The purpose of this study was to identify clinical and ultrasound (US) features of malignancy in patients using cytological results of follicular neoplasm (FN) in the thyroid. We followed 165 patients with cytology diagnosed FN and evaluated the final surgical histopathology outcomes in 114 patients between March 2006 and November 2008. Patient histopathology, age, sex, tumor size, and US characteristics and the color flow pattern of the lesions were analyzed and compared between benign and carcinomas. Twenty five (21.9%) of the 114 FN were found to be follicular carcinomas (FC); 15 minimally invasive FC, 4 widely invasive FC, and 6 FVPTC. Benign included 78 FA, 8 atypical FA, and 3 Hurthle cell adenomas. The incidence of malignancy was 31.8% (7/22) in men and 19.6% (18/92) in women (p=0.253); and it was similar throughout the different age (<45 vs. >45) and nodule size groups (<2 cm vs.>2 cm, <4 cm vs. >4 cm). The difference of shape, margin, the presence of a halo, internal content, and calcifications was not statistically significant (p value =0.05). In malignancy more frequent internal central color Doppler flow was present (p=0.030). Color Doppler flow pattern of FN with other clinicopathological factors should be carefully considered when predicting the malignant potential of FN.