Not all hepatitis B virus infected patients need to undergo liver puncture. Whether to undergo liver puncture should be considered according to the patient’s age, hepatitis B virus quantification, liver function and “major and minor triple positive”, etc. For chronic hepatitis B virus infected patients, if the liver function is persistently or repeatedly abnormal, they should consider undergoing liver puncture, especially if their liver function is greater than 1000 copies/ml. For chronic hepatitis B virus infected patients, no matter “major or minor triple positive”, if the liver function is persistently or repeatedly abnormal, and the viral quantification is more than 1000 copies/ml, liver puncture should be considered, especially for those patients who are going to receive interferon antiviral therapy. The vast majority of patients who have a liver puncture biopsy are ready to start interferon antiviral therapy. So, is there no need for a liver puncture when the liver function is normal? In this case, the decision depends on the quantification of the hepatitis B virus, the e-antigen status and the age of the patient. If the patient is “minor triple positive”, positive for hepatitis B virus, older than 40 years of age, and has an ALT level at the high end of the normal range, liver puncture should be considered, as this group of patients may have underlying hepatitis activity. It is important to note here that liver puncture is not necessary in patients who have already been diagnosed with cirrhosis or who already have more evidence supporting cirrhosis. Are the results of a liver puncture the “gold standard” for diagnosing liver disease? Imaging and serology have their own advantages in diagnosing liver disease and can reflect the extent of the disease from different perspectives. As far as current diagnostic methods are concerned, the results of liver biopsy, i.e. liver histology, are the most reliable for the diagnosis of liver diseases. Therefore, many people regard liver puncture biopsy as the “gold standard” for diagnosis. However, even if it is the “gold standard”, it is only relative, because the specimen taken out by liver puncture is very small, usually 1-2 cm long, which is about 1/200000000 of the weight of the whole liver. The distribution of the lesions in chronic liver diseases is not uniform, so sampling errors may occur. In patients with cirrhosis, due to the heavy degree of liver fibrosis, it is possible that only the liver parenchyma is taken during the puncture operation, while the fibrous tissue is missed, resulting in the missed diagnosis of cirrhosis, which is about 20%. What are the contraindications to liver puncture? People with bleeding tendency, such as hemophilia, platelet less than 70×109/L, and prothrombin activity (PTA%) <50%, are the main contraindications to liver puncture; other contraindications include severe jaundice, large amount of ascites and so on.