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 2018.

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 3 L4E per synoptic report, at least 5 L4E for a given case if the case is <5 L4E = 5 L4E for whole case; if the case is >5 L4E, 3 L4E/synoptic filled out malignant colorectal polyp in 2 blocks = 5 L4E, breast lumpectomy with carcinoma in 16 blocks = 4 L4E (rule 4) + 3 L4E (for synoptic report), hemithyroidectomy with PTC in 20 blocks = 5 L4E (rule 4) + 3 L4E (for synoptic report)


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 no synoptic has to be done, rule 1 applies
Partial nephrectomy in 10 blocks with clear cell RCC Yes 2.5 L4E + 3 L4E (synoptic) synoptic has to be done, rule 4 and rule 5 apply
Lumpectomy in 24 blocks with DCIS Yes 6 L4E + 3 L4E (synoptic) synoptic has to be done, rule 4 and rule 5 apply
Cytoprostatectomy in 32 blocks with prostate cancer and bladder cancer Yes 8 L4E + 3 L4E (synoptic for prostate cancer) + 3 L4E (synoptic for bladder cancer) synoptic has to be done, rule 4 and rule 5 apply

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.