Many people who have experienced hospital visits have heard, seen and even experienced “puncture biopsy”. It is not surprising that some people are afraid of these four words and are resistant to them, mainly because they do not know much about them yet. As a modern, minimally invasive medical technique, people will encounter it more and more in the future. Simply put, puncture is the use of a medical instrument with a needle-like shape to penetrate through the patient’s skin or the inner surface of a natural body cavity (such as the stomach, rectum, vagina, etc.) and into the target to be reached, which may be a natural structure of the body or a lesion. In everyday medical practice, puncture is a very frequently used technique, such as giving a patient an intramuscular “shot” to inject a drug, giving a patient a needle in a vein to draw blood for a test or an infusion, etc. All of these procedures are punctures. In ordinary daily life puncture is also often seen, sewing clothes, nail buttons, shoe soles, which can not be separated from the needle puncture! Obviously, the needle tool is the core tool necessary to implement and complete the piercing operation, collectively known as the piercing needle. Puncture needles are long and short, thick and thin, straight and curved, hard and soft, single-layer, there are also multi-layer casing type (as the arm outside the sleeve, outside the sleeve with a protective sleeve, called Troca in English), what kind of puncture needles are used, depends entirely on what kind of puncture purpose. By puncturing the needle tip to reach the target, if the target area is pus then the pus can be aspirated, if it is fluid then the fluid can be drained, if it is bile then the bile can be guided out, if it is urine then the urine can be released …… If it is a tumor, then the internal components of the tumor can be removed and sent for relevant examination, and biopsy is exactly such an operation. It is not difficult to understand that diagnosis is the front stop of treatment, and clear and correct diagnosis is the basis of all medical work. Diagnosis can be divided into clinical diagnosis (based on the symptoms and signs exhibited by the patient), laboratory diagnosis (based on the test results of blood, urine, stool and other samples), imaging diagnosis (based on what is seen in ultrasound, CT, MRI, isotope imaging, etc.), and pathological diagnosis (based on the structure of focal tissue or fragments under the microscope). The pathological diagnosis is the “Supreme Court decision” in medical diagnosis! Although occasionally wrong, it is the most authoritative and the final decision that is adopted. Pathological diagnosis must first obtain the tissue composition of the lesion, otherwise it is difficult to cook without rice even with high-end pathological examination equipment and a highly skilled pathologist! Histopathological examination of biopsies (biopsies for short) is an important advance in modern pathology. After the birth of microscope technology, people used it for a long time to study the histopathological anatomy of dead (cadaver) (referred to as autopsy), and after the development of surgical science people could obtain the tissue material they wanted in the surgically cut specimens, make pathological sections, and observe its cellular and tissue characteristics under the microscope, thus gradually forming surgical pathology, which is still the main form of pathological diagnostics. As therapeutics became more subdivided and integrated, the concept of biopsy was born out of the desire to know the pathological nature of the patient’s disease before surgery, so that a more precise treatment plan could be developed and the level of individualized treatment (tailored treatment) for the patient could be improved. Therefore, it can be said that biopsy is a pre-treatment pathological diagnosis method in which the diseased tissue is still in the patient’s body. Biopsy by surgical excision of a small portion of the lesion (excision for short) was prevalent for some time, but due to many drawbacks such as being more invasive and cumbersome, it was soon discovered that this method should be replaced by a minimally invasive and convenient technique. This technique is the puncture biopsy! The key to successful and safe puncture biopsy is whether the tip of the puncture needle enters the lesion accurately and avoids important structures such as blood vessels, trachea, esophagus, and intestine, in other words, the location of the needle tip must be well known. In the early stages, puncture biopsy relied on the doctor’s knowledge of anatomy and the touch of the hand for positioning, and the doctor’s visual observation (seeing is believing) was almost useless, so this kind of puncture was also called “blind puncture”. However, there are individual differences in physician knowledge and technique, and even the same physician may not be able to achieve accuracy in every case for different patients, because the patient’s anatomy is subject to variation, so the disadvantages of “blind puncture” are obvious. According to physicians who have had the experience of “blind puncture”, the time of puncture is “frightening” and afterwards “haunting”. Since the popularization of