The LELEX initiative to enhance cancer imaging communication: development of a consensus-based structured reporting template and lexicon for general oncologic imaging

Horvat, Natally; Moraes, Fabio Ynoe; Chagas, Lucia Antunes; Bratti, Vanessa Freitas; Tachibana, Adriano; Bitencourt, Almir Galvão Vieira; Salvajoli, Bernardo Peres; Amancio, Camila Trolez; dos Anjos, Carlos Augusto; Racy, Douglas Jorge; Coelho, Fernando Morbeck; D’Ippolito, Giuseppe; Oliveira, Graziela Campos; Horvat, Joao V.; Araujo-Filho, Jose de Arimateia; Colli, Leandro Machado; Barros, Luciana Holtz de C.; Godoy, Luis Filipe de Souza; Kowalski, Luiz Paulo; Queiroz, Marcelo Araujo; Sawamura, Márcio Valente Yamada; Fernandes, Maria Clara; Madi, Marisa Riscalla; Braghiroli, Maria Ignez; Helito, Paulo Victor Partezani; Do, Richard Kinh Gian; Chiarantano, Rodrigo Sampaio; Polizio, Rodrigo Pamplona; Chojniak, Rubens; Ribeiro Junior, Ulysses; Muglia, Valdair Francisco; Hoff, Paulo Marcelo Gehm; Buchpiguel, Carlos Alberto; Cerri, Giovanni Guido; Hricak, Hedvig; Nomura, Cesar Higa

doi:10.1590/0100-3984.2025.0088-en

Tabla de contenido Anterior Actual Siguiente

Tabla de contenido

Original Article • Radiol Bras 59 • 2026 • https://doi.org/10.1590/0100-3984.2025.0088-en linkcopy

The LELEX initiative to enhance cancer imaging communication: development of a consensus-based structured reporting template and lexicon for general oncologic imaging

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: The Laudo Estruturado e Léxico em Oncologia (LELEX, Lexicon and Structured Reporting in Oncology) initiative was established to develop a standardized lexicon and structured reporting system applicable across cancer types.

Methods: The São Paulo Radiology Society and Brazilian Society of Medical Oncology assembled a 27-member multidisciplinary consensus panel that included radiologists, medical and radiation oncologists, surgeons, and a patient representative. A literature review identified relevant oncologic reporting frameworks to guide the creation of a draft template and lexicon by the LELEX executive committee. Panelists were surveyed to assess current reporting practices and preferences between free-text and structured reports. Consensus (i.e., agreement by more than 80% of panelists) on the final lexicon and reporting system was reached through post-survey panel discussions.

Results: Compared with a traditional free-text report, a structured report incorporating the LELEX lexicon received significantly higher ratings for precision and was deemed better for guiding clinical decisions by > 88% of panelists. In post-survey discussions, consensus was achieved for all lexicon components, including diagnostic certainty terms, lesion count descriptors, and longitudinal comparison language. The structured report template was also agreed upon by the panel members.

Conclusion: The LELEX initiative established a consensus-driven structured reporting system and lexicon for general oncologic imaging baseline and follow-up assessments.

Keywords:
Radiology information systems; Radiology/education; Medical records/standards; Terminology as topic; Neoplasms/diagnostic imaging; Medical oncology/education; Decision making; Uncertainty; Longitudinal studies; Follow-up studies

