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In Reply.—We thank Dr Drevlow for his interest in our article. However, his concerns are unwarranted.
The decision to operate was made on the basis of all the available information, and the risks and benefits were discussed with the patient. With the current knowledge and state-ofthe-art in evaluating thyroid nodules, it would be poor practice to operate on every cold thyroid nodule. As this study was retrospective (as are most such clinical reports), randomization is not an issue.
We certainly object to the tone and implication in their questioning the calculations. Anyone familiar with fine-needle aspiration biopsy cytology should know that there are at least three categories of findings as follows: (1) benign, where the pathologist is fairly certain that there is no malignancy; (2) possibly malignant or indeterminate, meaning that the pathologist is unable to distinguish benign vs malignant with any certainty (most of these are follicular aspirates);
DWARAKANATHAN AA. Fine-Needle Aspiration Biopsy of the Thyroid-Reply. Arch Intern Med. 1990;150(11):2418. doi:10.1001/archinte.1990.00390220141040