Purpose: Fine-needle aspiration (FNA) cytology, a standard method for thyroid nodule diagnosis, cannot distinguish between benign follicular thyroid adenoma (FTA) and malignant follicular thyroid carcinoma (FTC). Previously, using expression profiling, we found that a combination of transcript expression levels from DDIT3, ARG2, C1orf24, and ITM1 distinguished between FTA and FTC. The goal of this study was to determine if antibody markers used alone or in combination could accurately distinguish between a wider variety of benign and malignant thyroid lesions in fixed sections and FNA samples. Experimental Design: Immunohistochemistry wasdoneon27FTA, 25FTC,and75otherbenign and malignant thyroid tissue sections using custom antibodies for chromosome 1open reading frame 24 (C1orf24) and integral membrane protein 1 (ITM1) and commercial antibodies for DNA damage^inducible transcript 3 (DDIT3) and arginase II (ARG2). FNA samples were also tested usingthe sameantibodies.RNA expressionwasmeasuredbyquantitative PCRin 33thyroidlesions. Results: C1orf24 and ITM1antibodies had an estimated sensitivity of 1.00 for distinguishing FTA from FTC. For the expanded analysis of all lesions studied, ITM1 had an estimated sensitivity of 1.00 for detecting malignancy. Because all four cancer biomarkers did well, producing overlapping confidence intervals, not one best marker was distinguished. Transcript levels also reliably predicted malignancy, but immunohistochemistry had a higher sensitivity. Malignant cells were easily detected in FNA samples using these markers. Conclusions: Weimprovedthis diagnostic testbyadding C1orf24 and ITM1customantibodies and showing use on a wider variety of thyroid pathology.We recommend that testing of all four cancer biomarkers now be advanced tolarger trials. Use of one or more of these antibodies shouldimprove diagnostic accuracy of suspicious thyroid nodules from both tissue sections and FNA samples.