The chest, including the lungs, mediastinum and chest wall (consisting of the bony thorax and muscular soft tissues enclosed by the sternum, ribs and thoracic vertebrae), is one of the body parts most susceptible to lesions. Routine examinations include plain chest X-rays, and the use of chest CT examinations is becoming increasingly popular, so the chances of detecting chest lesions are greatly increased, which leads to the problem of differential diagnosis of lesions. For example, a lung shadow or mass can be a benign lesion such as pneumonia, tuberculosis, inflammatory pseudotumor, or granuloma, or a malignant lesion such as lung cancer, lymphoma, or metastatic cancer. Although the lesions can be differentiated to some extent based on the patient’s clinical symptoms (e.g., fever, cough, hemoptysis), imaging manifestations, and treatment regression, the final and most accurate diagnosis is the pathological and bacterial diagnosis. Bronchoscopy is a common test for diagnosing pulmonary lesions, but it is generally limited to central or bronchus-related lesions, which is painful and risky; percutaneous biopsy with image guidance is the most common and widely used interventional test for diagnosing chest lesions. The most commonly used and most widely used interventional test for the diagnosis of chest lesions is image guided percutaneous biopsy. The scope of application of percutaneous biopsy for chest lesions: lung shadow or mass, mediastinal space, pleural thickening or mass, mass or bone destruction in the bones or soft tissues of the chest. Under what circumstances should percutaneous biopsy of chest lesions not be performed? That is, contraindications mainly include: 1, poor general condition of the patient, consciousness or mental impairment, unable to cooperate or tolerate the examination; 2, difficult to correct coagulation dysfunction, such as hematological disease, platelets below 50,000/mm3, undergoing anticoagulation therapy, etc.; 3, severe emphysema, pulmonary alveoli, pulmonary fibrosis, pulmonary heart disease, severe cough, etc. Percutaneous puncture biopsy of chest lesions is usually performed under CT guidance, and some lesions can be punctured under X-ray fluoroscopy or ultrasound. Pre-operative preparation mainly includes: 1. routine blood and coagulation tests, if any abnormalities should be corrected; 2. stop taking antiplatelet and anticoagulant drugs such as aspirin, poliovirus and warfarin; 3. perform auxiliary tests such as ECG, pulmonary function, chest enhanced CT and PET/CT if necessary; 4. fasting from food and water for 2-4 hours before surgery. What is the accuracy of percutaneous puncture biopsy? It varies according to the size of the lesion, whether the sampling is satisfactory, the nature of the lesion and the experience of the pathologist. If the lesion is too small or the site is special (e.g. obstructed by ribs, scapulae, adjacent to large blood vessels of the heart, etc.), the risk and difficulty of the puncture will be significantly increased and the sampling may not be satisfactory, which will affect the accuracy of the diagnosis. In most cases, the diagnostic accuracy of puncture biopsy is above 90%. What are the risks associated with percutaneous aspiration biopsy? Percutaneous puncture biopsy is generally safe and can be performed on an outpatient basis. If there is no discomfort after the procedure, the patient can go home and rest. The main risks or complications include: pneumothorax and hemorrhage, which are the two most common and are usually self-limiting and do not require special treatment, while some patients may require intubation and drainage or hemostatic treatment. The cases of hemoptysis, asphyxiation, cardiac macrovascular injury, tumor implantation and metastasis, air embolism causing cerebral infarction or sudden death are very rare.