Surgeons face significant interobserver variation in evaluating peritoneal lesions despite their experience.

• Consensus on lesion scoring achieved in only 22.5% of cases among 50 expert surgeons (α = 0.174).
• Agreement on morphologic terms reached in 26.5% of images (α = 0.0902), with “tumor nodule” used 90.4% of the time (p < 0.001).
• Consensus prediction of the probability of malignancy occurred in just 52.5% of cases (α = 0.155).

Standardizing lesion descriptions may enhance reliability in surgical planning and patient assessment.