Portuguese	English
RESSONÂNCIA MAGNÉTICA DO ABDOME SUPERIOR COM COLANGIORRESSONÂNCIA	MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY.
Indicação: Câncer de reto com metástases hepáticas.	Indication: Rectal cancer with liver metastases.
Técnica: Realizadas aquisições multiplanares, ponderadas em T1, em fase e fora de fase, em T2 e difusão, antes e após a administração do contraste venoso. Foram realizadas imagens fortemente pesadas em T2 para estudo colangiográfico.	Technique: Multiplanar acquisitions performed with T1-weighting in-phase and out-of-phase, T2-weighting, and diffusion, before and after intravenous contrast administration. Heavily T2-weighted images were obtained for cholangiographic evaluation.
Análise:	Analysis:
Análise comparativa com RM do abdome superior realizada no dia 22/08/2022	Comparative analysis with MRI from 08/22/2022
Houve discreto aumento da ascite, hoje em moderada quantidade.	There was a slight increase in ascites, now of a moderate amount.
Surgiu tecido de limites mal definidos ocupando os espaços adiposos do hilo hepático em topografia do terço proximal do hepatocolédoco, determinando redução abrupta de calibre do mesmo e acentuação da ectasia das vias biliares intra e extra-hepáticas, bem como redução da amplitude luminal do terço proximal da veia porta.	Ill-defined tissue appeared occupying the fat planes of the hepatic hilum at the level of the proximal third of the common bile duct, causing an abrupt reduction in caliber and marked ectasia of the intraand extra-hepatic bile ducts, as well as reduced luminal diameter of the proximal third of the portal vein.
Permanecem um pouco mais evidente do que nos estudos anteriores as lesões no segmento 4 junto à fissura do ligamento falciforme e área de espessamento tecidual hilar alta que determina redução abrupta de calibre em topografia da confluência biliar, sendo mais importante no ducto hepático esquerdo, e condiciona acentuação da dilatação biliar a montante, previamente individualizada, bem como afilamento do ramo esquerdo da porta e de ramo regional da artéria hepática esquerda.	The lesions in segment 4 near the falciform ligament fissure and the area of high hilar tissue thickening are slightly more evident than in previous studies, causing abrupt narrowing at the biliary confluence, predominantly affecting the left hepatic duct, leading to accentuated upstream biliary dilatation, previously noted, as well as tapering of the left portal vein branch and regional branch of the left hepatic artery.
Permanece espessamento tecidual envolvendo em 50% o tronco celíaco distal que encarcera a artéria hepática comum (que apresenta irregularidade parietal) e a origem das hepáticas direita e esquerda, notadamente esta última, sem evidente estenose, já relatado previamente.	Tissue thickening persists, involving 50% of the distal celiac trunk, encasing the common hepatic artery (which shows wall irregularity) and the origins of the right and left hepatic arteries, especially the latter, without evident stenosis, as previously reported.
Há extensão do referido espessamento tecidual à região anterior à crura diafragmática direita, lateralmente à origem da artéria mesentérica superior.	The aforementioned tissue thickening extends to the region anterior to the right diaphragmatic crus and laterally to the origin of the superior mesenteric artery.
Persistem inalteradas em número e em tamanho os nódulos hipovasculares secundários, definindose como lesões alvo as mais conspícuas: aglomeradas junto a superfície diafragmática do segmento 8 medindo em conjunto 8,2 × 4,3 cm inalterada. - no segmento 3, medindo 5,8 × 4,5 cm estável. - no segmento 6, medindo 4,8 × 4.1 cm inalterada.	The secondary hypovascular nodules remain unchanged in number and size, with the most conspicuous ones defined as target lesions: - clustered near the diaphragmatic surface of segment 8, collectively measuring 8.2 × 4.3 cm, unchanged. - in segment 3, measuring 5.8 × 4.5 cm, stable.- in segment 4, measuring 4.8 × 4.1 cm, unchanged.
Linfonodos proeminente à esquerda da origem da artéria mesentérica superior (1,6 × 1,0 cm) e no hilo hepático (2,5 × 1,2 cm).	Prominent lymph nodes to the left of the origin of the superior mesenteric artery (1.6 × 1.0 cm) and in the hepatic hilum (2.5 × 1.2 cm).
Persiste de aspecto semelhante a circulação colateral intracavitária, sendo mais importante periesplênica, associada a shunt esplenorrenal. Há ainda importante circulação colateral na tela subcutânea superficial, persistindo os sinais de má distribuição hídrica.	Intracavitary collateral circulation remains similar in appearance, most notably perisplenic, associated with a splenorenal shunt. There is also significant collateral circulation in the superficial subcutaneous tissue, with persistent signs of abnormal fluid distribution.
Esplenomegalia homogênea, medindo cerca de 15,4 cm no maior eixo coronal.	Homogeneous splenomegaly, measuring approximately 15.4 cm on the longest axis in the coronal plane.
Adrenais anatômicas.	Adrenal glands are unremarkable.
Achado de relevância não-oncológica:	Relevant non-oncologic finding:
Rins tópicos, com forma e volume normais.	Kidneys in normal location, with normal shape and volume.
Ausência de dilatação dos sistemas pielocalicianos.	No dilatation of the renal pelvis.
Aorta de curso e calibre normais.	Aorta with a normal course and caliber.

