If Amazon Ads has an existing server-to-server integration with a third-party measurement provider, you must use the adapter URL Amazon Ads provides, you cannot use a pixel.

The correct answer is true because if Amazon Ads has an existing server-to-server integration with a third-party measurement provider, you must use the adapter URL provided by Amazon Ads rather than a pixel. This is because server-to-server integrations are designed to send data directly between servers without the need for a pixel, which typically operates by sending data from the user's browser to a third-party server. The adapter URL is part of the server-to-server setup, enabling more efficient and accurate data transfer without the reliance on pixels, which can sometimes be subject to issues like ad blockers or privacy restrictions. Therefore, when using a server-to-server integration, the prescribed method is to use the adapter URL for seamless and secure data exchange.