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
Sawaya GF. Tests for Atypical Squamous Cells of Undetermined Significance—Reply. JAMA. 2006;295(11):1247–1248. doi:10.1001/jama.295.11.1247-b
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