The primary purpose of FNA biopsy is to identify benign nodules and avoid unnecessary surgery. Numerous reports confirm that the introduction of FNA reduces thyroid operations by 25% and increases the yield of carcinoma from 14% to at least 30%. With an improvement in surgical selectivity, the yield of carcinoma has significantly increased, and the impact of FNA on thyroid practice has been substantial. The economic impact of FNA biopsy is also considerable and makes this test a useful and cost-effective procedure. Our approach to a patient with nodular thyroid disease is outlined in Figure 1. This scheme rests on thyroid cytology, and FNA biopsy is used as the first diagnostic test. When an experienced clinician performs the aspiration and an experienced cytopathologist reviews the slides, the accuracy of the technique is better than 90%. In agreement with recent FNA series, we believe that FNA biopsy is a safe and reliable procedure and that complications are extremely rare. On the basis of our experience, its continued use as the first step in the diagnostic management of thyroid nodules seems justified.