To the Editor.
—Werk et al1 have appropriately pointed out the inefficiency of the clinical selection of nodules for surgery in a community hospital. The 6.5% cancer in excised nodules compares unfavorably with our finding of 55% cancer in 861 nodules excised because of needle biopsy findings. (These figures are a 1984 update of those already published.)2 From these figures, we estimate eight times as many operations are required to remove the same number of cancerous nodules when clinical evaluation instead of needle biopsy is used to select surgical candidates. Contemplation of the economic consequences and patient morbidity of failing to use needle biopsy encourages us to repeat our published suggestion; if a hospital staff does not have the capability of obtaining satisfactory needle biopsy data, it should not be doing elective surgery on thyroid nodules.3 It would be safer, and far less expensive, to send patients