Unable to determine from a needle asp. if i have cancer in thyroid nodule. whats next step?

Further biopsy: If there is a strong suspicion that cancer is present and the fine needle aspiration didn't show cancerous cells, then the physician may recommend a somewhat more signifciant biopsy procedure, where they make an incision in the skin over the area of concern and remove a larger piece of the nodule. If suspicion is low, then the physician may decide to wait with close follow-up.

Repeat it.: Apparently the next step is to repeat aspiration and then do a trial of suppression with follow-up in 3 months. Reaspiration, follow-up, and surgery would be done after that depending on whether the tumor is larger, smaller, or unchanged in size.

Options: You could rebiopsy. Maybe this time, also send out one tube for gene expression (molecular cytopath) to aid in the diagnosis. You could also go for surgery with biopsy taken while under anesthesia (frozen section) and proceed with total thyroidectomy if the intraoperative biopsy showed cancer. You could follow closely with ultrasound and rebiopsy if changes are seen with the nodule...