All patients were randomized in two groups: in the first group, "senior group", the colposcopy was performed by an experienced colposcopist; in the second group, "junior group", the colposcopy was . Medical Terminology chapter 13. On the other hand, 30% reportedly would take at least 1 random biopsy and 20% would take 2 or more random biopsies. Hero Images / Getty Images. A negative result means no cancer was detected. These technical elements were generally practiced equally among different volume practices, with the exception that fewer (26%) of those with moderate- to high-volume practices (>6 per month) examined the cervix with saline wash before applying 3% to 5% acetic acid and slightly more of this group (62%) routinely examined the vagina colposcopically. Mayo Clinic does not endorse companies or products. A colposcopy is a type of cervical cancer test. This add-on code may be appended to colposcopy CPT codes 57420-57421, 57452, 57454-57456, and 57460-57461. Colposcope: A special magnifying instrument used to examine the cervix, vagina, and vulva. Among colposcopists taking our survey, only 5% indicated that they sometimes or frequently used one of these types of adjuncts. \hline 128 & 56 & 54 & 91 & 190 & 23 & 160 & 298 & 445 & 50 \\ Of the 4200 surveys distributed, we received 501 responses, representing an 11.9% response rate. In comprehensive practice, the location of any biopsies and the method of ECS, if done, should be documented. Please try after some time. 3rd ed. You can wear whatever is comfortable on your way to the test. ObstetricianGynecologist (Ob-Gyn): A doctor with special training and education in women's health. Colposcopy is a visual discipline, and the appearance of lesions revealed that after application of dilute (3%5%), acetic acid may change with time. It's used to find abnormal cells in your cervix. Una colposcopia es un procedimiento que permite al profesional de la salud examinar detenidamente el cuello uterino, la vagina y la vulva de una mujer. You might feel pressure when the speculum goes in. The acetic acidsolution used to clean the vaginal area prior to a colposcopy can cause a pungent, vinegar-like odor that should fade in a day or two. Significant cytologic overall detection of low-grade squamous intraepithelial lesions demands an increased understanding of phy The primary goal of colposcopy is to identify precancerous and cancerous lesions so that they may be treated early. Accessed Nov. 12, 2019. Although standard curricula are available,1 the nature and quality of training vary widely.2 This may, in part, play a role in the low sensitivity of colposcopy in the United States.3 Studies of the individual elements of the colposcopy examination are lacking in the literature, and most elements of the examination practiced by colposcopists rely on expert opinion acquired during training and practice. Before you leave your colposcopy appointment, ask your doctor when you can expect the results. TD 3 : Taux de croissance annuel moyen (TCAM), ap psych unit 4, topic: operant conditioning, John David Jackson, Patricia Meglich, Robert Mathis, Sean Valentine, Elliot Aronson, Robin M. Akert, Samuel R. Sommers, Timothy D. Wilson, Information Technology Project Management: Providing Measurable Organizational Value, Operations Management: Sustainability and Supply Chain Management. There has been a rising interest in the colposcopy literature regarding the number of biopsies to obtain and the role of random biopsies in colposcopy practice.710 In our study, there was wide variation in routine (>75% of the time) biopsy practice among survey respondents. If you haven't heard any news from your healthcare provider after two weeks, call the office to check on the results. Phone: 301-857-7877 The performance of a new scoring system for, 7. Your doctor may apply a solution of vinegar or another type of solution to the area. In response to this question, the patient will most likely: Colposcopy is a medical term that means to visually examine the: True or false? Interim recommendations were then developed with input by the entire ASCCP Colposcopy Standards Committee, Board of Directors, and Chief Medical Research Advisor. Frequently asked questions: Special procedures FAQ 135: Colposcopy. What to expect when undergoing this gynecological test. With that said, if you are pregnant, a biopsy is usually avoided because it can cause cramping and may increase the risk of complications, such as premature labor or miscarriage. Feltmate CM, et al. This includes abstaining from sexual intercourse. Colposcopy in pregnancy is difficult. This website is using a security service to protect itself from online attacks. The Atlas of Colposcopy: Principles and Practice is a digital tool to train students, medical staff, and practitioners in colposcopy and the management of cervical neoplasia. Analyses were performed