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Ga-68 HER2-PET/CT images before neoadjuvant therapy, at end of second cycle, and before surgery. (A) Baseline scan demonstrated soft-tissue lesion measuring approximately 2.3 × 2.2 cm in upper outer quadrant of left breast, with marked radiotracer uptake and SUVmax of 10.1. (B) At end of second cycle, imaging revealed residual lesion of approximately 2.2 × 1.0 cm in same region, without abnormal radiotracer accumulation. (C) Preoperative imaging demonstrated further reduction in lesion size to approximately 2.0 × 0.6 cm, with no abnormal tracer uptake detected.
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Example cases illustrate the double-edged role of large language model (LLM) rationale quality. (A) A 50-year-old female patient with a palpable anterior chest wall mass (correct diagnosis: solitary fibrous tumor of the pleura). The LLM incorrectly suggested synovial sarcoma but provided a persuasive rationale (quality score: 4 of 5), describing a well-defined nodule at axial contrast-enhanced CT spanning the pleura and intercostal space with heterogeneous strong enhancement. Four of five readers (80%) accepted the incorrect suggestion. FDG = fluorodeoxyglucose. (B) A 61-year-old male patient with diabetes presented with cough, sputum, and dyspnea (correct diagnosis: mucormycosis). The LLM correctly suggested mucormycosis with an excellent rationale (quality score: 5 of 5), integrating the reverse halo sign on serial axial CT images and rapidly progressive cavitary lesions. Three of five readers initially selected incorrect diagnoses; after LLM output, all five selected the correct diagnosis (100% acceptance). Blue and orange reader icons denote high- and low-expertise readers, respectively.
Model confidence, reader expertise affect reader-LLM collaboration
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Lung Cancer
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Example cases illustrate the double-edged role of large language model (LLM) rationale quality. (A) A 50-year-old female patient with a palpable anterior chest wall mass (correct diagnosis: solitary fibrous tumor of the pleura). The LLM incorrectly suggested synovial sarcoma but provided a persuasive rationale (quality score: 4 of 5), describing a well-defined nodule at axial contrast-enhanced CT spanning the pleura and intercostal space with heterogeneous strong enhancement. Four of five readers (80%) accepted the incorrect suggestion. FDG = fluorodeoxyglucose. (B) A 61-year-old male patient with diabetes presented with cough, sputum, and dyspnea (correct diagnosis: mucormycosis). The LLM correctly suggested mucormycosis with an excellent rationale (quality score: 5 of 5), integrating the reverse halo sign on serial axial CT images and rapidly progressive cavitary lesions. Three of five readers initially selected incorrect diagnoses; after LLM output, all five selected the correct diagnosis (100% acceptance). Blue and orange reader icons denote high- and low-expertise readers, respectively.
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