Objective To assess the safety of confining histological examination to gall bladders with radiological and macroscopic features suggestive of cancer. Design Retrospective study. Setting Department of Histopathology, National Hospital of Sri Lanka. Method Analysis of all cholecystectomies performed at a tertiary care hospital during a one year period. Computerised histopathological reports and case notes were studied. Results Four hundred and seventy seven patients had undergone cholecystectomy for symptomatic gall stones. Four of these patients were found to have gall bladder cancer. In two of them the diagnosis had been suspected on pre-operative ultrasound scan. In the other two, gall bladder cancer was suspected at the time of surgery. Gall bladder cancer was found in 0.8% of specimens and it was suspected perioperatively in all these patients. Conclusion Our preliminary results suggest that a more selective approach to gall bladder histology may result in saving processing time and costs without adversely affecting patient safety. Index words: histopathology; gall bladder cancer; cost effectiveness DOI: 10.4038/cmj.v55i1.1702 Ceylon Medical Journal Vol.55, No.1 March 2010 pp.13-16