using Stata Version 14. ASCCP, 23219 Stringtown Rd, #210, Clarksburg, MD 20871. You should contact your healthcare provider if your symptoms are worse than expected or you develop any symptoms of infection. Mastectomy Mast-breast Ectomy-surgical removal 2. You'll lie on your back on a table with your feet in supports, just as during a pelvic exam or Pap test. These guidelines represent recommended practice in all parts of the examination including the following: precolposcopy evaluation, performing the procedure, documentation of findings, biopsy practice, and postprocedure follow-up. It might also sting or burn a little when they wash your cervix with the vinegar-like solution. Additionally, where the number of colposcopies performed per month affected the approach to colposcopy, we stratified the survey results by volume of colposcopy practice, i.e. E-mail: [emailprotected]. Please enter a valid 5-digit zip code or city or state. Of those answering the survey, 65% were physicians, 36% were advance practice clinicians (APCs), that is, nurse practitioners, certified nurse midwives, and physician assistants, and 4% listed others. There was some duplication of categories resulting in more than 100% total. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Evidence-based consensus recommendations for, 5. Reid R, Scalzi P. Genital warts and cervical cancer. Swipe through to. modify the keyword list to augment your search. If your doctor finds a suspicious area, a small sample of tissue may be collected for laboratory testing. Toluidine blue is sometimes applied for forensic purposes to demonstrate injuries. In general, most medical conditions diagnosed by colposcopy are treatable. Minimum and comprehensive colposcopy practice guidelines were developed. It can be helpful to take over-the-counter pain medication before the biopsy. Sixty-seven percent of affirmative votes were required for approval of individual recommendations. Colposcopy and biopsy practices differ by volume of colposcopy practice in pregnant women (see Table 3). You may have some vaginal bleeding and a dark discharge for a few days. 2019;8(12):5425-30. doi:10.1002/cam4.2435. The working group, therefore, implemented a national survey of current and recent ASCCP members to evaluate common elements of the colposcopy examination. In general, it is not typical to have a routine follow-up colposcopy at regular intervals, but you may need to have another colposcopy if you have an abnormal Pap smear in the future or other concerning findings. You may experience some spotting or very light bleeding from your vagina in the next day or two. Ninety-seven percent of respondents routinely performed ECS if the SCJ was not fully visualized and if referring cytology was HSIL or ASC-H (two thirds of those who do not perform ECS indicated that a diagnostic excision procedure is routinely planned in this situation.). In both minimum and comprehensive practice, biopsies, if indicated, should be taken at the SCJ and ECS, if performed, should be documented. A special device is used to collect the cells. All comments were considered in the development of final recommendations. Most Americans get their insurance coverage through an employer-based __________ plan. Anatomic variants can mimic disease. Less than half of respondents (48%) reported routinely performing colposcopy in the face of a mucopurulent discharge. "CIN" stands for cervical intraepithelial neoplasia, and the number describes how abnormal the tissue looks under the microscope. Colposcopy is typically done in your ob-gyns office. It magnifies the normal view, allowing your provider to see problems that can't be seen by the eyes alone. It may also be recommended if you have bleeding after sexual intercourse. After your procedure, your healthcare provider may recommend that you refrain from putting anything into your vagina for about 48 hours. Alternatively, some physicians achieve hemostasis with silver nitrate. The device is used to help physicians detect precancerous and cancerous tissue. Pain is typically treatable with over-the-counter pain medications such as Tylenol (acetaminophen)or Motrin (ibuprofen). chapter 6 medical term. During colposcopy, your doctor uses a special instrument called a colposcope. Other reasons for vulvar and vaginal colposcopy include cytology unexplained by cervical findings, vaginal and vulvar symptoms, and d Colposcopists who perform a limited number of colposcopy examinations should strive to meet at least the minimum elements. For example, if you have an infection, you may need to be treated with an antibiotic. