The Diagnosis of the Thyroid Nodule Using Aspiration Biopsy and Cytology

We are in a fortunate position when treating patients with a thyroid nodule because most nodules are benign and thyroid malignant neoplasms are of low virulence. Several issues in the diagnosis of these nodules are widely accepted: (1) some patients have certain features that are associated with a higher than average risk of thyroid cancer¹; (2) these factors can sometimes be identified by history, physical examination, and the response of the nodule to suppressive therapy¹,²; (3) most cancers are nonfunctioning ("cold") on radioactive isotope scan³; and (4) fine-needle aspiration for cytologic examination is safe and the most cost-effective way to select for probable malignant neoplasms among the large population of thyroid nodules.³,⁴In this issue of theArchives, Ramacciotti et al⁵report on the accuracy and use of aspiration biopsy and extend the initial data from Gershengorn et al⁶on See also p 1169.