publisher=International Agency for Research on Cancer }}</ref> Medical devices used for biopsy of the cervix include [[Instruments used in obstetrics and gynecology|punch forceps]]. Colposcopic impression, the estimate of disease severity based on the visual inspection, forms part of the diagnosis. Further diagnostic and treatment procedures are [[loop electrical excision procedure]] and [[cervical conization]], in which the inner lining of the cervix is removed to be examined pathologically. These are carried out if the biopsy confirms severe [[cervical intraepithelial neoplasia]].<ref name=":1">{{cite journal | vauthors = Athanasiou A, Veroniki AA, Efthimiou O, Kalliala I, Naci H, Bowden S, Paraskevaidi M, Arbyn M, Lyons D, Martin-Hirsch P, Bennett P, Paraskevaidis E, Salanti G, Kyrgiou M | display-authors = 6 | title = Comparative effectiveness and risk of preterm birth of local treatments for cervical intraepithelial neoplasia and stage IA1 cervical cancer: a systematic review and network meta-analysis | journal = The Lancet. Oncology | volume = 23 | issue = 8 | pages = 1097–1108 | date = August 2022 | pmid = 35835138 | pmc = 9630146 | doi = 10.1016/S1470-2045(22)00334-5 }}</ref><ref name=":2">{{Cite journal |date=2023-11-10 |title=Prevention of cervical cancer: what are the risks and benefits of different treatments? |url=https://evidence.nihr.ac.uk/alert/prevention-of-cervical-cancer-what-are-the-risks-and-benefits-of-different-treatments/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_60599|s2cid=265201829 }}</ref>

[[File:Squamous carcinoma of the cervix.jpg|right|thumb|This large squamous carcinoma (bottom of the picture) has obliterated the cervix and invaded the lower uterine segment. The uterus also has a round [[leiomyoma]] up higher.]]

Often before the biopsy, the doctor asks for medical imaging to rule out other causes of a woman's symptoms. Imaging modalities such as [[ultrasound]], CT scan, and MRI have been used to look for alternating disease, spread of the tumor, and effect on adjacent structures. Typically, they appear as heterogeneous masses on the cervix.<ref>{{cite journal | vauthors = Pannu HK, Corl FM, Fishman EK | title = CT evaluation of cervical cancer: spectrum of disease | journal = Radiographics | volume = 21 | issue = 5 | pages = 1155–1168 | date = September–October 2001 | pmid = 11553823 | doi = 10.1148/radiographics.21.5.g01se311155 }}</ref>

Interventions such as playing music during the procedure and viewing the procedure on a monitor can reduce the anxiety associated with the examination.<ref>{{cite journal | vauthors = Galaal K, Bryant A, Deane KH, Al-Khaduri M, Lopes AD | title = Interventions for reducing anxiety in women undergoing colposcopy | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 12 | pages = CD006013 | date = December 2011 | pmid = 22161395 | pmc = 4161490 | doi = 10.1002/14651858.cd006013.pub3 }}</ref>