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. In West and Central Africa, CFA member nations use a common currency, much like members of- A. the United Nations, B. NAFTA, C. the European Union, D. NATO. If your doctor or nurse sees something that doesnt look normal, theyll do a biopsy. True or false? . In: Pfenninger and Fowlers' Procedures for Primary Care. You can email the site owner to let them know you were blocked. The healthcare provider sees the tissues on the cervix and vaginal walls more clearly. In addition, a comprehensive examination includes evaluation of the upper vagina with magnification, examination of the cervix after application of 3%5% acetic acid using multiple magnifications, and the use of both white light and a red-free (blue or green) filter. According to theAmerican College of Obstetricians and Gynecologists, a colposcopy is recommended if a Pap smear of pelvic examination showed: A colposcopy does not extend all the way to the uterus, and it only provides a view of some areas of the cervix and some surrounding tissue.. The 2019 ASCCP Risk-Based Management Consensus Guidelines have several important differences from the 2012 Guidelines, while retaining many of principles, such as the principle of equal management for equal risk. The decision to biopsy was often influenced by the severity of the referral cytology and colposcopy practice volume (see Table 2). Implications for Establishing Standards, Articles in PubMed by Alan G. Waxman, MD, MPH, Articles in Google Scholar by Alan G. Waxman, MD, MPH, Other articles in this journal by Alan G. Waxman, MD, MPH, ASCCP Colposcopy Standards: Role of Colposcopy, Benefits, Potential Harms, and Terminology for Colposcopic Practice, ASCCP Colposcopy Standards: Risk-Based Colposcopy Practice, 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors, Evidence-Based Consensus Recommendations for Colposcopy Practice for Cervical Cancer Prevention in the United States, Privacy Policy (Updated December 15, 2022), American Society for Colposcopy and Cervical Pathology, Assess human papillomavirus (HPV) vaccination status (78%), Obtain signed consent whether or not biopsy performed (79%), Obtain signed consent only if biopsy planned (24%), Examine the cervix with saline before acetic acid wash (31%), Examine the cervix with 3-5% acetic acid (98%), Examine the cervix with Lugol iodine (45%), Examine the cervix with a green/blue filter (80%), Identify the visible limits of the squamocolumnar junction (SCJ) (98%), Achieve hemostasis with Monsel paste or silver nitrate (99%). has advised but does not receive an honorarium from any companies. Cloudflare Ray ID: 7c064a9d0a672ba4 57455 Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix ICD 10 Codes: N88.0 Leukoplakia of cervix (uteri) N87.9 Dysplasia of cervix unspecified Colposcopy PHOTOREPORT by EndoSoft 4 Acetowhite Epithelium 4 This procedure was electronically signed off on: 06/11/2018/ 2:19:41 PM By Debbie Doe, MD If you had a colposcopy with a biopsy, recovery may include some vaginal bleeding and mild crampingfor 24 to 48 hours after the procedure. The medical assistant asks, "Why aren't you following your diet?" Sixty-seven percent have been performing colposcopy for more than 10 years. After further editing and notification of stakeholder professional organizations, recommendations were posted on the ASCCP Web site for public comments between March 13 and 22, 2017, which resulted in additional modifications in response to the comments. Pelvic Exam: A physical examination of a woman's pelvic organs. Once on the examination table, you will be asked to lie down and place your feet instirrups. Only 25% indicated that they use the Reid (24%)5 or Swedescore (1%)6 scoring systems to define their colposcopic impression. This number increased to 84% in the presence of heavy bleeding. Among respondents who do ECS, 36% perform ECS before biopsy and 64% perform biopsy first. Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page. other information we have about you. Fourteen percent perform a biopsy on more than 1 lesion and only 4% on all visible lesions in pregnancy. There are also variations regarding colposcopy during pregnancy, performance of colposcopy for minimally abnormal screening results, number of biopsies to take, the role of the random biopsy, and routine ECS. The vulva is the outer part of the female genitalia, including the labia majora, labia minora and clitoris. low-volume practice (05 colposcopies performed per month), moderate volume (620) and high-volume practice (>20 colposcopies per month). If you are paying out of pocket, you should expect to pay between $200 and $600 depending on the facility and where you live. To collect the tissue, your doctor uses a sharp biopsy instrument to remove a small piece of tissue. It lets your doctor or nurse get a close-up look at your cervix the opening to your uterus. Once your healthcare provider removes the speculum, you may need a few minutes to rest. In developing the ASCCP Colposcopy Standards for colposcopy procedures, we based the framework for our recommendations on practice patterns endorsed by at