Large-needle thyroid biopsy: still necessary.

: Fine-needle aspiration and large-needle biopsy allow 87% of patients with nodular thyroid disease to avoid operation. We have been concerned that fine-needle aspiration used alone will miss a significant number of follicular neoplasms. Between January 1980 and April 1985, 46 patients had fine-needle aspiration, large-needle biopsy, and thyroidectomy, and the preoperative biopsy specimens suggested or the postoperative pathologic findings confirmed a follicular neoplasm. Seventeen patients had a thyroid carcinoma. All 17 patients also had hypercellular large-needle biopsies, but only nine of these patients had a fine-needle aspiration suspicious of malignancy (p = 0.0078). The inability of fine-needle aspiration to detect a significant number of thyroid cancers emphasizes the need to concomitantly perform large-needle biopsies in all acceptable cases.