Comparative analysis of large language models as decision support tools in oral pathology

This study evaluated the performance of four large language model based chatbots (LLMs) (ChatGPT-4.0, ChatGPT o1-preview, Gemini, and Meta AI) as decision-support systems for interpreting histopathologic descriptions of oral lesions, assessing agreement between their s generated a suggested primary interpretation and three differential diagnoses. Outputs were categorized as Different, Similar, or Correct compared to the consensus reference diagnosis established by two board-certified pathologists. Statistical analyses included the Friedman test to compare model performance, Wilcoxon signed-rank tests for pairwise comparisons, Cohen’s κ to assess agreement, and regression analyses to evaluate the influence of age and sex. Differential diagnosis performance was also analyzed. ChatGPT o1-preview demonstrated the highest proportion of outputs concordant with the reference diagnosis (68.6%), followed by Meta AI (65.7%), ChatGPT-4.0 (59.8%), and Gemini (27.5%). In terms of agreement with oral pathologists, ChatGPT o1-preview (κ = 0.66) and Meta AI (κ = 0.63) showed substantial agreement, ChatGPT-4.0 demonstrated moderate agreement (κ = 0.57), and Gemini showed poor agreement (κ = 0.24). Increasing patient age was associated with a mild but statistically significant reduction in model performance for ChatGPT-4.0, Meta AI, and Gemini, while no significant age effect was observed for ChatGPT o1-preview; patient sex had no significant impact. Among the evaluated chatbots, ChatGPT o1-preview showed the highest alignment with oral pathologists’ reference diagnoses. These findings support the potential role of LLMs as complementary decision-support tools for interpreting oral histopathology descriptions, while highlighting substantial inter-model variability and the need for cautious implementation with continued human oversight.