AbstractA definitive preoperative diagnosis is not readily available for the majority of patients with an enlarging thyroid gland or nodule, but thyroid needle biopsy yields an immediate, safe, and accurate histopathologic diagnosis. In a review of 460 patients having thyroid needle biopsy at the Cleveland Clinic from 1967 to 1976, sufficient biopsy material was available for diagnosis in 410 patients. In 44 patients operations were performed for benign disease for a variety of reasons. In 23 patients operations were performed for thyroid malignancy; in 14 of the latter group the diagnosis was made by needle biopsy and confirmed surgically. Of 9 other patients operated on for thyroid malignancy, 6 had thyroid surgery because needle biopsy showed a follicular neoplasm in which malignancy could not be ruled out, and in the remaining 3, clinical findings and the hypercellular nature of the biopsy prompted operation. In an additional 9 patients thyroid malignancy was diagnosed by needle biopsy, but no operation was performed (1 because of age and prohibitive cardiac risk, 2 because the cancer was metastatic to the thyroid from a separate primary, and 6 because the neoplasms were lymphoma or small cell undifferentiated carcinomas that were treated by radiotherapy). There were 3 complications in 460 biopsies (transient recurrent nerve palsy, hematoma, and local discomfort), all of which were short‐lived and minimal. The true value of needle biopsy was that 393 patients with benign disease were spared unnecessary surgery. After a quarter century of experience with this technique, the authors propose that needle biopsy be used more often to eliminate the mortality, morbidity, and significant cost of unnecessary thyroid surgery, and the uncertainty and expense of less accurate diagnostic methods.