FNB can be as good as you make it, and vice versa. Most worrisome to physicians and patients is the false negative diagnosis. The stringent criterion that I have advised for adequate sampling to exclude cancer can reduce the potential for false negative diagnoses to about 1%. Specific FNB tissue diagnoses provide the best guidelines for management decisions on when to operate and what operation to perform. However, each institution must generate its own FNB statistics. Management of follicular neoplasms requires integration of FNB findings with clinical features that relate to the probability of cancer and the risks thereof as well as the risks of operation. When FNB provides inadequate numbers of benign-appearing cells to exclude malignancy, unless there are compelling clinical features suggesting cancer, it may be suitable to observe as long as the course and subsequent FNBs fail to suggest cancer.