Some patients believe that since the ultrasound suggests 4B, they can just have surgery and not have to have a puncture. This is not true.
It is always recommended to have a puncture. This is because a thyroid nodule with an ultrasound report of 4B has about a 60% chance of being malignant. The B ultrasound is a relatively subjective test, and the same condition may be described differently by B ultrasound doctors with different experience, and will have different reference value for clinicians. Therefore a puncture is also needed for further clarification.