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Difference between revisions of "L4E rule 1-3 (2018)"
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(Created page with "This article covers '''L4E rule 1''', '''L4E rule 2''', and '''L4E rule 3''' for the 2018 L4E workload system. An overview of the L4E rules is found in the L4E rules...") |
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==History== | ==History== | ||
*''Rule 1'' and ''Rule 3'' are unchanged from ''[[Level 4 equivalent of 2014]]''. | *''Rule 1'' and ''Rule 3'' are unchanged from ''[[Level 4 equivalent of 2014]]''. | ||
*''Rule 2'' was changed to lower the value of | *''Rule 2'' was changed to lower the value of prostate core biopsies sets with a large number of cores; compare with ''[[L4E rule 1-3 (2014)]]''. | ||
==Details== | ==Details== | ||
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| 1-5 frags = 1 L4E, 6-10 frags = 2 L4E, 11-15 frags = 3 L4E, 16-20 frags = 4 L4E<br>"complex skin" includes inflammatory skin, malignancies except [[basal cell carcinoma|BCC]] and [[skin squamous cell carcinoma|SCC]], atypical melanocytic lesions, adnexal tumours, lymphoid infiltrates | | 1-5 frags = 1 L4E, 6-10 frags = 2 L4E, 11-15 frags = 3 L4E, 16-20 frags = 4 L4E<br>"complex skin" includes inflammatory skin, malignancies except [[basal cell carcinoma|BCC]] and [[skin squamous cell carcinoma|SCC]], atypical melanocytic lesions, adnexal tumours, lymphoid infiltrates | ||
| inflammatory skin biopsy 3 frags = 1 L4E, adnexal skin tumour 6 frags = 2 L4E | | inflammatory skin biopsy 3 frags = 1 L4E, adnexal skin tumour 6 frags = 2 L4E | ||
| Rule 1 <ref name= | | Rule 1 <ref name=capacp2018/> | ||
|- | |- | ||
| Simple skin (non-complex skin) | | Simple skin (non-complex skin) | ||
| 0.5 L4E/biopsy (1 L3/biopsy) | | 0.5 L4E/biopsy (1 L3/biopsy) | ||
| biopsies > 2 cm - use [[L4E rule 4 ( | | biopsies > 2 cm - use [[L4E rule 4 (2018)|L4E rule 4]]; includes [[basal cell carcinoma|BCC]], SCC, actinic keratosis, intradermal nevus | ||
| punch biopsy of BCC = 0.5 L4E, shave biopsy of [[seborrheic keratosis]] = 0.5 L4E | | punch biopsy of BCC = 0.5 L4E, shave biopsy of [[seborrheic keratosis]] = 0.5 L4E | ||
| Rule 1 <ref name= | | Rule 1 <ref name=capacp2018/> | ||
|- | |- | ||
| Medical GI biopsies | | Medical GI biopsies | ||
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| 1-3 frags = 0.5 L4E, 4-6 frags = 1 L4E, 7-9 frags = 1.5 L4E, 10-12 frags = 2 L4E, 13-15 frags = 2.5 L4E, 16-18 frags = 3 L4E, 19-21 frags = 3.5 L4E, 22-24 frags = 4 L4E | | 1-3 frags = 0.5 L4E, 4-6 frags = 1 L4E, 7-9 frags = 1.5 L4E, 10-12 frags = 2 L4E, 13-15 frags = 2.5 L4E, 16-18 frags = 3 L4E, 19-21 frags = 3.5 L4E, 22-24 frags = 4 L4E | ||
| 6 frags colorectal biopsies = 1 L4E | | 6 frags colorectal biopsies = 1 L4E | ||
| Rule 1 <ref name= | | Rule 1 <ref name=capacp2018/> | ||
|- | |- | ||
| Surgical GI biopsies (neoplastic/pre-neoplastic) | | Surgical GI biopsies (neoplastic/pre-neoplastic) | ||
| 1 L3/lesion (if submitted in one block) and low grade; lesion with high-grade dysplasia = 1 L4E | | 1 L3/lesion (if submitted in one block) and low grade; lesion with high-grade dysplasia = 1 L4E | ||
| lesions submitted in >1 block: use [[L4E rule 4 ( | | lesions submitted in >1 block: use [[L4E rule 4 (2018)|L4E rule 4]] | ||
| 2 HP polyps in one block = 1 L4E, 1 tubular adenoma negative for HG dysplasia = 0.5 L4E | | 2 HP polyps in one block = 1 L4E, 1 tubular adenoma negative for HG dysplasia = 0.5 L4E | ||
| Rule 1 <ref name= | | Rule 1 <ref name=capacp2018/> | ||
|- | |- | ||