Portuguese	English
RESSONÂNCIA MAGNÉTICA DO ABDOME SUPERIOR COM COLANGIORRESSONÂNCIA	MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY.
DADOS CLÍNICOS: Câncer de reto com metástases hepáticas.	CLINICAL INFORMATION: Rectal cancer with liver metastases.
TÉCNICA: Realizadas aquisições multiplanares antes e após a administração venosa meio de contraste hepatobiliar.	TECHNIQUE: Multiplanar acquisitions were performed before and after administration of hepatobiliary contrast.
COMPARAÇÃO: RM 22/08/2022	COMPARISON: MR from 08/22/2022
ACHADOS:	FINDINGS:
Hepatobiliar: Nova lesão irregular no hilo hepático, suspeito para metástase, infiltrando colédoco e veia porta.	Hepatobiliary: New irregular lesion at the hepatic hilum, suspicious for metastasis, infiltrating the common bile duct and portal vein.
Inalteradas as múltiplas metástases hepáticas bilobares, por exemplo: -Segmento 8, confluentes, 8.2 × 4,3 cm. -Segmento 6, 4,8 × 4,1 cm.	Unchanged multiple bilobar hepatic metastases, for example: - Segment 8, confluent lesions, 8.2 × 4.3 cm - Segment 6, 4.8 × 4.1 cm
Aumento da moderada dilatação das vias biliares, até o plano do hilo hepático devido tecido irregular.	Increased moderate biliary ductal dilation, up to the level of the hepatic hilum, due to the irregular tissue.
Baço: Esplenomegalia. Varizes periesplênica e shunt esplenorrenal.	Spleen: Splenomegaly. Perisplenic varices and splenorenal shunt.
Pâncreas: Sem alterações relevantes.	Pancreas: Unremarkable.
Adrenais: Sem alterações relevantes.	Adrenals: Unremarkable.
Rins: Sem alterações relevantes.	Kidneys: Unremarkable.
Linfonodos: Inalterados poucos linfonodos abdominais, com morfologia sugestiva de metástases: • À esquerda da origem da artéria mesentérica superior, 1,6 × 1,0 cm • Hilo hepático, 2,5 × 1,2 cm	Lymph nodes: Unchanged few abdominal lymph nodes, with morphology suggestive of metastases: • To the left of the origin of the superior mesenteric artery, 1.6 × 1.0 cm • Hepatic hilum, 2.5 × 1.2 cm
Peritônio/mesentério/intestino: Aumento da ascite, atualmente moderada.	Peritoneum/mesentery/bowel: Increased ascites, now moderate.
Ossos / partes moles: Circulação colateral e edema subcutâneo.	Bones / soft tissues: Subcutaneous collaterals and edema.
Outros: Inalterado tecido retroperitoneal metastático infiltrando aorta, tronco celíaco e crura diafragmática direita.	Other: Unchanged metastatic retroperitoneal tissue infiltrating the aorta, celiac trunk, and right diaphragmatic crus.
Impressão:	Impression:
Em comparação com TC 08/12/2022: 1. Inalteradas as múltiplas metástases hepáticas. 2. Nova lesão irregular no hilo hepático, causando aumento da moderada dilatação das vias biliares, consistente com metástase. 3. Inalteradas as poucas metástases linfonodais e retroperitoneal. 4. Aumento da ascite, atualmente moderada.	Since CT 12/08/2022: 1. Unchanged multiple hepatic metastases. 2. New irregular lesion at the hepatic hilum causing increased moderate biliary ductal dilation, consistent with metastasis. 3. Unchanged few lymph node and retroperitoneal metastases. 4. Increased ascites, now moderate.

