L4E rule 5 (2018)

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This article covers L4E rule 5 for the 2018 L4E workload system. An overview of the L4E rules is found in the [[L4E rules of 20148].

The definitive reference for the rule is found on the CAP-ACP website.[1]


  • This rule applies to specimens that require a synoptic report as per the College of American Pathologists (CAP) or are required by provincial health authorities.


Specimen type(s) Weight (L4E) Details Examples
All non-radical resections with cancer for which a synoptic report has to be filled-out as per CAP guidelines at least 5 L4E If the case is <5 L4E = 5 L4E; If the case is >5 L4E, no change Malignant colorectal polyp in 2 blocks = 5 L4E, breast lumpectomy with carcinoma in 15 blocks = 5 L4E (rule 4), hemithyroidectomy with PTC in 18 blocks = 6 L4E (rule 4)


Further examples

Specimen Rule 5 applies? L4E Explanation
Invasive malignant melanoma - 1 punch biopsy Yes 5 L4E synoptic has to be done, would otherwise by 1 L4E as per rule 1
Melanoma in situ - 1 punch biopsy No 1 L4E synoptic does not have to be done, rule 1 applies
Partial nephrectomy in 9 blocks with clear cell RCC Yes 5 L4E synoptic has to be done, would otherwise be 3 L4E as per rule 4
Lumpectomy in 24 blocks with DCIS No 8 L4E synoptic has to be done, rule 4 applies

See also


  1. 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. Accessed on: 19 May 2019.