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Benefits of PET or PET/CT Imaging Unproven in Recurrent Bowel Cancer

By MedImaging International staff writers
Posted on 08 Jan 2013

For patients with a suspected recurrence of bowel cancer, recent available study data allow no clear conclusions as to the advantages and disadvantages of utilizing positron emission tomography (PET) imaging, either alone or in combination with computed tomography (CT).

These findings are resulted from the fact that there no studies have directly compared the benefits of these imaging techniques in recurrent colorectal carcinoma (bowel cancer) with traditional diagnostic techniques. Although PET or PET/CT show a higher diagnostic accuracy (i.e., in specific instance), recurrences can be detected more effectively, it is still not clear how this actually affects patient-relevant outcomes such as quality of life. This was the conclusion of the final report of the German Institute for Quality and Efficiency in Health Care (IQWiG; Cologne, Germany), published on October 24, 2012.

Bowel cancer is the second most common cancerous tumor in both men and women. Yearly, more than 65,000 people are diagnosed with the disease in Germany and more than 25,000 die from it annually. Approximately 80% of the recurrences occur in the first two years after surgery for bowel cancer. After five years, virtually no more recurrences were detected. These can occur at the original site—the bowel—or as secondary tumors (metastases), for example, in the liver. Follow-up after surgery should therefore continue for five years.

Many specialists hope that when a recurrence is suspected, using PET or PET/CT scanning alone or in combination with other methods is better able to differentiate between benign and malignant tumors (recurrence diagnostics) and, if confirmed, to categorize the stage of malignant tumors appropriately ( i.e., to determine how advanced the cancer is [recurrence staging]). This information should provide patients with better treatment recommendations.

IQWiG searched the international literature for studies that had examined the consequences of a diagnostic intervention using PET or PET/CT on health aspects of direct pertinence to patients. For example, the diagnostic investigation findings--and suitably customized treatment--could contribute to better chances of survival for patients, save them from unnecessary operations or additional diagnostic interventions, or improve their quality of life.

For the preliminary report, IQWiG had already made an additional search for studies in which the diagnostic accuracy and prognostic capacity of PET or PET/CT had been compared with other diagnostic techniques. This referred to the question as to how frequently a PET study provides a correct finding.

The findings of a total of five evidence syntheses and 13 individual studies regarding this question could be assessed. The conclusion on recurrence detection was that PET and PET/CT appear capable of detecting or excluding recurrences more effectively than a traditional diagnostic intervention consisting solely or mostly on CT findings. This applies especially to local recurrences and distant metastases. It is not possible to state with conviction whether PET and PET/CT vary in terms of their diagnostic accuracy.

Significant questions in relation to PET technology remain unresolved. It has not yet been studied, for example, whether the higher accuracy of PET or PET/CT has a positive effect on mortality, the burden of disease, or quality of life. As long as this lack of data remains, a patient-relevant benefit of PET or of PET/CT as an adjunct to a suspicion-driven diagnostic study with traditional modalities is not validated. For instance, it is particularly not known whether a recurrence detected by using PET or PET/CT can actually be better treated and thereby generate a noticeable advantage for patients. Experts are therefore keenly awaiting the results of a Canadian study with more than 400 patients, which is to be published shortly.

Stefan Lange, the deputy director of IQWiG, commented on the new data gleaned by IQWiG during the evaluation procedure of the study on laparotomies, “The fact that the only benefit study on PET turned out to be unsuitable is extremely regrettable. The rupture of the logical link between diagnosis and treatment devalued the study results.”

As Mr. Lange explained, a fundamental principle of medicine is that a diagnostic intervention is only of benefit if it enables patients to receive more customized treatment.

Related Links:
German Institute for Quality and Efficiency in Health Care

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60 (174.04556274414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

61 (!!!!! 5165.1000976562): 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 (819.20623779297): SELECT fid FROM jos_deeppockets WHERE id=294744127 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744127 AND published='1' LIMIT 1

63 (492.09594726562): 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 (!!!!! 2483.8447570801): select jos_twitters.link from jos_twitters where cat=10

65 (102.04315185547): select jos_facebook.link from jos_facebook where cat=10

66 (125.88500976562): select jos_google_plus.link from jos_google_plus where cat=10

67 (47.922134399414): select jos_linkedin.link from jos_linkedin where cat=10

68 (87.02278137207): SELECT fid FROM jos_deeppockets WHERE id=294744127 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744127 AND published='1' LIMIT 1

69 (53.882598876953): 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 (472.06878662109): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744127 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (397.92060852051): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744127 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (97.036361694336): 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 (224.11346435547): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (70.095062255859): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (262.02201843262): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (56.028366088867): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (490.90385437012): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (190.97328186035): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (402.21214294434): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (!!!!! 1311.0637664795): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (60.081481933594): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (176.90658569336): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (233.17337036133): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (278.94973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (562.19100952148): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 4688.024520874): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744127 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (83.92333984375): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744127 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (64.13459777832): 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 (!!!!! 4321.0983276367): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (92.983245849609): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (!!!!! 5392.0745849609): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (!!!!! 3887.8917694092): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (519.99092102051): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (!!!!! 1724.9584197998): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (238.18016052246): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (886.91711425781): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (!!!!! 4070.9972381592): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (477.07557678223): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (!!!!! 1856.0886383057): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (354.05158996582): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (149.96528625488): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 3513.0977630615): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

105 (!!!!! 1147.0317840576): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

106 (!!!!! 5167.0074462891): 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=294744127 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (246.04797363281): 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=294744127 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1553.0586242676): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

109 (987.05291748047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

110 (86.069107055664): 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=294744127 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 2629.0416717529): 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=294744127 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1898.0503082275): 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 (689.02969360352): 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 (176.90658569336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

115 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

116 (133.99124145508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

117 (113.96408081055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

118 (113.96408081055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

119 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

120 (110.14938354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

121 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

122 (378.13186645508): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 234421.01478577): 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 (!!!!! 1537.0845794678): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744127 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744127 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 94107.866287231): ( 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 (!!!!! 7980.1082611084): ( 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 (!!!!! 7741.9281005859): 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 (187.87384033203): 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 (556.94580078125): 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 (61.988830566406): 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 (428.91502380371): 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 (!!!!! 1477.0030975342): 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 (73.909759521484): 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 (52.928924560547): 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 (529.05082702637): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (447.98851013184): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (179.05235290527): SELECT name FROM jos_deeppockets WHERE id=213

138 (43.153762817383): SELECT name FROM jos_deeppockets WHERE id=213

139 (800.84800720215): 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 (848.05488586426): 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 (174.99923706055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

142 (141.85905456543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

143 (!!!!! 9534.1205596924): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 2415.1802062988): 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=294744127 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (119.92454528809): 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=294744127 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (884.05609130859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (111.10305786133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (159.97886657715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

149 (104.18891906738): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

150 (!!!!! 2002.9544830322): 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 (!!!!! 2931.1180114746): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

152 (142.81272888184): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

153 (92.029571533203): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744127 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744127 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (698.08959960938): 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 (108.00361633301): 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 (73.909759521484): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (190.97328186035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

158 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744127 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744127 AND published='1' LIMIT 1

159 (51.021575927734): select jos_twitters.link from jos_twitters where cat=10

160 (32.901763916016): select jos_facebook.link from jos_facebook where cat=10

161 (35.04753112793): select jos_google_plus.link from jos_google_plus where cat=10

162 (36.001205444336): select jos_linkedin.link from jos_linkedin where cat=10

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