least 80% of those survey respondents in the combined moderate- and high-volume groups. Relevance of random biopsy at the transformation zone when, 10. Among those who document location, 98% identified the location by position on a clock face. The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. The device is placed at the opening of the vagina. Most people describe it feeling like a sharp pinch or a period cramp. By comparison, 72% of respondents would perform a biopsy on all lesions if the referral cytology was lesser abnormalities and 86% would perform a biopsy on all lesions for higher-grade cytology. Gage JC, Hanson VW, Abbey K, et al. Twenty-four percent would decline to perform colposcopy in the event of any vaginal bleeding. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. A colposcopy and biopsy only takes about 5-10 minutes. 61 terms. Immune system attacking healthy body tissue is a common cause. The patient's weight increased since his last visit and a review of the blood glucose readings reveals that the levels are consistently above 200 mg/dL. If you have a colposcopy with a biopsy, you may have pain and discomfort for 1 or 2 days. Colposcopy typically involves a second component, where the ecto- (outer)-cervix and/or endo- (inner)-cervix are biopsied. There are no food or drink restrictions associated with colposcopy. Wentzensen N, Walker JL, Gold MA, et al. The gyn said the changes to my cervix were severe just from what she saw during the colpo. (College Station, TX) The survey was deemed exempt from review by the institutional review board of University of Pittsburgh. Colposcopic examination with biopsies for pathologic assessment is the criterion standard in the diagnostic evaluation of cervical dysplasia. This separates the walls of your vagina so they can get a really good look at your cervix. Ninety percent of survey respondents routinely generated and documented a colposcopic impression. The total play counts over the past year for the 27 songs on your smart playlist are shown below. Three biopsies were taken and all three came back HSIL CIN 3. Keyword Highlighting When ECS was performed, 21% used a curette alone, 11% used a brush alone, and 65% routinely used both curette and brush. Typically, your practitioner will also place a 3% to 5% dilute acetic acidsolutionon your cervix to better visualize the area and distinguish between normal and abnormal tissue. The ob-gyn looks through the lens of the colposcope. KGladden_27. You may feel a slight burning. A colposcopy is a simple procedure that lets your doctor get a good look at your cervix. The results of our survey should not be generalized to all US colposcopists. A colposcopyis an in-office diagnostic procedure used to examine the inside of the vagina, vulva, and cervix. Avoid tampons, douching and vaginal intercourse for a week after your biopsy, or for as long as your doctor instructs you to. Please enter your age and the first day of your last period for more accurate abortion options. This content does not have an Arabic version. A colposcopy is typically performed by a gynecologist or other healthcare provider. Some busy gynecological practices only call if the biopsy is positive. Read copyright and permissions information. A biopsy is sometimes taken during a colposcopy. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). During a biopsy, a small piece of tissue is removed from the cervix, vagina, or vulva. Colposcopy is done to detect cervical cancer and changes that may lead to cervical cancer. A colposcopy is a medically safe procedure. has been the overall principal investigator or local principal investigator for the past 12 months including from Astra Zeneca, Baxalta, Pfizer, Inovio, Fujiboro, and Eli Lilly. Human Papillomavirus (HPV): The name for a group of related viruses, some of which cause genital warts and some of which are linked to cancer of the cervix, vulva, vagina, penis, anus, mouth, and throat. Your doctor may apply a chemical solution to the biopsy area to limit bleeding. Accessed Oct. 1, 2019. The other takes tissue from inside the opening of your cervix. A colposcopy is nearly pain-free. Explain to the physician why the visit could be coded at a higher level and ask if she agrees. How does it change the money supply? After the procedure this material will be expelled naturally: Patients can expect to have a thin coffee-ground like discharge for up to several days after the procedure. The value and validity of each element of the colposcopy examination thus identified were discussed within the working group and the larger steering committee. You may experience anxiety before your colposcopy exam. Other reasons for a patient to have a colposcopy include assessment of diethylstilbestrol (DES) exposure in utero, immunosuppression, abnormal appearance of the cervix or as a part of a sexual assault forensic