Unveiling the risks of ChatGPT in diagnostic surgical pathology

ChatGPT, an AI capable of processing and generating human-like language, has been studied in medical education and care, yet its potential in histopathological diagnosis remains unexplored. This study evaluates ChatGPT's reliability in addressing pathology-related diagnostic questions across ten subspecialties and its ability to provide scientific references. We crafted five clinico-pathological scenarios per subspecialty, simulating a pathologist using ChatGPT to refine differential diagnoses. Each scenario, aligned with current diagnostic guidelines and validated by expert pathologists, was posed as open-ended or multiple-choice questions, either requesting scientific references or not. Outputs were assessed by six pathologists according to. (1) usefulness in supporting the diagnosis and (2) absolute number of errors. We used directed acyclic graphs and structural causal models to determine the effect of each scenario type, field, question modality, and pathologist evaluation. We yielded 894 evaluations. ChatGPT provided useful answers in 62.2% of cases, and 32.1% of outputs contained no errors, while the remaining had at least one error. ChatGPT provided 214 bibliographic references: 70.1% correct, 12.1% inaccurate, and 17.8% non-existing. Scenario variability had the greatest impact on ratings, and latent knowledge across fields showed minimal variation. Although ChatGPT provided useful responses in one-third of cases, the frequency of errors and variability underscores its inadequacy for routine diagnostic use and highlights the need for discretion as a support tool. Imprecise referencing also suggests caution as a self-learning tool. It is essential to recognize the irreplaceable role of human experts in synthesizing images, clinical data, and experience for the intricate task of histopathological diagnosis.