Aspiration biopsies were performed on 1536 patients with goiter who showed scintigraphically "cold" nodules. Twelve among them had clinical and cytological positive diagnosis. The remaining 1524 patients had aspiration biopsies without suspicion of the malignant nature of their goiters. Among them, 45 patients had a positive or suspect cytological diagnosis. Fourteen had not been yet operated on. Thirty-one were operated on and 28 malignancies were confirmed histologically. In three patients, cytological diagnosis was false positive. The remaining patients were cytologically negative. Thirty-seven were operated on and four false negative cases were found. The application of aspiration biopsy on every patient with a cold thyroid nodule resulted in the detection and very early diagnosis of clinically unsuspected thyroid neoplasms, the great majority of which were confined to the gland itself without metastatic spread. This fact makes the prognosis better. In addition, it is probable that the early detection of differentiated thyroid neoplasms and their surgical ablation interrupt their natural course towards anaplastic carcinoma, with its grim prognosis. Cancer 45340-344, 1980. OITER IS USUALLY a benign, hyperplastic, or in-G flammatory enlargement of the thyroid gland, which, if not excessively large or hormone-producing, does not warrant therapeutical measures and has little influence on general health status. About 2.5% of all new goiters, however, are malignant thyroid neoplasms, requiring a different therapeutic approach and prognosis. A reliable and sure diagnostic differentiation between a usual hyperplastic or inflammatory goiter and a malignant goiter is needed to evaluate each case. Unless metastasis or local extension is evident, no purely clinical means exists to confirm or exclude car-cinoma of a thyroid nodule.5 Therefore, the patient with thyroid neoplasia in an early phase can be mis-diagnosed and/or overlooked. Only a histological diag
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