Artificial intelligence for image recognition in diagnosing oral and oropharyngeal cancer and leukoplakia

Visual diagnosis is one of the key features of squamous cell carcinoma of the oral cavity (OSCC) and oropharynx (OPSCC), both subsets of head and neck squamous cell carcinoma (HNSCC) with a heterogeneous clinical appearance. Advancements in artificial intelligence led to Image recognition being introduced recently into large language models (LLMs) such as ChatGPT 4.0. This exploratory study, for the first time, evaluated the application of image recognition by ChatGPT to diagnose squamous cell carcinoma and leukoplakia based on clinical images, with images without any lesion as a control group. A total of 45 clinical images were analyzed, comprising 15 cases each of SCC, leukoplakia, and non-lesion images. ChatGPT 4.0 was tasked with providing the most likely diagnosis based on these images in scenario one. In scenario two the image and the clinical history were provided, whereas in scenario three only the clinical history was given. The results and the accuracy of the LLM were rated by two independent reviewers and the overall performance was evaluated using the modified Artificial Intelligence Performance Index (AIPI. In this study, ChatGPT 4.0 demonstrated the ability to correctly identify leukoplakia cases using image recognition alone, while the ability to diagnose SCC was insufficient, but improved by including the clinical history in the prompt. Providing only the clinical history resulted in a misclassification of most leukoplakia and some SCC cases. Oral cavity lesions were more likely to be diagnosed correctly. In this exploratory study of 45 images of oral lesions, ChatGPT 4.0 demonstrated a convincing performance for detecting SCC only when the clinical history was added, whereas Leukoplakia was detected solely by image recognition. ChatGPT is therefore currently insufficient for reliable OPSCC and OSCC diagnosis, but further technological advancements may pave the way for the use in the clinical setting.