Component	Description	Consensus recommendation
Certainty lexicon*	Standardized terms linked to estimated probabilities to express diagnostic confidence	“Consistent with”: estimated probability > 90% “Suggestive of”: estimated probability ~ 75% “Possible”: estimated probability ~ 50% “Less likely”: estimated probability < 25%
Lesion counting lexicon	Terms used to estimate the number of lesions in a consistent manner	“Few”: 1–5 lesions “Multiple”: ≥ 6 lesions
Comparison terminology†	Subjective assessment of change over time using standardized language	“New”: Finding not seen on prior imaging “Increased”‡: Significant enlargement compared with prior imaging “Slightly increased”: Minimal enlargement compared with prior imaging “Unchanged”: No appreciable difference from prior imaging “Slightly decreased”: Minimal reduction in size “Decreased”: Significant reduction in size “Markedly decreased”: Substantial reduction in size “Resolved”: Finding no longer present on current imaging For each site of disease, describe two representative lesions in list format, including their location, size (in two orthogonal axial dimensions), and prior measurements, if changed.
Representative lesions	Guidance to report two representative lesions per organ, with location, size, and previous measurements, if changed	Example 1: A few increased liver metastases, for example: Segment 2, 2.5 × 2.0 cm, previously 1.5 × 1.0 cm. Segment 5, 1.8 × 1.0 cm, previously 1.0 × 0.5 cm. Example 2: Unchanged multiple peritoneal implants, for example: Right paracolic gutter, 2.5 × 1.5 cm. Left omental, 1.5 × 1.0 cm.
Structured reporting system	Key elements to include in a general oncologic imaging report	Imaging modality, body region, and date of the exam Clinical information Technique—Include details on intravenous contrast, oral contrast, acquisition method, and post-processing Comparison—Specify the modality and date of the prior imaging study used for direct comparison. Findings (organ-by-organ checklist)—When no relevant abnormalities are present, use concise terms such as “unremarkable” or “normal”. Clearly benign incidental findings may be briefly described at the radiologist’s discretion. If included, keep the description succinct (e.g., “simple renal cyst”) and avoid unnecessary detail. Impression—Provide a concise summary of key findings, including temporal context (comparison with prior imaging) Example: Since CT 02/02/2025: - Increased multiple liver metastases. - Increased peritoneal carcinomatosis.

Variable	(n = 18)
Years of training, mean ± SD (range)	16.8 ± 10.1 (6-36)
Institution type(s), n (%)
Public and private	9 (50.0)
Private only	8 (44.4)
Public only	1 (5.6)
Affiliation(s), n (%)
Academic and non-academic	9 (50.0)
Academic only	6 (33.3)
Non-academic only	3 (16.7)
Subspecialty, n (%)
Oncologic radiology	7 (38.9)
Abdominal radiology	6 (33.3)
Internal medicine (abdominal and thoracic radiology)	5 (27.8)
Thoracic or cardiovascular radiology	3 (16.7)
Nuclear medicine	2 (11.1)
Neuroradiology or head and neck radiology	2 (11.1)
Ultrasound	1 (5.6)
Musculoskeletal radiology	1 (5.6)
Breast radiology	1 (5.6)
Frequency of oncologic interpretation, n (%)
Always (almost every day)	14 (77.8)
Very frequently (> 10 days per month)	4 (22.2)
Oncologic imaging exams interpreted per week, mean ± SD (range)	69.4 ± 59.5 (10-250)
Frequency of clarification requests,* n (%)
Always (almost every day)	4 (22.2)
Very frequently (> 10 days per month)	3 (16.7)
Sometimes (5-10 days per month)	6 (33.3)
Rarely (< 5 days per month)	5 (27.8)
Frequency of structured report use for oncologic exams, n (%)
Always (almost every day)	4 (22.2)
Very frequently (> 10 days per month)	5 (27.8)
Sometimes (5-10 days per month)	3 (16.7)
Rarely (< 5 days per month)	2 (11.1)
Never	4 (22.2)
Use of a standardized lexicon in oncologic imaging reports, n (%)
Always (almost every day)	6 (33.3)
Very frequently (> 10 days per month)	6 (33.3)
Sometimes (5-10 days per month)	1 (5.6)
Rarely (< 5 days per month)	1 (5.6)
Never	4 (22.2)
Use of structured reports and a standardized lexicon during training, n (%)
Always (almost every day)	2 (11.1)
Very frequently (> 10 days per month)	5 (27.8)
Sometimes (5-10 days per month)	3 (16.7)
Rarely (< 5 days per month)	3 (16.7)
Never	5 (27.8)

