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PET/CT may Improve Prognosis for Patients with Inflammatory Breast Cancer

By MedImaging International staff writers
Posted on 23 Feb 2009

In the largest study to date to evaluate fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) imaging in the initial staging of inflammatory breast cancer (IBC), researchers were able to identify the precise location and extent of metastasis, offering the potential for a better prognosis for patients with this rare, but aggressive form of breast cancer.

"PET/CT is useful in staging IBC because it provides information on both the primary disease site as well as disease involvement throughout the rest of the body,” stated Homer A. Macapinlac, M.D., chair and professor of nuclear medicine at the University of Texas, M.D. Anderson Cancer Center (Houston, TX, USA). "In addition to detecting the presence of cancer, PET/CT is able to demonstrate the biology of cancer--revealing how aggressive the disease is--which can help physicians develop appropriate therapy approaches.”

For the study, published in the February 2009 issue of The Journal of Nuclear Medicine (JNM), researchers reported findings in 41 women between the ages of 25 and 71 with unilateral primary IBC who had originally presented with swelling, some pain, and skin changes, such as rash and skin discoloration. A palpable mass was not evident on physical examination in 26 patients (63%), which is not unusual in this form of breast cancer, and 90% had no symptoms of distant metastasis.

Each patient underwent a whole-body FDG-PET/CT exam. The scans showed that nearly half of the patients (49%) had distant metastasis, and 27% had disease in multiple sites. Neither finding had been previously detected by conventional imaging. These results were validated by biopsy and supplementary imaging.

"Breast cancer is a systemic disease, not just a local one. Most imaging modalities are localized and will therefore miss the spread of disease that is frequently present by the time IBC is diagnosed,” Dr. Macapinlac said. "The use of a whole-body modality such as PET/CT with its higher sensitivity, however, allows us to pinpoint metastasis in other parts of the body; for example, behind the clavicle, which can not be detected in a physical exam, or in the abdominal organs or pelvic lymph nodes.”

IBC tends to grow more quickly and aggressively than the more common types of breast cancer. Upon diagnosis, it is already considered to be at least stage IIIB (locally advanced) and even stage IV if it has metastasized to distant parts of the body. Because of this, IBC has been harder to successfully treat than other types of breast cancer. Knowing the extent of the disease at the start could have a great impact on the outcome for many patients, Dr. Macapinlac added.

"With FDG-PET/CT, physicians are able to accurately determine the location of metastases early in the disease process when appropriate treatment can be administered. Furthermore, a PET/CT procedure for IBC patients may be less than or equivalent to the total cost of separately imaging multiple organs and would require a single hospital visit and decreased imaging time when compared to the time required for a battery of regional staging studies,” Dr. Macapinlac said.

The researchers would like to see future studies that use PET/CT earlier in the process and also to track therapy response to determine whether or not it is succeeding.

"Knowing the extent of disease "up front has great implication for prognosis,” Dr. Macapinlac said. "IBC is a treatable disease. The sooner we can determine the extent, the sooner we can begin aggressive therapy.”

PET provides information about how the body is functioning at the cellular level, while CT provides an anatomic rendering of the inside of the body. In an FDG-PET/CT scan, the CT first generates detailed images of the inner anatomy of the body. The patient is then injected with a small amount of a radioactive drug, which is F-18-labeled glucose, and PET is performed. Because fast-growing cancer cells feed on sugars such as glucose, PET/CT delineates areas where the glucose accumulates in the body, identifying the location of cancer cells.

According to the American Cancer Society, IBC accounts for approximately 1-3% of all breast cancers diagnosed in the United States. It tends to occur in younger women, and African-Americans appear to be at higher risk. Physicians call the disease inflammatory breast cancer because the affected breast displays the same symptoms that occur with inflammation. However, the symptoms of IBC are not caused by infection or injury, but by cancer cells blocking lymph vessels in the skin. Patients frequently do not have a breast lump, and symptoms may not show up on a mammogram. Because it does not look like a typical breast tumor, the disease can be more difficult to detect.

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University of Texas, M.D. Anderson Cancer Center

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58 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

59 (181.91337585449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

60 (84.161758422852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

61 (148.05793762207): 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 (635.86235046387): SELECT fid FROM jos_deeppockets WHERE id=294722143 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722143 AND published='1' LIMIT 1

63 (56.028366088867): 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=213 ORDER BY `ordering`

64 (87.02278137207): select jos_twitters.link from jos_twitters where cat=10

65 (46.014785766602): select jos_facebook.link from jos_facebook where cat=10

66 (47.206878662109): select jos_google_plus.link from jos_google_plus where cat=10

67 (44.107437133789): select jos_linkedin.link from jos_linkedin where cat=10

68 (56.982040405273): SELECT fid FROM jos_deeppockets WHERE id=294722143 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722143 AND published='1' LIMIT 1

69 (50.067901611328): 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=213 ORDER BY `ordering`

70 (503.0632019043): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722143 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (403.88107299805): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722143 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (79.870223999023): 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 (54.836273193359): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (52.928924560547): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722143 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (31.948089599609): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722143 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (36.001205444336): 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 (140.90538024902): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (62.942504882812): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (54.121017456055): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

105 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

106 (98.943710327148): 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=294722143 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (74.148178100586): 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=294722143 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (150.91896057129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

109 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

110 (87.02278137207): 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=294722143 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (780.82084655762): 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=294722143 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (660.89630126953): 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 (367.16461181641): 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 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

115 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

116 (106.8115234375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

117 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

118 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

119 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

120 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

121 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

122 (255.10787963867): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 26402.950286865): 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 (642.06123352051): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722143 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722143 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 9952.0683288574): ( 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 (148.05793762207): ( 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 (81.062316894531): 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 (46.968460083008): 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 (88.930130004883): 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 (47.922134399414): 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 (368.11828613281): 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 (61.03515625): 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 (61.03515625): 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 (41.961669921875): 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 (438.92860412598): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (334.02442932129): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (46.968460083008): SELECT name FROM jos_deeppockets WHERE id=213

138 (31.948089599609): SELECT name FROM jos_deeppockets WHERE id=213

139 (629.90188598633): 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 '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (545.97854614258): 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 '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

142 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

143 (!!!!! 12926.10168457): TRUNCATE TABLE jos_trademed_module

144 (167.1314239502): 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=294722143 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (90.837478637695): 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=294722143 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (671.8635559082): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (98.943710327148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

149 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

150 (!!!!! 1784.086227417): 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 (128.98445129395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

152 (85.830688476562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

153 (81.062316894531): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722143 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722143 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (49.114227294922): 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=213 or channel_id is null)

155 (42.915344238281): 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=213 or channel_id is null)

156 (71.048736572266): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (106.0962677002): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

158 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722143 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722143 AND published='1' LIMIT 1

159 (53.882598876953): select jos_twitters.link from jos_twitters where cat=10

160 (40.054321289062): select jos_facebook.link from jos_facebook where cat=10

161 (51.975250244141): select jos_google_plus.link from jos_google_plus where cat=10

162 (58.889389038086): select jos_linkedin.link from jos_linkedin where cat=10

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