Puncture biopsy to obtain pathological diagnosis is the gold standard for the diagnosis of pancreatic cancer, which should be evaluated objectively: I. Puncture methods: 1. Intraoperative puncture: done by surgeons. This technique has not been applied for a long time, and only a few tertiary hospitals in China have this equipment, and for those doctors who have newly learned this technique, their operation technique still needs to be improved. Generally speaking, intraoperative puncture or biopsy is more targeted and has a higher success rate, while ultrasonic endoscopic puncture biopsy may not take tumor tissue. In foreign countries, ultrasound endoscopic pancreatic puncture usually has a pathologist on site to do pathology, and whether the amount of puncture can meet the diagnostic requirements is also determined by the pathologist, and it is not uncommon to see dozens of needles even to diagnose. In China, the punctures are mostly performed by endoscopists, who are not accompanied by pathologists, and often do not take enough material because of the fear of complications. Due to the small amount of puncture samples, most of the puncture diagnosis is based on cytopathology, which requires a high level of pathologists, and in this regard, there is a large gap between China and foreign countries. Whether it is pancreatic cancer or pancreatitis, pancreatic hypertension exists to varying degrees, and the probability of pancreatic leakage in patients with pancreatic hypertension is quite high, and pancreatic leakage further increases the difficulty of pancreatic disease diagnosis and treatment. If there is no or only mild pancreatitis, the puncture needle should focus on the enlarged lymph nodes around the pancreas or the parenchymal part of the mass in the pancreas, avoiding the edematous pancreatic tissue as much as possible. 2, combined with more severe pancreatitis or pancreatic duct dilatation, it is best not to puncture, wait for the pancreatitis to remit according to the first above puncture. 3, after conservative treatment, the patient has survived for more than 1 year, the condition is stable, and there are no obvious symptoms, only to clarify the diagnosis and puncture, for this group of patients, I personally think it is best not to puncture.