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.3,4 In this issue of the Archives, Ramacciotti et al5 report on the accuracy and use of aspiration biopsy and extend the initial data from Gershengorn et al6 on
See also p 1169.