Objective: To evaluate the accuracy, sensitivity, specificity, and predictive value of preoperative core needle biopsy (CNB) assessment of histological characteristics in primary cervical cancer. Setting: Retrospective cohort study. Population: Women older than 18 with primary cervical cancer enrolled in the prospective Leipzig School MMR study and had CNBs taken before their operation. Methods: We reviewed 318 cases of cervical carcinoma with available pathology reports from preoperative CNB assessment and from final postoperative evaluation of the hysterectomy specimen. Setting the postoperative comprehensive pathological evaluation as reference, we analysed CNB assessment of histological tumor characteristics. In addition, we performed multivariable logistic regression to identify factors influencing the accuracy in identifying lymphovascular space invasion (LVSI) and tumor grade. Main outcome measures: Accuracy, sensitivity, specificity, and predictive values of CNB assessment of histological tumor characteristics and the variables influencing these. Results: CNB was highly accurate in discriminating histological subtype. Sensitivity and specificity were 98.8% and 89% for squamous cell carcinoma (SCC), 92.9% and 96.6% for adenocarcinoma (AC), 33.3% and 100% in adenosquamous carcinoma respectively. Neuroendocrine carcinoma was always recognized correctly. The accuracy of the prediction of lymphovascular space invasion (LVSI) was 61.9% and was positively influenced by tumor size in preoperative MRI and negatively influenced by strong peritumoral inflammation. High tumor grade was diagnosed accurately in 73.9% of cases and was influenced by histological tumor type. Conclusions: CNB is an accurate sampling technique for histological classification of cervical cancer and represents a reasonable alternative to other biopsy techniques. Funding: “Stiftung gynäkologische Onkologie” (non-profit-organization).