ultrasound, X-ray CT, MRI and other imaging technologies, image-guided puncture techniques have developed rapidly, and the puncturing physician has regained the objective guidance of “seeing is believing”, and the images help physicians extend their vision into the details of the lesion. Ultrasound-guided biospy allows for dynamic monitoring, precise positioning, accurate puncture, and quick and easy operation. Superficial organs or lesions such as thyroid, breast, and superficial lymph nodes are areas where the excellent spatial resolution of high-frequency ultrasound plays an advantage, so ultrasound-guided puncture biopsy has become the most common method for preoperative pathological diagnosis of thyroid, breast, and lymph node tumors. It is possible that some medical institutions or some physicians still use “blind” biopsy, but this is undoubtedly a practice that should be abandoned as soon as possible, and image guided aspiration biopsy should be learned, mastered and advocated as soon as possible. Depending on the diameter of the puncture needle and the shape of the specimen obtained, puncture biopsies can be divided into coarse and fine needle aspiration, corresponding to histological and cytological diagnosis, respectively. Generally speaking, coarse needle aspiration can obtain formed, large tissue strips for histological diagnosis, while fine needle aspiration obtains mostly small tissue particles for cytological diagnosis. Histological diagnosis by coarse needle aspiration is abbreviated as CNB (core needle biopsy), while cytological diagnosis by fine needle aspiration is abbreviated as FNA (fine needle aspiration). Since CNB obtains not only the main cellular composition of the focal tissue, but also the interstitial components, it can provide a wealth of diagnostic information, while FNA obtains mainly clusters of cells, the number of which is much smaller than that of CNB, and the diagnostic information provided is mainly focused on characteristic cells. Therefore, it is best to be able to do CNB under strict control of trauma. However, in an organ with a rich blood supply such as the thyroid, the risk of bleeding due to coarse needle aspiration must be taken into account, so fine needle aspiration cytology (FNA) has a broader arena for thyroid tumor aspiration biopsy. Whether CNB or FNA, as long as the puncture is invasive, there is a theoretical risk of tumor cell shedding and dissemination along the puncture needle tract. In response to this problem, the manufacturing process of puncture needles has been continuously improved, such as making the needles thinner and thinner and the surface of the needles smoother and smoother, with the aim of minimizing the shedding and dissemination of cells as much as possible. The view that puncture operation will not cause tumor cell shedding and spreading is not scientific and not realistic. However, will tumor cell shedding and dissemination necessarily cause tumor metastasis in the puncture needle tract or even further away? The answer is that, although not absolutely not, for papillary thyroid cancer and follicular carcinoma, the chance of metastasis caused by puncture is negligible. This conclusion is not a figment of the imagination, but the result of a huge sample size counted worldwide over many years, a retrospective study that is very convincing! The metastasis of tumor cells is a very complex process involving many factors. Many tumors have metastasized distantly when first detected, while many tumors have not metastasized even after one or two decades of follow-up after puncture. Therefore, we should not only pay attention to the research of puncture products and technical techniques that can reduce metastasis, but also not hold back or even take individual cases or small probability events to negate or even hinder this minimally invasive diagnostic technology whose benefits far outweigh the disadvantages because of the fear of metastasis. For breast cancer, a tumor with relatively high malignancy and poor prognosis, puncture biopsy is also beneficial for timely determination of diagnosis, neoadjuvant chemotherapy, endocrine therapy, etc. An artificial tunnel needle protection method can be used, in which a protective trocar needle is prepositioned within the subcutaneous tissue at the skin puncture site and tumor margin, and the biopsy needle is completely passed through the tunnel protection needle for puncture operation, so that the tumor cells are mainly shed to the tunnel protection needle, and the removal of the protection needle can minimize cell shedding and dissemination on the puncture needle tract. Prostate cancer is also a tumor of relatively high malignancy, and puncture biopsy is recognized worldwide as a necessary part of the diagnosis of prostate cancer, and it is almost always a coarse needle puncture, with as many as one or two dozen needles, which can be considered the king of puncture biopsy needles in the whole body, but urologists are not only not resistant to prostate biopsy, but are also exploring more needles and larger specimens. This is the reason why the criticism of puncture biopsy, especially fine needle biopsy, for papillary thyroid cancer, which has a better prognosis, is worthy of criticism!