L4E rule 7-8 (2014)

This article covers L4E rule 7 and L4E rule 8 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.

Overview

• 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).

Details

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

Notes:

• ‡ Stomach biopsies which (routinely) come with a Warthin-Starry are not counted.

See also

• L4E rules of 2014.
• L4E rule 7-8 (2018).