On ultrasound examination, the enlarged and asymmetric gland usually contains multiple solid nodules 1 to 4 cm large. Coarse calcifications may be present, as may areas of hemorrhage or necrosis. A solitary nodule found on clinical or scintigraphic examination has been considered more likely to be neoplastic than multiple nodules.5 On pathologic examination, however, half of clinically identified single nodules have proved to be dominant nodules of multinodular goiters.22 In another study,23 33% of patients undergoing surgical treatment for papillary cancer had coexistent benign nodules found intraoperatively. Therefore, multinodularity does not mean benign disease. Every nodule must be examined for its own ultrasonographic characteristics. As with the physical examination, if ultrasonography can identify a single dominant or more malignant-appearing nodule in a multinodular gland, FNA is directed to the more suspicious-looking nodule. A palpable or dominant nodule should particularly be suspect.