Performance of Artificial Intelligence Chatbots in Answering Clinical Questions on Japanese Practical Guidelines for Implant-based Breast Reconstruction

Artificial intelligence (AI) chatbots, including ChatGPT-4 (GPT-4) and Grok-1 (Grok), have been shown to be potentially useful in several medical fields, but have not been examined in plastic and aesthetic surgery. The aim of this study is to evaluate the responses of these AI chatbots for clinical questions (CQs) related to the guidelines for implant-based breast reconstruction (IBBR) published by the Japan Society of Plastic and Reconstructive Surgery (JSPRS) in 2021. CQs in the JSPRS guidelines were used as question sources. Responses from two AI chatbots, GPT-4 and Grok, were evaluated for accuracy, informativeness, and readability by five Japanese Board-certified breast reconstruction specialists and five Japanese clinical fellows of plastic surgery. GPT-4 outperformed Grok significantly in terms of accuracy (p < 0.001), informativeness (p < 0.001), and readability (p < 0.001) when evaluated by plastic surgery fellows. Compared to the original guidelines, Grok scored significantly lower in all three areas (all p < 0.001). The accuracy of GPT-4 was rated to be significantly higher based on scores given by plastic surgery fellows compared to those of breast reconstruction specialists (p = 0.012), whereas there was no significant difference between these scores for Grok. The study suggests that GPT-4 has the potential to assist in interpreting and applying clinical guidelines for IBBR but importantly there is still a risk that AI chatbots can misinform. Further studies are needed to understand the broader role of current and future AI chatbots in breast reconstruction surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .