Performance of latest AI models, RAG, and MCP on lung cancer-related questions.

[BACKGROUND] Large language models (LLMs) have advanced rapidly. However, concerns remain regarding their reliability in clinical settings due to the inherent issues of hallucinations and inadequate referencing.

[MATERIALS AND METHODS] We evaluated six current LLMs: GPT-4.1 (GPT), o3, Gemini-2.5-Pro-Preview-0506 (Gemini), Grok-3 (Grok), Qwen3-235B-A22B (Qwen3), and Claude Sonnet 4 (Claude), as well as two technologies that extend LLM capabilities using external knowledge bases: retrieval-augmented generation (RAG) and Model Context Protocol (MCP). Each model was evaluated using 50 questions selected from a 132-question pool developed based on the Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2024 Edition). Three models-Qwen, GPT, and Grok-were further analyzed to assess performance changes with RAG and MCP integration. All responses were independently reviewed by two qualitative evaluators.

[RESULTS] Overall, o3 achieved the highest accuracy (50%), followed by GPT (48%) and Gemini (48%), then Grok (44%), Qwen (40%), and Claude (36%). However, implementing RAG (LLM-RAG) or MCP (LLM-MCP) significantly improved accuracy, with statistical differences observed between baseline LLMs and their RAG- or MCP-enhanced counterparts. Lexical richness and semantic noise both diminished, whereas the semantic clarity and accuracy of verbs, noun-verb combinations, and content words improved.

[CONCLUSIONS] The six latest LLMs performed similarly on lung cancer-related questions. The integration of RAG or MCP significantly enhanced accuracy while simplifying sentence structure, focusing more on the main topics, and using more accurate vocabulary.