Due to its accuracy and limited invasiveness, ultrasound (US)-guided fine needle aspiration biopsy (FNAB) is universally considered the pivotal diagnostic technique in the management of thyroid nodules. Procedural tricks and technical devices may vary across different institutions, giving raise to minor differences in the diagnostic performance of FNAB. Verbal and non-verbal communication skills of the medical staff may also contribute to a successful maneuver by reducing the patient’s anxiety. Besides, the cross talk between the referring clinicians and pathologists is fundamental to enhance the quality of FNAB results. In the last decade, core needle biopsy (CNB), traditionally confined to a complementary role to FNAB in a limited number of clinical settings, has been proposed for a more extensive use in the work-up of thyroid nodules.