| Breast core biopsies & prostate core biopsies | | Breast core biopsies & prostate core biopsies | ||
| 0. | | 1 L4E for 1st core + 0.25 L4E for each additional core + 3 L4E for synoptic (if mandated - see [[L4E rule 5 (2018)|L4E rule 5]]) | ||
| | | should use clinicians core count (if available), if clinicians' count not available use gross count | ||
| 4 breast cores = | | 4 breast cores = 1.75 L4E<br>12 prostate cores (without synoptic report) = 3.75 L4E<br>12 prostate cores (with synoptic report) = 6.75 L4E | ||
| Rule 2 <ref name= | | Rule 2 <ref name=capacp2018>Workload and Workforce Committee of the CAP-ACP. Workload Measurement Guidelines. Canadian Association of Pathologists (CAP-ACP). 2018. URL: [https://www.cap-acp.org/cmsUploads/CAP/File/CAP-ACP_Workload_Model_2018_Final_2020180907(1).pdf https://www.cap-acp.org/cmsUploads/CAP/File/CAP-ACP_Workload_Model_2018_Final_2020180907(1).pdf]. Accessed on: 19 May 2019.</ref> | ||
|- | |- | ||
| Core biopsies (not including prostate, breast) | | Core biopsies (not including prostate, breast) | ||
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| 1-5 cores = 1 L4E, 6-10 cores = 2 L4E, 11-15 cores = 3 L4E, 16-20 cores = 4 L4E | | 1-5 cores = 1 L4E, 6-10 cores = 2 L4E, 11-15 cores = 3 L4E, 16-20 cores = 4 L4E | ||
| 3 cores of lymph node = 1 L4E, 6 cores of mediastinal mass = 2 L4E | | 3 cores of lymph node = 1 L4E, 6 cores of mediastinal mass = 2 L4E | ||
| Rule 2 <ref name= | | Rule 2 <ref name=capacp2018/> | ||
|- | |- | ||
| Fragmented tissue/ curettage | | Fragmented tissue/ curettage | ||
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| 1-3 blocks = 1 L4E, 4-6 blocks = 2 L4E, 7-9 blocks = 3 L4E, 10-12 blocks = 4 L4E, 13-15 blocks = 5 L4E, 16-18 blocks = 6 L4E, 19-21 blocks = 7 L4E | | 1-3 blocks = 1 L4E, 4-6 blocks = 2 L4E, 7-9 blocks = 3 L4E, 10-12 blocks = 4 L4E, 13-15 blocks = 5 L4E, 16-18 blocks = 6 L4E, 19-21 blocks = 7 L4E | ||
| endometrial biopsy in 2 blocks = 1 L4E, TURP in 7 blocks = 3 L4E, bladder biopsy in 12 blocks = 4 L4E | | endometrial biopsy in 2 blocks = 1 L4E, TURP in 7 blocks = 3 L4E, bladder biopsy in 12 blocks = 4 L4E | ||
| Rule 3 <ref name= | | Rule 3 <ref name=capacp2018/> | ||
|} | |} | ||
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{{hide3|9. Random colonic biopsies 20 frags. L4E?|Answer: 3 L4E<br>Why? Rule 1: 20 frags x L3/3 frags ~ 6.66 L3 -> truncated to 6 L3, 6 L3 ~ 3 L4E}} | {{hide3|9. Random colonic biopsies 20 frags. L4E?|Answer: 3 L4E<br>Why? Rule 1: 20 frags x L3/3 frags ~ 6.66 L3 -> truncated to 6 L3, 6 L3 ~ 3 L4E}} | ||
{{hide3|10. Prostate biopsy with 12 cores. L4E?|Answer: | {{hide3|10. Prostate biopsy with 12 cores without synoptic report. L4E?|Answer: 3.75 L4E<br>Why? Rule 2: 1 L4E (first core) + 11 cores x 0.25 L4E/core ~ 3.75 L4E}} | ||
{{hide3|11. Breast biopsy with 2 cores. L4E?|Answer: 1 L4E<br>Why? Rule 2: | {{hide3|11. Breast biopsy with 2 cores. L4E?|Answer: 1.25 L4E<br>Why? Rule 2: 1 L4E + 0.25 L4E ~ 1.25 L4E}} | ||
{{hide3|12. Endometrial biopsy in 2 blocks. L4E?|Answer: 1 L4E<br>Why? Rule 3: 1-3 blocks ~ 1 L4E}} | {{hide3|12. Endometrial biopsy in 2 blocks. L4E?|Answer: 1 L4E<br>Why? Rule 3: 1-3 blocks ~ 1 L4E}} | ||
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==Quiz== | ==Quiz== | ||
You can test your knowledge in the ''[[Quiz:L4E rules 1-3 ( | You can test your knowledge in the ''[[Quiz:L4E rules 1-3 (2018)|L4E rules 1-3 quiz]]''. | ||
==See also== | ==See also== | ||
*[[L4E rules of 2018]]. | *[[L4E rules of 2018]]. | ||
*[[L4E rule 1-3 (2014)]]. | |||
==References== | ==References== | ||