examination. This solution looks like mustard and turns black when exposed to blood. The ASCCP provided travel and logistic support for the colposcopy standards committee and working groups. What happens during a colposcopy and biopsy? You may opt-out of email communications at any time by clicking on Ninety-six percent of survey respondents indicated that they document the location of lesions seen. It is performed similar to a Pap smear but uses an illuminated magnifying instrument (colposcope) to look for cell changes, growths, and inflammation. YOU MIGHT ALSO LIKE. information and will only use or disclose that information as set forth in our notice of cervical squamous intraepithelial lesions, Get new journal Tables of Contents sent right to your email inbox, ASCCP Colposcopy Standards: How Do We Perform Colposcopy? In addition, many doctor's offices post online to a patient portal where you can view test results. Your doctor may recommend colposcopy if your Pap test result is abnormal. Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected through the examination. In addition, the colposcopist performing a comprehensive examination should document whether cervical manipulation is needed to completely visualize the SCJ, and if lesions are present, the extent of lesion visualized (fully/not fully), lesion size and location, and description (color, contour, border, vascular changes). It magnifies the image many times. Colposcopy is a medical term that means to visually examine the: vagina The traditional kind of health insurance wherein patients can choose any provider or hospital they wish and change physicians at will is: indemnity or fee-for-service. [1] Numbing should be requested prior to proceedure. Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. The exam takes 5 to 10 minutes, and is a lot like getting a Pap smear. Does this seem to be the case here? [9] A score below 5 does not require biopsy because of low risk of cancer, a score from 5 to 7 requires biopsy, and a score 8 or above does not require biopsy because it is likely more efficient to intervene directly (e.g., by excision). In addition to some light vaginal bleeding, you may notice a dark discharge from the solutionthat your healthcare provider used to help visualize your cervix. Most respondents indicated that they document their findings using text and/or a drawing (80% and 66%, respectively). It uses an instrument with a magnifying lens and a light, called a colposcope. To prepare for your colposcopy, your doctor may recommend that you: You may experience anxiety as you wait for your colposcopy exam. Other reasons for a patient to have a colposcopy include: Many physicians base their current evaluation and treatment decisions on[citation needed] the report "Evidence-Based Consensus Recommendations for Colposcopy Practice for Cervical Cancer Prevention in the United States", developed by the American Society for Colposcopy and Cervical Pathology, most recently in 2017. Important factors that may contribute to these limitations in the United States include lack of the following: (1) standardized terminology, (2) recommendations for colposcopy-biopsy practice and procedures, and (3) quality assurance measures. In this procedure the clinician uses a magnification lens (the colposcope) to view the cervix for cellular changes and locate sites appropriate for biopsy. The doctor or nurse will put a speculum into your vagina and open it. To provide you with the most relevant and helpful information, and understand which In specific cases, his employer has received payment for his consultation from Photocure, Papivax, Inovio, PDS Biotechnologies, Natera, and Immunovaccine. It can also be used to check the result of a treatment. This may cause a burning or tingling sensation. If your doctor finds an unusual area of cells during your colposcopy procedure, a sample of tissue can be collected for laboratory testing (biopsy). Here are 2 things you can do to make things easier: Schedule your colposcopy for when you wont have your period or when the bleeding is light. Posthysterectomy patients who were diagnosed with vaginal high-grade intraepithelial lesion (HSIL) by colposcopy-directed biopsy with colposcopy impression of extensive HSIL or suspicion of cancer and underwent upper or total vaginectomy from January 2009 to December 2017 were included. 