L4E rule 7-8 (2014)
From Libre Pathology
The definitive reference for the rule is found on the CAP-ACP website.
- Rule 7 applies to specimens with additional stains and/or diagnostic (class 1) immunostains requested by the pathologist.
- Rule 8 applies to specimens with class 2 immunostains (e.g. ER/PR/HER2 for breast cancer).
|Specimen type(s)||Weight (L4E)||Details||Examples||Rule|
|All specimen types||0.15 L4E/class 1 immunostain slide, 0.15 L4E/non-onerous special stain||does not include class 2 IHC tests † (e.g. ER/PR/HER2 for breast ca), does not include so called onerous special stains (see below), 1 IHC = 0.33 L4E, 2 IHC = 0.66 L4E, 3 IHC = 1 L4E ...||2 lung cores with CRC demonstrated with 5 IHC = 1 L4E (rule 1) + 5 x 0.15 L4E||Rule 7|
|All specimen types||0.5 L4E/onerous special stain||includes only time consuming special stains: Warthin-Starry stain, ZN stain, Fite stain; stain must be ordered by pathologist - if the stain is done upfront/routinely by the lab it is not counted ‡||one lung core biopsy with granulomas - ZN, GMS, PASD done = 1 (rule 1) + 0.5 + 2 x 0.15 L4E||Rule 7|
|All specimen types||0.33 L4E/immunofluorescent stain||applies only to immunofluorescent stains (IFs)||skin biopsy with 4 IFs = 1 L4E (rule 1) + 4 x 0.33 L4E||Rule 7|
|All specimen types||0.5 L4E/class 2 immunostain slide||does not apply to IHCs done in a diagnostic context, e.g. using ER to demonstrate metastatic breast ca in a vertebra body||2 breast cores with ER/PR/HER2 IHC = 1 L4E (rule 1) + 3 x 0.5 L4E||Rule 8|
- ‡ Stomach biopsies which (routinely) come with a Warthin-Starry are not counted.
- 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.