Breast tumors are divided into two categories: benign tumors and malignant tumors. Benign tumors are less harmful to human body, with fibroadenoma accounting for the most, and surgical excision is the completion of all treatments. Surgery is only one aspect of standardized treatment. Surgery alone without other treatments is not enough, but also requires chemotherapy, radiotherapy, endocrine therapy, targeted therapy, biological therapy, etc. At the time of initial diagnosis, benign lesions are considered, and the possibility of malignant lesions is very small, so puncture biopsy is not recommended. Because the pathological result of the puncture biopsy is benign or requires surgical excision, it is more reasonable to make a curved cosmetic incision around the areola to remove the tumor directly (almost all lesions on the breast can be removed through this cosmetic incision) and send it for pathological examination after excision. In this way, the tumor is removed at the same time as the diagnosis, and there is no need to perform a puncture biopsy first to add psychological and financial burden to the patient. If malignant lesions are considered at the time of initial diagnosis, there are two types of treatment: firstly, if they are malignant and need neoadjuvant treatment before radical surgery (that is, chemotherapy before surgery), these patients need to undergo puncture biopsy first; secondly, if they are malignant and do not need any other treatment before radical surgery, these patients can directly undergo tumor excision biopsy and choose further surgery according to the biopsy results. The second category is those who are malignant and do not require any other treatment before radical surgery. As we learn more about breast cancer, most patients with primary breast cancer will fall into the first category, which is chemotherapy followed by radical surgery, the rationale for which will be discussed in a separate article. So can we be more specific to distinguish these two cases? In fact, the clinical judgment based on experience has a large error, and generally, those with large masses and palpable enlarged axillary lymph nodes on the affected side are treated with puncture biopsy first (category I). In contrast, patients with smaller or even small swellings who are not sure of accurate puncture of the swelling should opt for surgical excisional biopsy as much as possible, and these patients often do not require neoadjuvant therapy either (category II). In practice there are many other special cases, regardless of the choice of biopsy modality, the choice of biopsy is the right decision, biopsy pathology is the gold standard for the diagnosis of malignant breast disease. Biopsy pathology is the gold standard for the diagnosis of malignant breast disease. With the principle of trusting the doctor and trusting the physician, and with the principle that the patient’s medical benefit comes first, the patient will be able to choose the most suitable and individualized medical treatment.