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In Reply: Dr Budenholzer refers to the study by Coste et al.¹ Although of substantial methodological rigor, in that "split-sample" study, conventional cytology was performed first and the monolayer slide prepared from the remaining material. The order in which testing is performed may affect results; the quality of the second specimen may be compromised and results biased in favor of the first test. To address this concern, some investigators have randomized the order of the tests.² Others have randomized individual women to different cytology collection and preparation methods and compared important clinical outcomes.³

Although sensitivity and specificity cannot be directly determined in a randomized trial without performing a reference standard in all subjects, the proportions of women referred for colposcopy along with the numbers of cases of cervical neoplasia identified can be compared head-to-head. Such clinical outcomes are useful to clinicians and policymakers to determine more precisely the actual trade-offs . . . [Full Text of this Article]

George F. Sawaya, MD
sawayag@obgyn.ucsf.edu
Department of Obstetrics, Gynecology and Reproductive Sciences
University of California, San Francisco

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