Stereotactic radiotherapy (SBRT) is an acceptable standard of care for patients with early-stage non-small cell lung cancer who are unable to undergo surgery. With advances in technology, SBRT has become increasingly safe, with no cases of death in recent multicenter studies. And because the biopsy procedure itself can produce significant adverse effects, some patients and physicians choose to treat with SBRT in cases where the pathology is not fully defined. The main risk of treatment is the increased cost and potential toxicity to benign disease. To address this situation, Charles Rutter et al. from Yale University School of Medicine conducted a retrospective study that found that the rate of biopsy-free SBRT has increased in the United States in recent years and that trends in this approach and the cost effectiveness of the branch must be studied. The article was published in the June 2014 issue of Lung Cancer. The retrospective study included 6960 patients with stage I non-small cell lung cancer who underwent SBRT in the U.S. National Cancer Database from 2003 to 2011. Information was compared across years according to the proportion not biopsied, and factors associated with this selection were analyzed. The number of patients who underwent SBRT in the United States per year according to whether they were biopsied or not. The results of the study showed that the majority (95.5%) of the 6960 patients underwent biopsy prior to SBRT. And the rate of SBRT without biopsy gradually increased as time advanced (OR1.11, P=0.038). Univariate comparisons showed that older inoperable patients located in New England or the Pacific were more likely to undergo biopsy-free SBRT. while facility type and location (p<0.001), inoperability (p<0.001), and smaller tumor size (p=0.013) were associated with biopsy-free SBRT. Multivariate analysis showed a trend toward higher rates of biopsy-free SBRT in recent years (p=0.093). The study suggests that the rate of biopsy-free SBRT has increased in recent years in the United States, and trends in this approach and the cost effectiveness of the branch must be investigated.