Hepatic aspiration is the common term for liver puncture biopsy, which involves the use of a very fine needle to puncture the liver and obtain a small specimen of liver, which is then examined under a microscope by an experienced pathologist after various stains. Pathology is the “gold standard” of liver disease diagnosis and is the most reliable method of diagnosis. For hepatitis B virus carriers, a liver aspiration can tell if the blood test is normal but there is a slight inflammation inside the liver. However, since liver aspiration can be damaging to the patient and expensive, not all hepatitis B carriers need to have it. Only the following two cases need liver puncture: 1. Patients with positive HBV DNA and elevated transaminases (ALT or AST) but less than 2 times the upper limit of normal should have liver puncture. These patients have abnormalities in blood liver function tests but do not yet meet the criteria for antiviral therapy. Liver puncture is recommended because it will also include a small number of patients who have a high degree of liver inflammation and fibrosis, but who do not have significant elevations on liver function tests. Liver puncture to screen the portion of people who need treatment is an effective means to prevent them from progressing to cirrhosis or liver cancer. 2. Hepatitis B virus carriers with positive HBV DNA and consistently normal transaminases should have liver puncture during the age of 30-40 years. Those who have persistently normal transaminases (checked once every 3 months) and are >30 years old, especially those with a family history of cirrhosis or liver cancer, are recommended to undergo liver aspiration biopsy to clarify liver fibrosis in order to know whether antiviral treatment is needed.