Diagnostic performance of advanced large language models in cystoscopy: evidence from a retrospective study and clinical cases

Abstract

PURPOSE: To evaluate the diagnostic capabilities of advanced large language models (LLMs) in interpreting cystoscopy images for the identification of common urological conditions. MATERIALS AND METHODS: A retrospective analysis was conducted on 603 cystoscopy images obtained from 101 procedures. Two advanced LLMs, both at the forefront of artificial intelligence technology, were employed to interpret these images. The diagnostic interpretations generated by these LLMs were systematically compared against standard clinical diagnostic assessments. The study's primary outcome measure was the overall diagnostic accuracy of the LLMs. Secondary outcomes focused on evaluating condition-specific accuracies across various urological conditions. RESULTS: The combined diagnostic accuracy of both LLMs was 89.2%, with ChatGPT-4 V and Claude 3.5 Sonnet achieving accuracies of 82.8% and 79.8%, respectively. Condition-specific accuracies varied considerably, for specific urological disorders: bladder tumors (ChatGPT-4 V: 92.2%, Claude 3.5 Sonnet: 80.9%), BPH (35.3%, 32.4%), cystitis (94.5%, 98.9%), bladder diverticula (92.3%, 53.8%), and bladder trabeculae (55.8%, 59.6%). As for normal anatomical structures: ureteral orifice (ChatGPT-4 V: 48.8%, Claude 3.5 Sonnet: 61.0%), bladder neck (97.9%, 93.8%), and prostatic urethra (64.3%,57.1%). CONCLUSIONS: Advanced language models demonstrated varying levels of diagnostic accuracy in cystoscopy image interpretation, excelling in cystitis detection while showing lower accuracy for other conditions, notably benign prostatic hyperplasia. These findings suggest promising potential for LLMs as supportive tools in urological diagnosis, particularly for urologists in training or early career stages. This study underscores the need for continued research and development to optimize these AI-driven tools, with the ultimate goal of improving diagnostic accuracy and efficiency in urological practice. CLINICAL TRIAL NUMBER: Not applicable.

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