Reviewer's report 
 Additional Collection Devices Used In Conjunction With The SurePath Liquid-Based Pap Test Title: 
Broom Device Do Not Enhance Diagnostic Utility 
 2  18 August 2004 Version: Date: 
 Joel Bentz Reviewer: 
Reviewer's report: 
General 
This revised manuscript is very much improved, and is nearly ready for acceptance. 
The results of this trial are very useful for both laboratories and clinicians that use liquid-based pap 
for cervical cytology. The authors have addressed almost all of the initial concerns brought up in the 
first review. However, they have not provided a complete response to one of the 3 critical concerns that was mentioned in the first review (point #2). ------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
Please see first review, as point #2. The authors should explain in the discussion why they choose 
the sequence of cervical sampling in the study patients, and whether that might influence the results 
that they observed in the study outcomes. The SurePath broom was always used to collect a sample 
first, followed by one of the alternative collection devices. A repeat cervical sample, especially within 
a short time of the initial cervical sampling, might be a suboptimal sample due to mechanical 
exfoliation effect on the cervical epithelium. The results from the current study would even suggest 
this, as some of the second samplings were reported as QNS. Perhaps the authors could explain the reasoning behind why certain collection devices should be used in a certain order (e.g. to minimize blood or trauma, etc). If there is a particular reason why the SurePath broom should be 
used first, before additonal collection devices, should be explained. This needs to be discussed and 
explained by the authors. The study appears to have a bias for the SurePath Broom device (the first 
sampling) due to the study design, which has the additional collection devices using "left overs" from 
the cervicovaginal epithelium after the initial sampling. Also, please explain (in the discussion) the 
rationale for choosing two different cervical sampling strategies: a single collection device (eg. the 
SurePath Broom) VS. using a combination of collection devices (plastic spatula + EC brush) OR using SurePath Broom PLUS additional collection devices. 
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
None 
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Discretionary Revisions (which the author can choose to ignore) 
Did the study have IRB review? If so, it probably should be mentioned in the manuscript. 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
Dr. Bentz has served as a consultant to TriPath Care Technologies. Specifically, 
He has received honoraria for speaking engagements and as an expert reviewer for company 
sponsored clinical trials. Dr. Bentz does not hold any financial interest in any commecial company discussed in the study.