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SPECT/CT Technique Provides Improved Detection of Lymph Node Metastasis in Patients with Melanoma

By MedImaging International staff writers
Posted on 25 Sep 2012

Preoperative three-dimensional (3D) visualization of sentinel lymph nodes (SLNs) used with single-photon emission computed tomography/computed tomography (SPECT/CT) imaging was associated with a higher rate of identification of positive SLNs and a higher rate of disease-free survival among patients with melanoma, according to new findings.

The study’s findings were published in the September 12, 2012, issue of the Journal of the American Medical Association (JAMA). “Melanoma has become an increasing interdisciplinary public health challenge worldwide. According to the World Health Organization, the incidence of melanoma is increasing faster than any other cancer in the world. Melanoma is the third most common cancer in Australia and the fifth most common cancer in the United States. The American Cancer Society estimated that approximately 70,230 new melanomas were diagnosed in the United States during 2011, resulting in approximately 8,790 deaths,” reported the authors. “Because melanoma, depending on tumor depth, metastasizes early into regional lymph nodes, sentinel lymph node excision [SLNE] is probably the most important diagnostic and potentially therapeutic procedure for patients with melanoma. The histological status of the sentinel lymph node is the most relevant prognostic factor for overall survival in patients with melanoma, independent of primary tumor thickness.”

The investigators added that the recently introduced hybrid SPECT/CT imaging technology could help reduce the high false-negative rate of SLNE by providing additional anatomic data to the surgeon.

Ingo Stoffels, MD, of the University of Essen-Duisburg (Essen, Germany), and colleagues conducted a study to compare the link between SLNE with versus without preoperative SPECT/CT imaging and metastatic node detection and disease-free survival in patients with cutaneous melanoma. The study included use of a melanoma patient database to identify a group of 464 patients eligible for SLNE between March 2003 and April 2011. A total of 403 patients with clinically negative lymph nodes, who underwent SLNE with or without preoperative SPECT/CT, qualified for subsequent analysis. Between March 2003 and October 2008, 254 patients with melanoma underwent SLNE without preoperative SPECT/CT. Between November 2008 and April 2011 all sentinel node scintigraphies were performed as SPECT/CT in 149 patients. Using SPECT/CT allowed SLNE in the head and neck area more frequently (2.0% for standard vs. 23.5% for SPECT/CT).

A total of 833 SLNs were removed from 403 patients. The researchers detected 2.40 SLNs per patient in the SPECT/CT group and 1.87 SLNs per patient in the standard group; 51 of 358 excised SLNs (14.2%) in the SPECT/CT cohort and 54 of 475 SLNs (11.4%) in the standard cohort showed metastatic involvement. The scientists were able to identify 41 patients (27.5%) with positive SLNs in the SPECT/CT cohort and 48 (18.9%) with positive SLNs in the standard cohort. The number of positive SLNs per patient was significantly higher in the SPECT/CT cohort than in the standard cohort (0.34 vs. 0.21).

“The local relapse rate in the SPECT/CT cohort was lower than in the standard cohort (6.8% vs. 23.8%), which prolonged four-year disease-free survival (93.9% vs. 79.2%),” reported the researchers.

The researchers noted that with the SPECT/CT technique, they were able to use smaller incisions in the head and neck area as well as alternative entry points due to the exact anatomic localization of the SLN.

“In conclusion, the preoperative visualization of SLN with SPECT/CT is technically feasible and facilitates the detection of additional positive SLNs. The use of this technique offers the physician the preoperative possibility of determining the exact location and visualization of the SLN…,” the researchers wrote in their article. “In patients with cutaneous melanoma, the use of SPECT/CT-aided SLNE compared with SLNE alone was associated with higher detection of metastatic involvement and a higher rate of disease-free survival.”

Related Links:
University of Essen-Duisburg

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62 (625.1335144043): SELECT fid FROM jos_deeppockets WHERE id=294742656 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294742656 AND published='1' LIMIT 1

63 (429.86869812012): 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 (77.009201049805): select jos_twitters.link from jos_twitters where cat=10

65 (60.081481933594): select jos_facebook.link from jos_facebook where cat=10

66 (46.014785766602): select jos_google_plus.link from jos_google_plus where cat=10

67 (38.862228393555): select jos_linkedin.link from jos_linkedin where cat=10

68 (40.054321289062): SELECT fid FROM jos_deeppockets WHERE id=294742656 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294742656 AND published='1' LIMIT 1

69 (51.021575927734): 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 (434.16023254395): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742656 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (293.01643371582): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742656 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (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`

73 (92.029571533203): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (80.108642578125): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (67.949295043945): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742656 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (43.869018554688): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742656 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (49.114227294922): 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 (87.976455688477): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

105 (49.829483032227): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

106 (85.115432739258): 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=294742656 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (75.817108154297): 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=294742656 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=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

109 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

110 (77.962875366211): 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=294742656 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (730.03768920898): 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=294742656 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (908.85162353516): 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 (535.96496582031): 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 (164.98565673828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

115 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

116 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

117 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

118 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

119 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

120 (364.06517028809): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 58943.033218384): 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

122 (146.15058898926): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

123 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

124 (!!!!! 2187.967300415): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742656 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742656 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 642393.82743835): ( 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 (101.08947753906): ( 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 (408.88786315918): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (63.180923461914): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (288.96331787109): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (45.061111450195): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (154.97207641602): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (68.902969360352): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (543.11752319336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (488.9965057373): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (281.09550476074): SELECT name FROM jos_deeppockets WHERE id=213

136 (53.882598876953): SELECT name FROM jos_deeppockets WHERE id=213

137 (700.95062255859): 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

138 (653.02848815918): 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

139 (123.02398681641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

140 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

141 (!!!!! 24916.172027588): TRUNCATE TABLE jos_trademed_module

142 (!!!!! 4992.0082092285): 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=294742656 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (203.13262939453): 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=294742656 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (978.94668579102): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (699.04327392578): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (945.09124755859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

147 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

148 (!!!!! 1466.9895172119): 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

149 (94.890594482422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

150 (!!!!! 1019.9546813965): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

151 (751.01852416992): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742656 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742656 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (75.101852416992): 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)

153 (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=213 or channel_id is null)

154 (387.90702819824): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (!!!!! 3017.1871185303): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

156 (321.1498260498): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742656 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742656 AND published='1' LIMIT 1

157 (191.92695617676): select jos_twitters.link from jos_twitters where cat=10

158 (43.153762817383): select jos_facebook.link from jos_facebook where cat=10

159 (64.849853515625): select jos_google_plus.link from jos_google_plus where cat=10

160 (45.7763671875): select jos_linkedin.link from jos_linkedin where cat=10

161 (395.05958557129): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 12377.023696899): insert into jos_banners_delta values (14615,'2025-06-20 11:38:01','216.73.216.120','view'),(14202,'2025-06-20 11:38:01','216.73.216.120','view'),(14203,'2025-06-20 11:38:01','216.73.216.120','view')

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