Ultrasound (US)-guided fine-needle aspiration biopsy (FNA) was performed on 268 thyroid nodules (135 palpable, 133 nonpalpable) in 210 patients with various thyroid conditions; 62 nodules also had palpation-guided FNA. Surgical pathology was obtained in 67 malignant nodules and 32 benign nodules. Although the initial failure rate for palpation-guided FNA (12 of 62) was significantly higher than that for US-guided FNA (10 of 268) (p < 0.001), sensitivity (96%), specificity (91%), accuracy (94%), and positive (96%) and negative predictive values (91%) of US-guided FNA for malignancy (n = 99) were not significantly different from those (88%, 90%, 88%, 95%, and 75%, respectively) of palpation-guided FNA (n = 34) for those nodules where an adequate biopsy was obtained. US-guided FNA established a correct diagnosis in 20 of 22 patients with nonpalpable malignancy and in another nodule in the opposite thyroid lobe in 16 of 17 patients with thyroid malignancy. This procedure determined the correct cancer staging in 19 of 21 patients. US-guided FNA can reliably (1) select a patient who needs surgery and (2) avoid unnecessary surgery. This technique will help determine a cancer staging and institute an appropriate treatment.
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