The diagnosis of bone tumors is complicated and difficult because of the reality that “different images of the same disease and different diseases”. The correct diagnosis requires the combination of clinical, imaging and pathology. Among them, pathological diagnosis plays a key role in the selection of treatment plan. Puncture biopsy is the main way to obtain pathological diagnosis. Obtaining certain pathological tissues for qualitative and etiological diagnosis by puncture biopsy before treatment is of great importance for the selection of treatment plan and evaluation of efficacy. For example, 1 patient with a final diagnosis of osteosarcoma. Without preoperative biopsy, 1. preoperative neoadjuvant chemotherapy cannot be administered, and the efficacy of preoperative chemotherapy cannot be evaluated, and there will be no basis for the selection and adjustment of postoperative chemotherapy regimens. 2. intraoperatively, if rapid pathology cannot be diagnosed for various reasons, then the choice of the correct surgical approach will be affected, which means that the first ray of hope for life is lost. Therefore, puncture biopsy has a very important significance for the diagnosis, treatment and prognosis of bone tumors.