Background: It is well known that resistance to lamivudine commonly develops during the treatment of hepatitis B virus (HBV) infection; therefore, the detection of lamivudine-resistant mutants is of clinical importance.Methods: Serum samples from HBV-infected patients were analyzed for HBV mutations associated with lamivudine resistance (eg, YMDD) using PCR pyrosequencing assay. Results: We found that pyrosequencing had a detection limit of 20% mutant (MUT)/(MUT+ wildtype [WT]) in serum samples. Its sensitivity and specificity in the identification of YMDD mutations was 100% and 90%, respectively, and the accuracy rate in detection of artificially made predominately WT, predominately MUT, and equal mixtures of MUT and WT was 98.3%, 96.7%, and 95.0%, respectively. YMDD mutations were identified in 69.7% of 271 HBV patients treated with lamivudine for approximately 1 year.Conclusions: Pyrosequencing had a detection limit of MUT/(MUT+WT) of 20% and could finely identify predominately WT, predominately MUT, and equal mixtures, thus revealing detailed heterogeneity information on YMDD mutations in the HBV-infected patients.