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PET/CT Found Effective in Detection of Breast Cancer Metastases

By MedImaging International staff writers
Posted on 29 Sep 2010

Results from a recent retrospective study suggest that positron emission tomography/computed tomography (PET/CT) scanning might offer the most efficient and effective detection of newly diagnosed breast cancer that has metastasized to the bone. The new findings may mean less stress and more timely therapy for patients, and could make the longtime use of radionuclide bone scans for breast cancer obsolete in this setting.

Approximately one-third of women diagnosed with early-stage breast cancer will have their cancer metastasize to other parts of the body, with the bone being the most common site of initial detectable spread. Controversy continues as to whether CT and bone scans should be standard in evaluating patients for these metastases, or whether integrated PET/CT scanning might be more effective at detecting breast tumors that have reached neighboring bones. Of the about 200,000 cases of early stage breast cancer diagnosed in the United States each year, one in three will eventually metastasize to other areas of the body. In nearly half of these women, the first detectable distant site is the bone. (Distant sites can include any location in the body other than the lymph nodes located closest to the primary tumor.) Yet there is no standard approach for the detection of such metastases.

Bone scans, PET, and CT all continue to be used alone or in combination for the detection of breast cancers suspected to have spread. In some cases, physicians use all three imaging techniques. Each has its own strengths. For example, bone scans detect bony regions in the process of growth or repair, which can be a sign of metastatic disease. PET, on the other hand, evaluates abnormalities of biochemical activity in the body, such as cells that metabolize glucose unusually fast. Such features are a hallmark of a cancer cell. Meanwhile, CT generates anatomic images that can help physicians isolate and analyze the size and shape of tumors.

With one machine, simultaneous PET/CT draws on the strengths of each tool to both detect and locate abnormal and potentially cancerous cells. Moreover, its diagnostic reach can go beyond the bone. "In contrast with bone scans, which are only able to detect bone metastases, PET/CT has the advantage of concurrently imaging other common sites of breast cancer metastases such as the liver and lungs,” said lead author Patrick Morris, a breast cancer specialist at Memorial Sloan-Kettering Cancer Center (New York, NY, USA). "Therefore, PET/CT may not only be superior to bone scan for the detection of bone metastases, it may also be more convenient for patients.”

To find out whether PET/CT can be strong enough to abandon the need for additional testing and bone scans are simply redundant, the collaborative team identified 163 women with suspected metastatic breast cancer who had been evaluated by both PET/CT and bone scans at Memorial Sloan-Kettering between January 2003 and June 2008. As reported in the study, published in the June 2010 issue of the Journal of Clinical Oncology, the investigators compared the images and, when possible, correlated them with confirmatory biopsy results.

The majority of the dual tests were in agreement, leaving just 31 cases (19%) conflicting. In only two of these cases did a bone scan reach a positive result when the PET/CT did not, and neither woman received a subsequent confirmation of metastases. Of the remaining mismatched pairs, a majority represented cases of a PET/CT catching tumors that a bone scan missed. Dr. Morris estimates that some metastases could have been found by up to three or four months earlier using PET/CT instead of a bone scan. Furthermore, PET/CT uncovered cancer's spread outside the bone in 62% of patients in the study, which was led by senior author Dr. Heather McArthur, a breast cancer oncologist at Memorial Sloan-Kettering.

This improved accuracy and efficiency over older imaging applications may help patients and their clinicians save time and money, as well as emotional and physical pain. "False-positive radiology findings without a biopsy confirmation can lead to inappropriate therapeutic interventions and significant distress for the patient,” Dr. Morris noted. "False- negative findings, on the other hand, may result in delayed therapy, symptoms, and altered quality of life. Therefore, the development of a simple, reliable, and convenient test for imaging patients with suspected metastatic breast cancer is desirable.”

Dr. Morris added that the findings should be interpreted with caution, and that a long-term study with a more generalizable patient population would help validate the best method of metastases detection. "If this data holds true in a prospective trial, the issue can be laid to rest and PET/CT could replace CT plus bone scan,” noted Maxine Jochelson, director of radiology for the Breast and Imaging Center and a coauthor on the paper.