Variable	(n = 9)
Years of training, mean ± SD (range)	18.3 ± 10.6 (8-39)
Institution type(s), n (%)
Public and private	5 (55.6)
Private only	3 (33.3)
Public only	1 (11.1)
Affiliation(s), n (%)
Academic and non-academic	3 (33.3)
Academic only	4 (44.4)
Non-academic only	1 (11.1)
Subspecialty, n (%)
Oncology	3 (33.3)
Radiotherapy	2 (22.2)
Surgery	2 (22.2)
Public Health	1 (11.1)
Nongovernmental Organization	1 (11.1)
Frequency of reading oncologic reports, n (%)
Always (almost every day)	7 (77.8)
Rarely (< 5 days per month)	2 (22.2)
Frequency of consulting a radiologist for clarification on a radiology report, n (%)
Always (almost every day)	2 (22.2)
Very frequently (> 10 days per month)	3 (33.3)
Sometimes (5-10 days per month)	2 (22.2)
Rarely (< 5 days per month)	1 (11.1)
Never	1 (11.1)
Frequency of reading structured reports
from oncologic imaging exams, n (%)
Always (almost every day)	1 (11.1)
Very frequently (> 10 days per month)	1 (11.1)
Sometimes (5-10 days per month)	4 (44.4)
Rarely (< 5 days per month)	1 (11.1)
Never	2 (22.2)
Frequency of reading standardized lexicon from oncologic imaging exams, n (%)
Always (almost every day)	0 (0)
Very frequently (> 10 days per month)	2 (22.2)
Sometimes (5-10 days per month)	2 (22.2)
Rarely (< 5 days per month)	2 (22.2)
Never	3 (33.3)

Category	Response	Report 1	Report 2	P
Category	Response	n (%)	n (%)	P
Radiologists
	Very clear	1 (5.6)	15 (83.3)
	Clear	6 (33.3)	2 (11.1)
Clarity rating	Neutral	3 (16.7)	1 (5.6)	0.0001
	Unclear	7 (38.9)	0 (0.0)
	Very Unclear	1 (5.6)	0 (0.0)
	Very precise	1 (5.6)	13 (72.2)
	Somewhat precise	4 (22.2)	4 (22.2)
Precision rating	Neutral	3 (16.7)	1 (5.6)	0.0003
	Somewhat imprecise	7 (38.9)	0 (0.0)
	Very imprecise	3 (16.7)	0 (0.0)
	Very satisfied	0 (0.0)	14 (77.8)
	Somewhat satisfied	5 (27.8)	3 (16.7)
Satisfaction level	Neutral	2 (11.1)	1 (5.6)	0.00003
	Somewhat dissatisfied	8 (44.4)	0 (0.0)
	Very dissatisfied	3 (16.7)	0 (0.0)
Non-radiologists
	Very clear	0 (0.0)	5 (55.6)
	Clear	5 (55.6)	4 (44.4)
Clarity rating	Neutral	2 (22.2)	0 (0.0)	0.076
	Unclear	2 (22.2)	0 (0.0)
	Very Unclear	0 (0.0)	0 (0.0)
	Very precise	1 (11.1)	3 (33.3)
	Somewhat precise	3 (33.3)	6 (66.7)
Precision rating	Neutral	2 (22.2)	0 (0.0)	0.031
	Somewhat imprecise	3 (33.3)	0 (0.0)
	Very imprecise	0 (0.0)	0 (0.0)
	Very satisfied	0 (0.0)	4 (44.4)
	Somewhat satisfied	5 (55.6)	5 (55.6)
Satisfaction level	Neutral	2 (22.2)	0 (0.0)	0.076
	Somewhat dissatisfied	2 (22.2)	0 (0.0)
	Very dissatisfied	0 (0.0)	0 (0.0)

