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Inku Hwang

Publications and source records attributed to Inku Hwang.

10 recordsLinked to original sources
PubMed2006

The cost-effectiveness of CT colonography in screening for colorectal neoplasia.

BACKGROUND: We examined the cost-effectiveness of 2- and 3-dimensional computerized tomography (CT) colonography as a screening test for colorectal neoplasia. METHODS: We created a Markov model of the natural history of colorectal cancer. Effectiveness of screening was based upon the diagnostic accuracy of tests in detecting polyps and cancer. RESULTS: CT colonography every 5 or 10 yr was effective and cost-effective relative to no screening. Optical colonoscopy dominates 2-dimensional CT colonography done every 5 or 10 yr. Optical colonoscopy is weakly dominant over 3-dimensional CT colonography done every 10 yr. 3-D CT colonography done every 5 yr is more effective than optical colonoscopy every 10 yr, but costs an incremental 156,000 dollars per life-year gained. Sensitivity analyses show that test costs, accuracy, and adherence are critical determinants of incremental cost-effectiveness. 3-D CT colonography every 5 yr is a dominant strategy if optical colonoscopy costs 1.6 times more than CT colonography. However, optical colonoscopy is a dominant strategy if the sensitivity of CT colonography for 1 cm adenomas is 83% or lower. CONCLUSIONS: CT colonography is an effective screening test for colorectal neoplasia. However, it is more expensive and generally less effective than optical colonoscopy. CT colonography can be reasonably cost-effective when the diagnostic accuracy of CT colonography is high, as with primary 3-dimensional technology, and if costs are about 60% of those of optical colonoscopy. Overall, CT colonography technology will need to improve its accuracy and reliability to be a cost-effective screening option.

Aged↗
PubMed2004

Nonadenomatous polyps at CT colonography: prevalence, size distribution, and detection rates.

PURPOSE: To prospectively investigate with computed tomographic (CT) colonography the prevalence and size distribution of nonadenomatous polyps in asymptomatic adults and to compare the detection rates of adenomatous and nonadenomatous polyps. MATERIALS AND METHODS: A total of 1233 asymptomatic adults (mean age, 57.8 years; 505 women, 728 men) underwent same-day CT colonography and optical colonoscopy procedures. CT colonoscopy studies were interpreted prospectively with a primary three-dimensional approach immediately before optical colonoscopy. Statistical analysis was performed with the chi(2) test. Size, prevalence, and by-polyp detection differences were compared between adenomatous and nonadenomatous polyps. RESULTS: Seven hundred fifty-six (57.7%) colorectal polyps identified at optical colonoscopy in 410 (33.3%) patients were nonadenomatous; of these lesions, 622 (82.3%) were diminutive (</=5 mm). Nonadenomatous polyps accounted for 622 (64.4%) of 966 diminutive lesions and 134 (39.9%) of 344 polyps 6 mm or larger (P <.001). The prevalence rate for nonadenomatous polyps was 8.8% (109 of 1233 patients) and 2.0% (25 of 1233 patients) at 6- and 10-mm thresholds, respectively. CT colonography by-polyp sensitivity for nonadenomatous lesions was 73.1% (98 of 134 patients) and 73.3% (22 of 30 patients) at 6- and 10-mm thresholds, respectively, compared with 85.7% (180 of 210 patients) and 92.2% (47 of 51 patients) for adenomas (P <.01). In 1065 patients that did not have a 6-mm or larger adenoma at optical colonoscopy, CT colonography depicted a nonadenomatous polyp that was 6 mm or larger in 63 (5.9%) patients and a nonadenomatous polyp that was 10 mm or larger in 15 (1.4%) patients. CONCLUSION: More than 80% of nonadenomatous polyps were diminutive, but they accounted for nearly 40% of polyps that were 6 mm or larger. Fortunately, CT colonography is significantly (P <.01) less sensitive in the detection of lesions that have no malignant potential when compared with similar-sized adenomas that have malignant potential.

Aged↗
PubMed2003

Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults.

BACKGROUND: We evaluated the performance characteristics of computed tomographic (CT) virtual colonoscopy for the detection of colorectal neoplasia in an average-risk screening population. METHODS: A total of 1233 asymptomatic adults (mean age, 57.8 years) underwent same-day virtual and optical colonoscopy. Radiologists used the three-dimensional endoluminal display for the initial detection of polyps on CT virtual colonoscopy. For the initial examination of each colonic segment, the colonoscopists were unaware of the findings on virtual colonoscopy, which were revealed to them before any subsequent reexamination. The sensitivity and specificity of virtual colonoscopy and the sensitivity of optical colonoscopy were calculated with the use of the findings of the final, unblinded optical colonoscopy as the reference standard. RESULTS: The sensitivity of virtual colonoscopy for adenomatous polyps was 93.8 percent for polyps at least 10 mm in diameter, 93.9 percent for polyps at least 8 mm in diameter, and 88.7 percent for polyps at least 6 mm in diameter. The sensitivity of optical colonoscopy for adenomatous polyps was 87.5 percent, 91.5 percent, and 92.3 percent for the three sizes of polyps, respectively. The specificity of virtual colonoscopy for adenomatous polyps was 96.0 percent for polyps at least 10 mm in diameter, 92.2 percent for polyps at least 8 mm in diameter, and 79.6 percent for polyps at least 6 mm in diameter. Two polyps were malignant; both were detected on virtual colonoscopy, and one of them was missed on optical colonoscopy before the results on virtual colonoscopy were revealed. CONCLUSIONS: CT virtual colonoscopy with the use of a three-dimensional approach is an accurate screening method for the detection of colorectal neoplasia in asymptomatic average-risk adults and compares favorably with optical colonoscopy in terms of the detection of clinically relevant lesions.

Adenoma↗
PubMed2002

"Ecstasy"-induced hepatitis in an active duty soldier.

3,4-Methylenedioxymethamphetamine, or "Ecstasy," is a drug commonly used at "rave" parties to heighten energy and intimacy. Although its complications have been well described in Europe, including less common side effects such as hepatic failure and rhabdomyolysis, physicians in the United States have less experience with this drug because of the shorter duration of its use in this country. We present a case of an active duty soldier who was admitted for acute hepatitis secondary to Ecstasy ingestion and describe its proposed pathophysiology. We believe that with the increased use of Ecstasy in the United States, especially among younger patients, including soldiers, military physicians will need to be more familiar with this potentially deadly drug.

Adult↗