The increase in the accuracy of ultrasound diagnosis is due to the rapid development of ultrasound instruments and technology, the in-depth understanding of ultrasound doctors about diseases, and the tacit understanding of communication and cooperation between ultrasound doctors and clinicians. As a result, concepts such as ultrasound specialty VIP consultation rooms and precision diagnosis have emerged and proliferated. Of course, these are all trends, but also the real ultrasound elite to show their abilities, pay a rewarding platform. However, ultrasound precision diagnosis will have an end point, which is pathological diagnosis, ultrasound diagnosis can only be infinitely close to pathological diagnosis. Why? Ultrasound diagnosis, like X-ray, CT, MRI, etc., is a kind of imaging examination and diagnosis, which is a diagnosis given by an imaging physician after an imaging examination, based on what is seen in the imaging examination and combined with relevant disease information. Despite the rapid development of various ultrasonography diagnostic techniques (such as elastography, color Doppler imaging, B-flow imaging, three-dimensional imaging, ultrasonography, ultrasound fluorescence imaging, etc.), ultrasound has been developed to the level of molecular diagnosis, which has brought benefits to patients and provided an effective technical support for ultrasound accurate diagnosis. How far is ultrasound from pathology? However, the accuracy of ultrasound diagnosis can also be affected by a variety of factors, such as whether the imaging performance of the disease is typical, whether the diagnostic imaging physician has sufficient diagnostic experience and whether the patient’s own condition interferes with the imaging results. In ultrasound examination, there are often different ultrasound manifestations and features of the same lesion; and sometimes the same ultrasound manifestations and features often appear on different lesions, which determines that ultrasound diagnosis cannot achieve 100% clear diagnosis. In this sense, accurate ultrasound diagnosis is only a game for a few ultrasound elites, who should have solid knowledge of imaging, anatomy, physiology, biochemistry, pathology and corresponding clinical knowledge, as well as the grasp and identification of various disease features and imaging manifestations, and the process of forming ultrasound elites is also the process of continuous enrichment of their knowledge, accumulation of experience and rationalization of their thinking. Of course, accurate ultrasound diagnosis is only a relative concept, and no doctor can achieve 100%. For senior ultrasound doctors, the accuracy of this diagnosis is just higher, so it is advisable to stop being arrogant and impatient; for junior ultrasound doctors, there is great room for improvement in diagnostic accuracy by learning with an open mind and seeking advice. Therefore, one size does not fit all and there is no myth about the accuracy of ultrasound diagnosis. Currently, pathologists at home and abroad are called “doctor’s doctor” and consider pathological diagnosis to be the most reliable, the “gold standard” and the “final judgment” on diseases. It is the “gold standard” and the “final word” on the disease. However, pathological diagnosis also has limitations. Pathological diagnosis is only a diagnosis of what the clinician sends to the examination, relying on the pathologist as a group of doctors to observe and interpret the lesion tissue, which is essentially a process of subjective judgment and objective, closely related to the professional level and experience of the pathologist. Strictly speaking, pathological diagnosis is only infinitely close to the essence of the disease! Therefore, when pathologists make pathological diagnosis, in addition to careful pathological examination of the lesion tissues taken in a timely manner, they must also closely combine clinical diagnosis, imaging performance, pathological features, and if necessary, they need to dynamically observe and discuss with clinicians and imaging physicians, so that they can finally grasp the essence of the disease and get the correct pathological diagnosis! How far is ultrasound from pathology? Studies have shown that the accuracy of diagnosis made by clinicians through questioning and physical examination is between 50% and 60%, the accuracy after combining imaging and laboratory tests is between 70% and 80%, while the accuracy of pathological diagnosis is between 95% and 99.8%. It is clear that there is still a gap between the accuracy of pure imaging diagnosis and pathology diagnosis. As an ultrasonographer, when diagnosing a disease, one cannot diagnose only with images, as images can sometimes be deceiving. It is only by fully combining other imaging and laboratory tests, combining medical history, effectively communicating with clinicians and patients, and effectively applying solid clinical and ultrasound knowledge that ultrasound diagnostic results can be closer to the essence of pathology or disease. In the absence of more information or with insufficient knowledge and confidence, the ultrasonographer’s blind precision diagnosis will only increase the patient’s psychological burden and lead to “overly aggressive” treatment by the clinician, and may cause tension in the doctor-patient relationship. Of course, diseases with characteristic manifestations that can be clearly diagnosed, such as bile and kidney stones, liver and kidney cysts, hypertrophic cardiomyopathy, etc., cannot be diagnosed conservatively. Ultrasound can be closer or farther from the pathology, and it all depends on how the ultrasonographer investigates the nature of the disease, whether it is comprehensive or one-sided, whether it is serious, scientific or risky and fluky.