{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:03:07Z","timestamp":1789988587900,"version":"4.0.1"},"reference-count":23,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n To evaluate the real\u2010world diagnostic performance of a multimodal large language model (LLM) for image\u2010based assessment of oral mucosal lesions compared with clinicians of varying expertise.<\/jats:p>\n <\/jats:sec>\n \n Study Design<\/jats:title>\n Prospective international multicenter diagnostic accuracy study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Twenty university and tertiary head and neck centers in Italy, Belgium, France, Spain, and Israel.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We enrolled 350 consecutive patients (320 with oral lesions, 30 with normal mucosa). Clinical photographs and basic epidemiologic data were analyzed using Gemini 2.5 Advanced with a standardized prompt. Model outputs for lesion detection, malignancy versus benign versus normal, precise histologic diagnosis, and urgency class were compared with histopathology and with 4 clinicians. Sensitivity, specificity, accuracy, and agreement were calculated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n AI\u2010Gemini achieved 97.1% accuracy for lesion detection and malignancy classification, with sensitivity 98.5% and specificity 96.2% for malignancy, and 88.0% accuracy for precise histologic diagnosis. The head and neck surgeon achieved the highest accuracy for precise diagnosis (97.7%). Three\u2010class diagnostic accuracy was 94.2% for AI\u2010Gemini and 67.0% to 86.5% for nonsurgeon clinicians. Urgency assignment was correct in 70% of cases (\n \u03ba<\/jats:italic>\n \u2009=\u20090.716), with a conservative tendency to overestimate risk. Agreement with histologic diagnosis was almost perfect (\n \u03ba<\/jats:italic>\n \u2009=\u20090.929).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In this exploratory study, a multimodal LLM showed encouraging performance in image\u2010based evaluation of oral mucosal lesions. However, given the exploratory single\u2010reader design, these findings should not be interpreted as evidence of equivalence or superiority relative to clinicians and require further prospective external validation before any potential clinical deployment in telemedicine or primary care settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ohn.70437","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T10:36:57Z","timestamp":1789987017000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Image\u2010Based Diagnosis of Oral Lesions: Performance of a Vision\u2010Language Model versus Human Clinicians"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7789-145X","authenticated-orcid":false,"given":"Luigi A.","family":"Vaira","sequence":"first","affiliation":[{"name":"Maxillofacial Surgery Operative Unit, Department of Medicine Surgery and Pharmacy University of Sassari Sassari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome R.","family":"Lechien","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mons School of Medicine, UMONS. Research Institute for Health Sciences and Technology University of Mons (UMons) Mons Belgium"},{"name":"Department of Otolaryngology\u2013Head Neck Surgery Elsan Polyclinic of Poitiers Poitiers France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Fabiola Giudici","sequence":"additional","affiliation":[{"name":"Unit of Cancer Epidemiology Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Gasparato","sequence":"additional","affiliation":[{"name":"Dental School University of Sassari Sassari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Maniaci","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery University of Enna Kore Enna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"De Vito","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Operative Unit, Department of Medicine, Surgery and Pharmacy University of Sassari Sassari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Maglitto","sequence":"additional","affiliation":[{"name":"Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science Federico II University of Naples Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Mayo\u2010Y\u00e1\u00f1ez","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology, Head and Neck Surgery Department Complexo Hospitalario Universitario A Coru\u00f1a (CHUAC), A Coru\u00f1a Galicia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Troise","sequence":"additional","affiliation":[{"name":"Head and Neck Section, Department of Neurosciences, Reproductive and Odontostomatological Science Federico II University of Naples Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos M.","family":"Chiesa\u2010Estomba","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head & Neck Surgery Hospital Universitario Donostia San Sebastian Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Gabriele","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, Department of Medical Biotechnologies University of Siena Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Frosolini","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit, Department of Medical Biotechnologies University of Siena Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Radulesco","sequence":"additional","affiliation":[{"name":"ENT\u2010HNS Department, Aix Marseille Univ, APHM, CNRS, IUSTI La Conception University Hospital Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiana","family":"Allevi","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Department, ASSt Santi Paolo e Carlo University of Milan Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentino","family":"Vellone","sequence":"additional","affiliation":[{"name":"Department of Life Science, Health, and Health Professions Universit\u00e0 degli Studi \u201cLink\u201d, 00a165 Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Committeri","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit Santa Maria Hospital Terni Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Spallaccia","sequence":"additional","affiliation":[{"name":"Maxillofacial Surgery Unit Santa Maria Hospital Terni Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Resi","family":"Pucci","sequence":"additional","affiliation":[{"name":"Head and Neck Department. San Camillo Hospital Oral and Maxillofacial Unit Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Consorti","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Division of Maxillofacial Surgery Marche University Hospitals\u2013Umberto I Ancona Italy"},{"name":"Department of Biomedical Sciences and Public Health Polytechnic University of Marche Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Cirignaco","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, Division of Maxillofacial Surgery Marche University Hospitals\u2013Umberto I Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Crimi","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical\u2010Surgical Specialties, School of Dentistry University of Catania Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marzia","family":"Petrocelli","sequence":"additional","affiliation":[{"name":"Oral and Maxillo\u2010Facial Unit AUSL Bologna Bellaria\u2010Maggiore Hospital Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora M.C.","family":"Trecca","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Maxillofacial Surgery, IRCCS Research, Hospital Casa Sollievo della Sofferenza San Giovanni Rotondo Foggia Italy"},{"name":"Department of Otorhinolaryngology University Hospital of Foggia, Head and Neck Surgery Foggia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giannicola","family":"Iannella","sequence":"additional","affiliation":[{"name":"Department of \u2018Organi di Senso\u2019 University \u201cLa Sapienza\u201d Rome 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