Evaluating the efficacy of few‐shot learning for GPT‐4Vision in neurodegenerative disease histopathology: A comparative analysis with convolutional neural network model

Abstract Aims Recent advances in artificial intelligence, particularly with large language models like GPT‐4Vision (GPT‐4V)—a derivative feature of ChatGPT—have expanded the potential for medical image interpretation. This study evaluates the accuracy of GPT‐4V in image classification tasks of histopathological images and compares its performance with a traditional convolutional neural network (CNN). Methods We utilised 1520 images, including haematoxylin and eosin staining and tau immunohistochemistry, from patients with various neurodegenerative diseases, such as Alzheimer's disease (AD), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). We assessed GPT‐4V's performance using multi‐step prompts to determine how textual context influences image interpretation. We also employed few‐shot learning to enhance improvements in GPT‐4V's diagnostic performance in classifying three specific tau lesions—astrocytic plaques, neuritic plaques and tufted astrocytes—and compared the outcomes with the CNN model YOLOv8. Results GPT‐4V accurately recognised staining techniques and tissue origin but struggled with specific lesion identification. The interpretation of images was notably influenced by the provided textual context, which sometimes led to diagnostic inaccuracies. For instance, when presented with images of the motor cortex, the diagnosis shifted inappropriately from AD to CBD or PSP. However, few‐shot learning markedly improved GPT‐4V's diagnostic capabilities, enhancing accuracy from 40% in zero‐shot learning to 90% with 20‐shot learning, matching the performance of YOLOv8, which required 100‐shot learning to achieve the same accuracy. Conclusions Although GPT‐4V faces challenges in independently interpreting histopathological images, few‐shot learning significantly improves its performance. This approach is especially promising for neuropathology, where acquiring extensive labelled datasets is often challenging.