L4E rule 5 (2014)

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This article covers L4E rule 5 for the 2014 L4E workload system. An overview of the L4E rules is found in the L4E rules of 2014.

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).


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). 2014. URL: https://www.cap-acp.org/cmsUploads/CAP/File/CAP-ACP%202014%20Workload%20FINAL.pdf. Accessed on: 17 October 2017.