BSGAR BSUR observational study of mesenteric panniculitis.

Those of you present at the inaugural combined BSGAR – BSUR meeting in Liverpool this year may remember me floatig an observational study of mesenteric panniculitis (MP). All of you are familiar with the MP problem: Diagnosed on CT by radiologists, a postulated association with lymphoma (about which there is a ton of debate), followed by endless questions from referrers about whether follow-up is necessary or not, and with what frequency? A systematic review by us concluded that, “No available study can determine an association between MP and subsequent malignancy with certainty” (European Radiology 2016;26:4531-7). This was primarily because available evidence is mostly retrospective and single centre.

So, we would like to do a prospective observational study of MP that provides, at least, a start to answering some basic questions: Notably how frequent is MP (and what imaging strategies, if any, do we use for follow-up?), and is subsequent malignancy genuinely increased? At the moment all we ask of you is this:

1: A commitment to record locally the name, hospital number and date of CT scan of any individual patient you diagnose with MP over the coming New Year, i.e. 1st January 2020 to 31st December 2020 inclusive (the numerator). We are NOT presently requesting patient data transfer of any description, so you can start thinking about this when you sit in front of your workstation on Jan 2nd (or even Jan 1st for those unfortunates on-call…).

 2: A commitment to provide an estimate of the total number of abdomino-pelvic CT scans interpreted by you during 2020 (i.e. the denominator).

3: An email from you stating that you are potentially interested in helping. Your name (e.g. in the subject line) and hospital is probably all we need for now. Please email to:

panniculitis@ucl.ac.uk

Return emails from that inbox will be from “Med.Panniculitis”.

Please understand we are NOT asking you to report MP if your practice ignores it currently, nor are we asking you to follow-up patients if you don’t do that either. Please continue with your current practice, simply noting those patients who you think have MP. Early in the New Year I will write a formal study protocol and disseminate to all those expressing interest. That will clarify methods, primary and secondary study endpoints, and the information required subsequently regarding your patients, and the ethical permissions around this (which is effectively an audit). I will also investigate how we might link to cancer registries. We will also assemble a definitions set, so that we can be clear (or as clear as we can be) regarding what constitutes MP on CT. And we need a study acronym! This acronym will be used to identify the author “group” under which all participating radiologists will be named, so you will get PUBMED citable publications from helping us.

Because each of us diagnose relatively few cases of MP individually, burden should be very minimal (unless you have a pretty low threshold for diagnosing MP!), but our collective power will hopefully provide many subjects. BSGAR/BSUR members have already completed some fabulous NHS multicenter studies that have generated practice-changing evidence: I hope we can do this once more. Thanks for considering this request.

With Best Wishes

Steve Halligan

Professor of Radiology, UCL.