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MRI Better than Ultrasound, Mammography in Identifying Breast Cancer in High-Risk Women

By MedImaging staff writers
Posted on 15 Apr 2008

Investigators recently recommended that breast magnetic resonance imaging (MRI) should become a vital component of yearly breast cancer screening for high-risk women age 35 and older. Young women with a high genetic risk of breast cancer should start screening with breast MRI as young as age 25 or as early as age 20 if a family member had breast cancer before the age of 30.

Dr. Christopher Riedl, from the department of diagnostic radiology at the Medical University of Vienna (Austria) made these recommendations in March 2008 at the European Congress of Radiology (ECR), held in Vienna, Austria. He presented his study's findings that compared the accuracy of mammography, ultrasound, and breast MRI in detecting cancer in a cohort of 327 women who underwent 672 complete surveillance rounds at a single imaging center.

Between 1999 and 2007, 28 cancer lesions were identified. Of these, only breast MRI detected 12. Mammography detected 14 for a sensitivity of 50%, ultrasound detected 12 for 42.9% sensitivity, and breast MRI detected 24 for a sensitivity of 85.7%. In the 672 screening cycles, 136 suspicious findings (BI-RADS [Breast Imaging Reporting and Data System] 4 or 5) were detected, and all the lesions underwent needle-localized open breast biopsy. "We prefer to be aggressive with very high-risk patients,” Dr. Riedl said. About 80% of the lesions were benign.

Out of the women recruited between January 1999 to January 2001, 46 tested positive for the BRCA1 or BRCA2 gene. Starting January 2002, eligibility for the study was expanded to include women age 25 or older who had three or more first-degree relatives with breast cancer diagnosed before the age of 61, two relatives diagnosed before the age of 51, one relative diagnosed with breast cancer before the age of 36, or a relative diagnosed at any age with ovarian cancer. Women younger than age 25 with a relative who had cancer before that age were also eligible.

Women who had received treatment for breast or ovarian cancer were eligible to enroll after 12 months of treatment, unless they had metastatic disease. This expanded eligibility to a broader and more representative population of very high-risk women, according to Dr. Riedl.

The total population ranged in age from 22 to 80 years, with a median age of 41 years.
The women had annual mammograms, ultrasound, and breast MRI. Plans were made to schedule all three procedures on the same day. Young women were scheduled only during the second week of their menstrual cycle to lessen nonspecific, hormone-related enhancement of benign breast tissue. Women who failed to have the three procedures completed within 30 days were excluded from that specific screening cycle but their earlier and future completed screening rounds were evaluated.

During the course of the study, 27 of the 327 women were excluded during the course of the study because of bilateral mastectomy; 10 participants died, with five due to breast cancer and five to ovarian cancer. Mammograms were reviewed by a radiologist with 10 years of experience who knew of the women's risk factors. Breast MRI scans were reviewed by a different radiologist with 10 years of reading experience, and high-frequency ultrasound was done by one of two experienced radiologists. All radiologists were blinded to the results of the technique they were not interpreting.

In addition to detecting 42.9% of the cancers not seen in mammograms and ultrasound, breast MRI detected significantly more invasive and preinvasive cancers, according to Dr. Riedl. MRI alone identified five (54%) of the 11 cases of ductal carcinoma in situ. MRI was also better in diagnosing atypical ductal hyperplasia (ADH) lesions. Out of 35 of these premalignant lesions, 32 were detected by breast MRI alone; ultrasound detected two, and mammography detected nine.

The number of false-positive results was high, particularly for breast MRI. Mammography had 25 false-positives, ultrasound had 26, and MRI had 101. Dr. Riedl ascribed the high false-positive rate to the uncommonly high number of detected lesions classified as ADH. With this population, ADH detection is extremely important because it aids in further individual risk assessment, according to Dr. Riedl.

"For the population we studied, the question is not if these women will get cancer, but when,” Dr. Riedl concluded. "It is their personal choice about whether they wish to have prophylactic mastectomy, but we need to provide them with another alternative.”

Whether this population should not undergo mammography and ultrasound altogether, Dr. Riedl reported that this might be a future clinical protocol recommended for younger women at high risk of breast cancer, but at this time he could not definitively recommend it.

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57 (!!!!! 1774.0726470947): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

58 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

59 (158.07151794434): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

60 (79.154968261719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

61 (122.0703125): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (617.02728271484): SELECT fid FROM jos_deeppockets WHERE id=278240000 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=278240000 AND published='1' LIMIT 1

63 (459.90943908691): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

64 (60.081481933594): select jos_twitters.link from jos_twitters where cat=10

65 (36.954879760742): select jos_facebook.link from jos_facebook where cat=10

66 (37.908554077148): select jos_google_plus.link from jos_google_plus where cat=10

67 (39.100646972656): select jos_linkedin.link from jos_linkedin where cat=10

68 (40.054321289062): SELECT fid FROM jos_deeppockets WHERE id=278240000 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=278240000 AND published='1' LIMIT 1

69 (41.007995605469): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

70 (370.02563476562): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=278240000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (358.10470581055): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=278240000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (54.121017456055): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (65.088272094727): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (86.069107055664): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (68.902969360352): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=278240000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (41.007995605469): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=278240000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (45.061111450195): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (120.87821960449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

105 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

106 (66.995620727539): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=278240000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (68.902969360352): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=278240000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

109 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

110 (64.13459777832): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=278240000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (699.04327392578): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=278240000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (763.1778717041): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (533.8191986084): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (149.01161193848): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

115 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

116 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

117 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

118 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

119 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

120 (60.796737670898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

121 (86.784362792969): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

122 (432.96813964844): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 31072.13973999): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (644.92225646973): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=278240000 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=278240000 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 10250.091552734): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (103.95050048828): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (57.93571472168): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (40.054321289062): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (86.069107055664): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (51.021575927734): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (424.14665222168): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (107.0499420166): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (56.028366088867): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (43.153762817383): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (642.06123352051): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (472.06878662109): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (362.87307739258): SELECT name FROM jos_deeppockets WHERE id=212

138 (57.93571472168): SELECT name FROM jos_deeppockets WHERE id=212

139 (822.06726074219): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (743.15071105957): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

142 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

143 (!!!!! 10083.913803101): TRUNCATE TABLE jos_trademed_module

144 (122.0703125): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=278240000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (93.936920166016): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=278240000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (694.03648376465): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (96.08268737793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

149 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

150 (!!!!! 1616.9548034668): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

152 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

153 (55.789947509766): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=278240000 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=278240000 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (45.061111450195): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

155 (40.054321289062): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

156 (114.91775512695): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (459.90943908691): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

158 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=278240000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=278240000 AND published='1' LIMIT 1

159 (72.002410888672): select jos_twitters.link from jos_twitters where cat=10

160 (36.954879760742): select jos_facebook.link from jos_facebook where cat=10

161 (37.908554077148): select jos_google_plus.link from jos_google_plus where cat=10

162 (36.954879760742): select jos_linkedin.link from jos_linkedin where cat=10

163 (391.00646972656): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1184.9403381348): insert into jos_banners_delta values (14615,'2025-06-30 16:36:07','216.73.216.249','view'),(14202,'2025-06-30 16:36:07','216.73.216.249','view'),(14203,'2025-06-30 16:36:07','216.73.216.249','view')

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