I have been aspirating palpable “lumps and bumps” for over 30 years and also interpreting aspirates performed by radiologists, endocrinologists, and other physicians; the last 9 years performing mostly thyroidal aspirates. What follows is based on my reflections and on the insight developed into the particular problem of thyroid nodules. We have to understand the limitations of fine needle aspiration (FNA) of thyroidal lesions. FNA is a diagnostic tool. Tools only work if they are handled properly. The five most important things I have learned in all these years are: (1) the role of the aspirator is crucial, (2) the technique is deceptively simple, (3) you have to have a team, (4) communication with the referring physician is essential, and (5) you have to persist.

THE ROLE OF THE ASPIRATOR IS CRUCIAL

I cannot overemphasise this premise. I believe that this still is overlooked in the literature. Frequently I read about how important it is to have an experienced cytopathologist interpreting the smears. The cytopathologist is only as good as the sample he obtains or receives. You can have the best cytopathologist in the world and he will not be able to diagnose your patient’s nodule accurately if you only aspirated blood. Remember, that to acquire experience you must perform a sufficient number of aspirations. How many is enough? Only you will know. Also, you have to be self critical, and you must be a life-long learner. After 30 years I am still tinkering with my technique and getting better. In the last 9 years at the Washington Hospital Center I have aspirated over 10 000 patients (92% thyroids). There is a positive relation between “procedural experience” and outcomes. This is not restricted to FNA.

THE TECHNIQUE IS DECEPTIVELY SIMPLE

Again, I want to reiterate that not many “aspirators” realise that it is not only a matter of inserting a needle. The backbone …