One is an imaging test and the other is a surgical operation plus pathology. There is no comparison between the two, but a puncture biopsy is the gold standard for the diagnosis of thyroid nodules. For example, patients with multiple nodules can be screened with ultrasonography to see which nodule is most likely to be malignant and selectively biopsied by puncture, or nodules with strong or weak echogenicity can be evaluated with ultrasonography to determine which part of the puncture may be more significant. Ultrasonography is a method that reflects the overall perfusion of the nodule and is more accurate than 2D in assessing the nodule’s status, especially when the nodule is large and bleeding forms a hematoma in the nodule, which slowly absorbs over time and then consolidates and appears to be a low-grade nodular lesion, which often appears malignant on ultrasound. This can be judged by ultrasonography. If there is no blood supply inside, it means that there is no active tissue inside, and then it can be considered that the hematoma has formed a state of consolidation after absorption. The few tissues removed by puncture biopsy must be examined pathologically, as pathology is the most accurate method to determine the nature of the nodule.