['The aim of this study was to assess the malignancy rate in patients with Hürthle cell metaplasia (HCM) on fine-needle aspiration biopsy (FNAB).', 'The pathology results of patients with benign colloid (BC) and HCM on FNAB were compared using a prospective database.', 'One hundred fifty-three (65%) patients had BC on FNAB, and 82 (35%) had HCM. The mean nodule size was similar in both groups (25 ± 2 mm vs 26 mm ± 2 mm, P = .83). Malignancy was identified on the final pathology report in 21 (14%) versus 13 (16%) patients in the BC and HCM groups, respectively (P = .66). Of the patients with malignancy, the tumor was determined as microcarcinoma in 76% in the BC groups versus 85% in the HCM group (P = .48) and as incidental in 71% versus 85% (P = .39).'] Is hürthle cell metaplasia on fine-needle aspiration biopsy by itself an indication for thyroid surgery?