Pre-surgical diagnosis of thyroid carcinoma typically relies on biopsy or cytology. Fine needle aspiration (FNA) allows for cytological assessment. Depending on the sampling, FNA can accurately identify thyroid malignancy; however, in many cases, FNA findings are inconclusive. Several institutions, including Roswell Park Comprehensive Cancer Center, presently evaluate the tissue architecture and cellular component of thyroid nodules by performing core needle biopsy and smears. This method has been shown to generally have a lower non-diagnosis result rate, when compared to FNA. We propose that core needle biopsy pathology is more effective than fine needle aspiration cytology in identifying and properly classifying thyroid tumors. In a retrospective review of papillary thyroid cancer (PTC) cases at our institution, we found that pathology assessment of surgical samples agreed with pre-surgical characterization based on core needle biopsy 1.78-times more often than with pre-surgical fine needle aspirate cytology. Review of Tall Cell Variant (TCV) cases, which is particularly aggressive variant of PTC, demonstrated that core needle biopsies were 1.6-times more likely to correctly identify TCV cases pre-surgically. In this scenario, accurate pre-surgical diagnosis facilitates appropriate surgical planning – our practice is total thyroidectomy for TCV rather than lobectomy. Patients benefited from correct pre-surgical diagnosis in receiving a single surgery and prompt management of their disease.