Lost in Interpretation: The Case for Standardized Radiologic Reporting of Liver Lesions in Colorectal Liver Metastases

The management of colorectal liver metastases (CRLM) warrants a standardized radiologic reporting framework, as the decision to pursue curative-intent resection vs lifelong systemic therapy can hinge on the precision of a single preoperative imaging report. Currently, determinations of resectability rely on free-text reports that often omit critical vascular, biliary, and segmental anatomic details. The result is an underappreciated information gap that compounds intersurgeon variability in resectability assessment and potentially delays or precludes access to curative operation. Drawing on the precedent of structured reporting templates successfully implemented for pancreatic ductal adenocarcinoma and hepatocellular carcinoma (LI-RADS), we propose a CRLM reporting framework spanning six domains: hepatic tumor burden, vascular inflow, venous outflow, biliary involvement, parenchymal quality, and extrahepatic disease. Further efforts will require multidisciplinary collaboration to drive the implementation of standardized radiologic reporting, which may aid in providing consistent and equitable surgical decision-making for CRLM patients.