To the Editor.
—WE read with interest the experience of Ramacciotti et al1 in selecting patients for thyroid nodule surgery by fine-needle biopsy as well as the editorial comments of Blum.2 Both concluded that a test that identifies five of 19 papillary, two of two follicular, and one of four medullary carcinomas as "benign" was not reliable as a single diagnostic tool. We agree that these results justify such a conclusion. However, our somewhat larger experience from 1,005 nodule operations and 474 cases of cancer studied between 1976 and January 1984 permit a different conclusion. None of 20 medullary, only three of 297 papillary, and only two of 104 follicular carcinomas were diagnosed as benign by fine-needle biopsy. These false negatives were all from our first 500 satisfactory biopsies from a total experience of more than 4,000. Four of the five false negatives by fine needle were correctly