FNA cytology is often reported as follows: 1. Benign (seen in 70-75% of cases) This indicates that the nodule is a benign lesion that may be due to inflammation (thyroiditis), glandular secretory dysfunction (glial nodules), irregular glandular growth (“proliferative”), or cystic lesion (fluid at the periphery of the nodule). 2. Malignant (seen in 4-7% of cases) This means that the nodule is cancerous and includes several different types of thyroid cancer. The most common is “papillary cell carcinoma”, followed by “follicular cell carcinoma” and, less frequently, “medullary thyroid carcinoma” and “undifferentiated thyroid carcinoma”. “3. The nature of the nodule cannot be determined, often because the tissue removed contains too few thyroid cells or because a large number of blood cells are seen due to bleeding (seen in 1-10% of cases). In this case, the nodule may be benign or malignant in nature; however, this does not mean that it is benign (not to be confused with benign), and if necessary, another FNA may be repeated at a later time, or the specialist may decide whether to proceed directly to surgery. Most endocrinologists believe that 6-8 months of thyroid hormone suppression followed by a repeat FNA is more appropriate in this case, and that a second expert opinion, with another cytopathologist reviewing the smear for thyroid disease, may be more definitive in the diagnosis. If the diagnosis is “follicular neoplasm”, nearly half of the smears may be cancerous (follicular cell carcinoma) and should be treated surgically. The accuracy of FNA depends on good specimens obtained by FNA and the sophistication and experience in microscopic examination of cell smears. In addition, it may not be possible to detect small foci such as paranodal or intra-nodal cancers. Therefore, FNA is not a 100% perfect and accurate technique.