location_on

Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
E-mail: radiologiabrasileira@cbr.org.br

rss_feed Acompañe los números de esta revista en su lector de RSS

[1] CT, computed tomography.

[TFN1] ^*
If an imaging finding is clearly diagnostic—such as a cyst, hemangioma, or known metastasis—the use of the certainty lexicon may be omitted. For example: Unchanged multiple liver metastases.

[TFN2] ^†
Clearly benign lesions do not require comparison with prior studies; a brief description is sufficient—for example, “Renal cysts.”

[TFN3] ^‡
Use of the term “Markedly increased” is not recommended.

1 - Léxico de certeza
Termo de certeza	Estimativa de probabilidade
Compatível com	> 90%
Sugestivo de	~ 75%
Possível	~ 50%
Pouco provável	< 25%
2 Léxico de número de lesões
Termo de número	Número estimado
Poucos (as)	1–5
Múltiplos (as)	> 6
3 Comparação – interpretação subjetiva
Termo comparativo
Desaparecimento
Redução significativa
Redução
Discreta redução
Inalterado (a)
Discreto aumento
Aumento
Novo (a)
4 Lesões representativas (2 por órgão)
Localização, [] × []* cm, anteriormente [] × []* cm
* 2 eixos ortogonais no plano axial
5 Exemplo
Aumento dos poucos nódulos hepáticos, compatíveis com metástases, por exemplo:
Segmento 2, 2.5 × 2.0 cm, previamente 1.5 × 1.0 cm
Segmento 5, 1.8 × 1.0 cm, previamente 0.5 × 0.5 cm

[Data] TOMOGRAFIA DE TÓRAX, ABDOME E PELVE DADOS CLÍNICOS: []
TÉCNICA:
Meio de contraste intravenoso: com / sem contraste
Meio de contraste oral: não / sim
Aquisição: axial de TC de tórax, abdome e pelve
COMPARAÇÃO: XXX (Modalidade e data – Estudos usados para comparação direta)
ACHADOS:
PULMÕES/VIAS AÉREAS:	Sem alterações relevantes.
PLEURA/PERICÁRDIO:	Ausência de derrame.
MEDIASTINO/ LINFONODOS TORÁCICOS:	Ausência de linfonodopatia.
HEPATOBILIAR:	Sem alterações relevantes.
BAÇO:	Sem alterações relevantes.
PÂNCREAS:	Sem alterações relevantes.
ADRENAIS:	Sem alterações relevantes.
RINS:	Sem alterações relevantes.
LINFONODOS
ABDOMINO-PÉLVICOS:	Ausência de linfonodopatia
ÓRGÃOS PÉLVICOS:	Sem alterações relevantes.
PERITÔNIO/MESENTÉRIO/ INTESTINO:	Sem alterações relevantes.
OSSO/PARTES MOLES:	Ausência de lesões suspeitas
OUTROS:	Nenhum.
IMPRESSÃO:		Em comparação com XXX:
Termo de certeza	Estimativa de probabilidade
Compatível com	> 90%
Sugestivo de	~ 75%
Possível	~ 50%
Pouco provável	< 25%