2017; doi:10.1097/LGT.0000000000000338. Journal of Lower Genital Tract Disease. The ECC utilizes a long straight curette, a Soft-ECC curette employing fabric to simultaneously collect tissue, or a cytobrush (like a small pipe-cleaner) to scrape the inside of the cervical canal. p16 and Other Epithelial Cancer Biomarkers. [9], Significant complications from a colposcopy are not common but may include bleeding, infection at the biopsy site or endometrium, and failure to identify the lesion. Recommendations were made for the performance of colposcopy in minimum and comprehensive colposcopy practices. There are differences in practice regarding other elements of the procedure, including routine use of Lugol iodine, use of saline wash, routine colposcopy of the vagina, and documenting the size of lesions. [citation needed], A colposcope is used to identify visible clues suggestive of abnormal tissue. Our review of 390 articles in the English language literature retrieved from PubMed from 1982 to 2015 using search terms appropriate for colposcopic technique, methods, and instrumentation did not reveal any evidence supporting or refuting specific colposcopic methodology.4 Our literature search, further, included colposcopic adjuncts as part of our second charge. You will be asked to undress from the waist down and may be asked to change into a gown. Twenty-four percent reported use of a digital imaging or print photos, some in addition to written forms of documentation. Accessed Oct. 1, 2019. Translate a magazine ad or advertising slogan into a foreign language you are studying. M.E. Abdelhakim AM, et al. This gets rid of the bad cells so new, normal cells can grow back in the same spot. [citation needed], After a complete examination, the colposcopist determines the areas with the highest degree of visible abnormality and may obtain biopsies from these areas using a long biopsy instrument, such as a punch forceps, SpiraBrush CX or SoftBiopsy. The solution helps highlight any areas of suspicious cells. Blood vessel enlargement, bleeding, or irregularities are often visible through the colposcope. Precancer. A . El dispositivo se coloca en la abertura de la vagina para observar problemas que no se pueden detectar a simple vista. If you get a biopsy, you might have some discomfort. Terms and Conditions of Use, Get the latest on COVID-19, pregnancy, and breastfeeding. Cervical mapping is a separately identifiable service performed by a physician during a . By comparison, 68% indicated that they would proceed in the presence of vaginitis and 74% after a recently treated gonorrhea or chlamydia infection. 128578466564942354378491677381901826237481416070172988684451085071. A pre-cancerous lesion may prompt the need for further evaluation such as a repeat biopsy, a larger biopsy, or close monitoring with more frequent Pap smears or colposcopies. Read common questions on the coronavirus and ACOGs evidence-based answers. Unless the person has a visible lesion, colposcopy for this population does not detect a recurrence of cancer. More than half (56%) of survey respondents indicated that they would perform colposcopy in pregnancy with screening results of lesser abnormalities, i.e., HPV+ ASC-US, HPV 16/18+ NILM, or LSIL. Planned Parenthood Federation of America, Inc. is a registered 501(c)(3) nonprofit under EIN 13-1644147. For trusted, in-depth advice from ob-gyns, turn to Your Pregnancy and Childbirth: Month to Month. The literature . Colposcopic characteristics and Lugols staining differentiate anal high-grade and low-grade squamous intraepithelial lesions during high resolution anoscopy. Number of cervical biopsies and sensitivity of, 9. [citation needed], Colposcopy with biopsy does not cause infertility or subfertility. The American College of Obstetricians and Gynecologists. 2019; doi:10.1016/j.jogoh.2019.07.007. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. If travel is required for meetings with any industry, the company pays for his travel-related expenses. [2][3] The development of colposcopy involved experimentation on Jewish inmates from Auschwitz.[4]. Cervix: The lower, narrow end of the uterus at the top of the vagina. Your information is private and anonymous. You may search for similar articles that contain these same keywords or you may The minimum colposcopy practice should be the baseline requirements for a colposcopy examination in the United States. With a cytology of ASC-H or HSIL, 20% indicated that they would take no biopsies, 26% at least 1 random biopsy, and 55% 2 or more random biopsies. The recommendations for minimum and comprehensive colposcopy practice derived from this survey with input from the steering committee and from public comments addressed the following 6 major components of the colposcopy procedure: the precolposcopy evaluation, the examination, use of colposcopy adjuncts, documentation, biopsy sampling, and postcolposcopy procedures (see text and Table 4). There is controversy in the literature over the role of taking random (nondirected) biopsies.810 This was addressed by Working Group 2 of the Colposcopy Standards Committee and they found no added benefit for women with low risk of precancer.11 The evidence from the literature is clear that sensitivity is increased with taking multiple biopsies.7,10 Working group 2 underscored this in most situations using a risk-based approach.11.