The final diagnosis of cervical masses relies on cytology and pathological examination. Tissue samples can be obtained using fine-needle aspiration (FNA) or surgical excision. Fine-needle aspiration is a simple and minimally invasive method that causes little discomfort to the patient, making it widely accepted and commonly used in clinical practice. This involves using a needle with a gauge size of 9-12 or a notched aspiration needle to penetrate the mass, aspirating tissues from within the mass, and preparing smears for cytological and pathological analysis.
It is important to ensure that the puncture site is accurate and avoid damaging blood vessels. Performing the procedure under the guidance of imaging diagnostic tools can improve accuracy and reduce complications. However, a limitation of this method is that only a small amount of tissue is obtained, sometimes making it difficult to yield positive results, with a false-negative rate of approximately 10%.
If the fine-needle aspiration results are negative and malignancy cannot be excluded clinically, especially when no primary lesion is identified, excisional biopsy of the mass may be performed. Generally, it is preferable to completely remove a single mass for pathological examination rather than performing partial excision, which could lead to tumor dissemination or metastasis. If complete removal is not feasible, a wedge-shaped tissue section can be obtained from the most prominent part of the mass for pathological analysis.
Once the tissue specimen has been collected, the wedge incision on the mass should be carefully sutured to minimize the risk of local dissemination of tumor cells.