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

Makoto Shiraishi; Yoshihiro Sowa; Koichi Tomita; Yasunobu Terao; Toshihiko Satake; Mayu Muto; Yuhei Morita; Shino Higai; Yoshihiro Toyohara; Yasue Kurokawa; Ataru Sunaga; Mutsumi Okazaki

doi:10.1007/s00266-024-04515-y

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

Aesthetic Plast Surg. 2024 Nov 26. doi: 10.1007/s00266-024-04515-y. Online ahead of print.

Authors

Makoto Shiraishi¹, Yoshihiro Sowa², Koichi Tomita³, Yasunobu Terao⁴, Toshihiko Satake⁵, Mayu Muto^{5

6

7}, Yuhei Morita^{8

9}, Shino Higai⁸, Yoshihiro Toyohara⁸, Yasue Kurokawa⁸, Ataru Sunaga⁸, Mutsumi Okazaki¹

Affiliations

¹ Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan.
² Department of Plastic Surgery, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi, Japan. ysowawan@gmail.com.
³ Department of Plastic and Reconstructive Surgery, Kindai University, Osaka, Japan.
⁴ Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
⁵ Department of Plastic, Reconstructive and Aesthetic Surgery, Toyama University Hospital, Toyama, Japan.
⁶ Lala Breast Reconstruction Clinic Yokohama, Yokohama, Japan.
⁷ Department of Plastic Surgery, Yokohama City University Medical Center, Yokohama, Japan.
⁸ Department of Plastic Surgery, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi, Japan.
⁹ Japanese Red Cross Koga Hospital, Koga, Japan.

PMID: 39592492
DOI: 10.1007/s00266-024-04515-y

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Level of evidence iv: 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 .

Keywords: Artificial intelligence; Breast implant; Breast reconstruction; ChatGPT; Grok.