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Main Authors: Li, Sijing, Qiu, Zhongwei, Liu, Jiang, Zhang, Wenqiao, Lin, Tianwei, Xie, Yihan, An, Jianxiang, Yun, Boxiang, Yang, Chenglin, Xiao, Jun, Guo, Guangyu, Yao, Jiawen, Liu, Wei, Gao, Yuan, Yan, Ke, Cao, Weiwei, Zheng, Zhilin, Mok, Tony C. W., Cao, Kai, Shi, Yu, Zhang, Jiuyu, Zhou, Jian, Ooi, Beng Chin, Xia, Yingda, Zhang, Ling
Format: Preprint
Published: 2026
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Online Access:https://arxiv.org/abs/2603.05867
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author Li, Sijing
Qiu, Zhongwei
Liu, Jiang
Zhang, Wenqiao
Lin, Tianwei
Xie, Yihan
An, Jianxiang
Yun, Boxiang
Yang, Chenglin
Xiao, Jun
Guo, Guangyu
Yao, Jiawen
Liu, Wei
Gao, Yuan
Yan, Ke
Cao, Weiwei
Zheng, Zhilin
Mok, Tony C. W.
Cao, Kai
Shi, Yu
Zhang, Jiuyu
Zhou, Jian
Ooi, Beng Chin
Xia, Yingda
Zhang, Ling
author_facet Li, Sijing
Qiu, Zhongwei
Liu, Jiang
Zhang, Wenqiao
Lin, Tianwei
Xie, Yihan
An, Jianxiang
Yun, Boxiang
Yang, Chenglin
Xiao, Jun
Guo, Guangyu
Yao, Jiawen
Liu, Wei
Gao, Yuan
Yan, Ke
Cao, Weiwei
Zheng, Zhilin
Mok, Tony C. W.
Cao, Kai
Shi, Yu
Zhang, Jiuyu
Zhou, Jian
Ooi, Beng Chin
Xia, Yingda
Zhang, Ling
contents Accurate tumor analysis is central to clinical radiology and precision oncology, where early detection, reliable lesion characterization, and pathology-level risk assessment guide diagnosis and treatment planning. Chain-of-Thought (CoT) reasoning is particularly important in this setting because it enables step-by-step interpretation from imaging findings to clinical impressions and pathology conclusions, improving traceability and reducing diagnostic errors. Here, we target the clinical tumor analysis task and build a large-scale benchmark that operationalizes a multimodal reasoning pipeline, spanning findings, impressions, and pathology predictions. We curate TumorCoT, a large-scale dataset of 1.5M CoT-labeled VQA instructions paired with 3D CT scans, with step-aligned rationales and cross-modal alignments along the trajectory from findings to impression to pathology, enabling evaluation of both answer accuracy and reasoning consistency. We further propose TumorChain, a multimodal interleaved reasoning framework that tightly couples 3D imaging encoders, clinical text understanding, and organ-level vision-language alignment. Through cross-modal alignment and iterative interleaved causal reasoning, TumorChain grounds visual evidence, aggregates conclusions, and issues pathology predictions after multiple rounds of self-refinement, improving traceability and reducing hallucination risk. Experiments show consistent improvements over strong baselines in lesion detection, impression generation, and pathology classification, and demonstrate strong generalization on the DeepTumorVQA benchmark. These results highlight the potential of multimodal reasoning for reliable and interpretable tumor analysis in clinical practice. Detailed information about our project can be found on our project homepage at https://github.com/ZJU4HealthCare/TumorChain.
format Preprint
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institution arXiv
publishDate 2026
record_format arxiv
spellingShingle TumorChain: Interleaved Multimodal Chain-of-Thought Reasoning for Traceable Clinical Tumor Analysis
Li, Sijing
Qiu, Zhongwei
Liu, Jiang
Zhang, Wenqiao
Lin, Tianwei
Xie, Yihan
An, Jianxiang
Yun, Boxiang
Yang, Chenglin
Xiao, Jun
Guo, Guangyu
Yao, Jiawen
Liu, Wei
Gao, Yuan
Yan, Ke
Cao, Weiwei
Zheng, Zhilin
Mok, Tony C. W.
Cao, Kai
Shi, Yu
Zhang, Jiuyu
Zhou, Jian
Ooi, Beng Chin
Xia, Yingda
Zhang, Ling
Computer Vision and Pattern Recognition
Accurate tumor analysis is central to clinical radiology and precision oncology, where early detection, reliable lesion characterization, and pathology-level risk assessment guide diagnosis and treatment planning. Chain-of-Thought (CoT) reasoning is particularly important in this setting because it enables step-by-step interpretation from imaging findings to clinical impressions and pathology conclusions, improving traceability and reducing diagnostic errors. Here, we target the clinical tumor analysis task and build a large-scale benchmark that operationalizes a multimodal reasoning pipeline, spanning findings, impressions, and pathology predictions. We curate TumorCoT, a large-scale dataset of 1.5M CoT-labeled VQA instructions paired with 3D CT scans, with step-aligned rationales and cross-modal alignments along the trajectory from findings to impression to pathology, enabling evaluation of both answer accuracy and reasoning consistency. We further propose TumorChain, a multimodal interleaved reasoning framework that tightly couples 3D imaging encoders, clinical text understanding, and organ-level vision-language alignment. Through cross-modal alignment and iterative interleaved causal reasoning, TumorChain grounds visual evidence, aggregates conclusions, and issues pathology predictions after multiple rounds of self-refinement, improving traceability and reducing hallucination risk. Experiments show consistent improvements over strong baselines in lesion detection, impression generation, and pathology classification, and demonstrate strong generalization on the DeepTumorVQA benchmark. These results highlight the potential of multimodal reasoning for reliable and interpretable tumor analysis in clinical practice. Detailed information about our project can be found on our project homepage at https://github.com/ZJU4HealthCare/TumorChain.
title TumorChain: Interleaved Multimodal Chain-of-Thought Reasoning for Traceable Clinical Tumor Analysis
topic Computer Vision and Pattern Recognition
url https://arxiv.org/abs/2603.05867