Historically and currently, improved staging for any disease is valuable, particularly in differentiating which stage of disease is amenable to what treatment or, perhaps more importantly, what patients can safely be spared therapy that is not helpful, is expensive, and/or is dangerous. Sentinel lymph node biopsy for extremity melanoma (>1.0 mm thick) is a case in point.
Kokudo and colleagues report a massive and expensive effort to preoperatively stage patients with gallbladder cancer referred to a hospital specialized in treating patients with cancer. To some extent, they and their data are victims of referral bias. The current application of their conclusions to most patients being evaluated for biliary surgery worldwide is not feasible due to the dominance of the twin tenets of minimal access and cost control. Furthermore, the extensive work-up and precise extended operations where indicated still create a very low yield of well patients in the long run.