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New Guidelines for the Use of Breast MRI to Supplement Conventional Imaging

By MedImaging International staff writers
Posted on 11 Mar 2009

Updated guidelines for physicians that represent best practices for using magnetic resonance imaging (MRI) to newly diagnose breast cancer and to make treatment decisions for breast cancer have just been published.

Breast radiologists and surgeons at the Seattle Cancer Care Alliance (SCCA; WA, USA) and the Roswell Park Cancer Institute (Buffalo, NY, USA) authored the report, published in the February 2009 issue of the Journal of the National Comprehensive Cancer Network (JNCCN), upon which the guidelines are based.

The SCCA breast imaging program, led by Connie Lehman, M.D., has established itself as a national leader in breast MRI-based on pioneering research it has published in the past few years. Lehman is corresponding author of the study, which summarizes an extensive review of published, peer-reviewed studies.

Among the key recommendations: (1) MRI is not a substitute for screening or diagnostic mammography, and when indicated, diagnostic breast ultrasound. MRI supplements the use of these standard-imaging tools in appropriately selected clinical situations. (2) For women with diagnosed breast cancer, MRI provides enhanced detection in both the breast known to have cancer and the opposite (contralateral) breast. (3) Surgical decisions should not be based solely on MRI findings because not all suspicious lesions on MRI are cancer. Suspicious lesions should be biopsied before a surgery plan is devised in order to avoid surgical overtreatment. (4) In the rare instances where cancer is found in the lymph nodes but not the breast, an MRI can find the location of cancer in the breast in nearly 60% of women.

"Exciting research over the past decade makes it clear that breast MRI finds cancers that are missed by mammography and ultrasound,” said Dr. Lehman, who is the director of radiology at the SCCA and a professor at the University of Washington School of Medicine (Seattle, USA). "The next phase of research is to understand more completely the impact of this improved cancer detection on treatment outcomes.”

Breast MRI is a comparatively new clinical tool for detecting breast cancer and techniques for using the sensitive equipment vary by site. Dr. Lehman and colleagues urge that clear standards for technical parameters be established, as well as performance measures at clinical sites that offer MRI.

"Healthcare policy decisions regarding the use of important but expensive technology must be based upon evidence that these tools are providing measurable benefit to patients,” Dr. Anderson noted. "This study provides that evidence for breast MRI.”

The MRI guidelines adopted by the U.S. National Comprehensive Cancer Network (NCCN; Fort Washington, PA, USA), an alliance of 21 of the world's leading cancer centers, working together to develop treatment guidelines for most cancers, and focused on research that improves the quality, effectiveness, and efficiency of cancer care, state that MRI examinations should be performed and interpreted by an expert breast-imaging team working together with a multidisciplinary diagnosis and treatment team. Breast MRI exams require dedicated equipment and breast-imaging radiologists who are familiar with the technical details for image interpretation. The NCCN guidelines also say that imaging centers need to have the ability to perform MRI-guided needle biopsy sampling of lesions detected by MRI to properly evaluate possible abnormalities.

Related Links:
Seattle Cancer Care Alliance
Roswell Park Cancer Institute

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60 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

61 (84.161758422852): 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 (490.18859863281): SELECT fid FROM jos_deeppockets WHERE id=294722355 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722355 AND published='1' LIMIT 1

63 (43.869018554688): 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 (44.822692871094): select jos_twitters.link from jos_twitters where cat=10

65 (28.848648071289): select jos_facebook.link from jos_facebook where cat=10

66 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

67 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

68 (36.954879760742): SELECT fid FROM jos_deeppockets WHERE id=294722355 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722355 AND published='1' LIMIT 1

69 (30.994415283203): 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 (392.91381835938): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722355 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (328.06396484375): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722355 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (48.87580871582): 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 (54.121017456055): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (66.041946411133): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722355 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (37.908554077148): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722355 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (42.915344238281): 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 (81.062316894531): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

105 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

106 (51.021575927734): 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=294722355 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (47.922134399414): 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=294722355 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (80.82389831543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

109 (69.856643676758): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

110 (48.87580871582): 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=294722355 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (545.02487182617): 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=294722355 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (720.97778320312): 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 (530.00450134277): 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 (181.19812011719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

115 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

116 (65.803527832031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

117 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

118 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

119 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

120 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

121 (36.001205444336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

122 (420.09353637695): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 22839.784622192): 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 (813.96102905273): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722355 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722355 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 10242.938995361): ( 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 (149.96528625488): ( 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 (77.962875366211): 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 (51.021575927734): 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 (80.108642578125): 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 (49.114227294922): 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 (514.98413085938): 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 (75.101852416992): 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 (58.174133300781): 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 (47.922134399414): 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 (781.05926513672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (608.20579528809): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (56.982040405273): SELECT name FROM jos_deeppockets WHERE id=212

138 (41.961669921875): SELECT name FROM jos_deeppockets WHERE id=212

139 (971.07887268066): 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 (998.02017211914): 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 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

142 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

143 (!!!!! 31606.912612915): TRUNCATE TABLE jos_trademed_module

144 (191.92695617676): 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=294722355 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (99.897384643555): 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=294722355 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (753.87954711914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (293.97010803223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

149 (327.11029052734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

150 (!!!!! 2479.076385498): 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 (126.12342834473): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

152 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

153 (962.0189666748): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722355 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722355 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (66.995620727539): 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 (46.968460083008): 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 (58.174133300781): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (226.02081298828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

158 (226.02081298828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722355 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722355 AND published='1' LIMIT 1

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

160 (44.107437133789): select jos_facebook.link from jos_facebook where cat=10

161 (41.961669921875): select jos_google_plus.link from jos_google_plus where cat=10

162 (41.007995605469): select jos_linkedin.link from jos_linkedin where cat=10

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