Why is it necessary to have a puncture first when a thyroid nodule is found? Thyroid nodules are a common clinical condition with an incidence of 20% to 76%, of which malignant nodules account for 5% to 15%. For malignant thyroid nodules, early detection, early diagnosis and early treatment should be done. At present, high-frequency ultrasonography can diagnose thyroid nodules with a diameter of 2 mm or more, and has a high reference value for determining the benignity and malignancy of nodules. However, the final criteria for determining the benignity and malignancy of thyroid nodules depends on the pathology results, and the gold standard for preoperative diagnosis of benignity and malignancy of nodules is a puncture biopsy pathology. Thyroid puncture biopsy: Thyroid puncture biopsy refers to the insertion of a hair-thin needle into the thyroid nodule through the skin under the real-time guidance and monitoring of ultrasound to take the cells or tissues from the lesion, and then place the removed cells or tissues under a high-powered microscope to observe their morphology and structure and determine their benignity or malignancy. This puncture sampling operation is precise, safe, less traumatic and less painful. The importance of preoperative thyroid puncture biopsy: A standardized procedure for the diagnosis and treatment of thyroid nodules should be as follows: imaging (including ultrasound, CT, MRI, etc.) reveals that the thyroid nodules may be malignant, and then a puncture biopsy pathology is performed to determine the benignity or malignancy of the nodules. If the pathology results suggest that the nodules are malignant, then further treatment is needed, such as the choice of open surgery, or even some early tiny malignant nodules can choose minimally invasive ablation treatment. Imaging is only a chance diagnosis, commonly understood as looking at the “look” of a thyroid nodule to guess whether it is benign or malignant, and the accuracy of guessing is higher for experienced doctors and lower for less experienced doctors. For these nodules that are suspected to be malignant on imaging, what will be the consequences if they are not biopsied before surgery and are operated on directly? The consequence is that a large proportion of patients have been opened for “wrongful surgery” because the pathological examination results are benign after the lesion is opened, and there is no need for surgery. For example, a thyroid nodule with an ultrasound grade of 4 (ACR2017 grading standard) has a probability of malignancy of 5-20%, which means that of 100 patients with such ultrasound images, only 5-20 of them are malignant, and if you see a nodule with an ultrasound grade of 4 and go for an operation, then maybe 80-95 of them with benign nodules will be opened ” wrong knife”. Therefore, it is necessary to clarify the benignity and malignancy of thyroid nodules through preoperative puncture biopsy pathology, and to develop further treatment plans based on the pathology results, which is a responsible attitude towards health. The biopsy is basically non-invasive, and there is no difference between the usual blood tests, the cost effectiveness is the best, the results out of the target, even if malignant, but also to do preoperative planning according to the pathology of surgery or ablation, not to open a large knife or open a small, but also to make up for the knife.