The interdepartmental research team, which also included Steve Larson, chief of the Nuclear Medicine Service at Memorial Sloan-Kettering, and Dr. McArthur, is currently working on the design of just such a trial. "We encourage patients to consider participating in these and future trials to examine the optimum imaging approach,” concluded Dr. Morris.

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Memorial Sloan-Kettering Cancer Center

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56 (601.76849365234): 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=294731357 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1163.9595031738): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

58 (!!!!! 3726.0055541992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

59 (!!!!! 3553.1520843506): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

60 (139.23645019531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

61 (366.9261932373): 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 (439.88227844238): SELECT fid FROM jos_deeppockets WHERE id=294731357 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294731357 AND published='1' LIMIT 1

63 (298.02322387695): 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 (327.82554626465): select jos_twitters.link from jos_twitters where cat=10

65 (283.95652770996): select jos_facebook.link from jos_facebook where cat=10

66 (195.98007202148): select jos_google_plus.link from jos_google_plus where cat=10

67 (468.96934509277): select jos_linkedin.link from jos_linkedin where cat=10

68 (!!!!! 1049.0417480469): SELECT fid FROM jos_deeppockets WHERE id=294731357 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294731357 AND published='1' LIMIT 1

69 (!!!!! 3600.1205444336): 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 (372.88665771484): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294731357 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (229.1202545166): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294731357 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 1127.0046234131): 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 (!!!!! 4399.0612030029): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (490.90385437012): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (!!!!! 2044.9161529541): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (290.1554107666): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (293.97010803223): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (!!!!! 1297.9507446289): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (388.14544677734): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (148.05793762207): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (595.8080291748): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (82.015991210938): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 1111.0305786133): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294731357 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (376.93977355957): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294731357 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (173.80714416504): 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 (530.95817565918): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (!!!!! 4070.0435638428): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (256.06155395508): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (58.889389038086): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (94.890594482422): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (31.232833862305): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 2005.1002502441): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

105 (160.21728515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

106 (94.890594482422): 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=294731357 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (107.0499420166): 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=294731357 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1029.0145874023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

109 (216.00723266602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

110 (66.041946411133): 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=294731357 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (626.80244445801): 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=294731357 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (827.07405090332): 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 (485.89706420898): 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 (114.91775512695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

115 (111.10305786133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

116 (124.93133544922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

117 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

118 (68.187713623047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

119 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

120 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

121 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

122 (226.97448730469): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 179924.96490479): 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 (!!!!! 6659.0309143066): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294731357 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294731357 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 68937.063217163): ( 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 (!!!!! 2718.9254760742): ( 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 (166.17774963379): 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 (224.82872009277): 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 (41.961669921875): 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 (30.040740966797): 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 (530.95817565918): 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 (!!!!! 2485.990524292): 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 (!!!!! 1158.9527130127): 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 (195.98007202148): 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 (475.88348388672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (507.11631774902): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (61.988830566406): SELECT name FROM jos_deeppockets WHERE id=213

138 (38.862228393555): SELECT name FROM jos_deeppockets WHERE id=213

139 (802.04010009766): 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 (750.78010559082): 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 (!!!!! 3064.8708343506): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

142 (69.856643676758): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

143 (!!!!! 20102.977752686): TRUNCATE TABLE jos_trademed_module

144 (560.99891662598): 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=294731357 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (180.95970153809): 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=294731357 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1581.9072723389): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 5729.9137115479): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

149 (803.94744873047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

150 (!!!!! 2054.9297332764): 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 (143.05114746094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

152 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

153 (39.100646972656): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294731357 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294731357 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (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=213 or channel_id is null)

155 (37.193298339844): 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 (34.093856811523): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 4209.9952697754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

158 (!!!!! 2398.9677429199): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294731357 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294731357 AND published='1' LIMIT 1

159 (!!!!! 3192.9016113281): select jos_twitters.link from jos_twitters where cat=10

160 (!!!!! 3353.1188964844): select jos_facebook.link from jos_facebook where cat=10

161 (!!!!! 1080.0361633301): select jos_google_plus.link from jos_google_plus where cat=10

162 (293.97010803223): select jos_linkedin.link from jos_linkedin where cat=10

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