Objective:Cone biopsy of the cervix is a procedure often performed when there is concern about the possibility of invasive disease of the cervix. Cold knife cone (CKC) requires a general anaesthetic and is known to have greater morbidity than procedures such as large loop excision of the transformation zone of the cervix. Our objective was to define the clinical reasoning, histology and outcomes for all patients undergoing cone biopsy at Gold Coast and Robina Hospitals. 

Methods:A retrospective audit was performed on all patients who underwent cone biopsies at Gold Coast and Robina Hospitals from 01/01/2012–01/12/2016. Data collected included clinical indication, specimen histology, specimen depth, margins involved, complications and six month post procedure pap smear. 

Results:There were 73 patients who underwent a cervical cone biopsy during the study period by a general gynaecologist. The most common clinical indication to perform cone was inadequate colposcopy 22(30.1%). The majority of patients had a cone procedure for premalignant disease 69(94.5%).  Average depth of the specimens was 17.1mm. Margins were involved in 12(16.4%) There was a listed complication in 12(16.4%). 13(17.8%) patients had normal cervix reported in the cone biopsy specimen.

Conclusions:A retrospective audit of nearly 5 years data in a tertiary hospital setting has shown that the majority of cone biopsies were performed for premalignant disease. Given these findings our study prompts the question whether CKC is clinically indicated in the vast majority of cases.