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Redefining a Positive CT Finding for Lung Cancer May Slash Radiation Risks and Unneeded Surgery

By MedImaging International staff writers
Posted on 12 Mar 2013

Amending a key measure used to define positive test findings in baseline computed tomography (CT) imaging screening for lung cancer could help decrease the prospect of “further diagnostic work-up.”

The new study was conducted by investigators from the Icahn School of Medicine at Mount Sinai (New York, NY, USA), and is the latest data from the International Early Lung Cancer Action Program (I-ELCAP). The findings were published February 19, 2013, in the journal Annals of Internal Medicine.

In CT screening for lung cancer, the positive result of the initial low-dose CT indicates whether further diagnostic work-up is needed before the first arranged repeated screening. Currently, the researchers’ threshold for defining a positive result is 5 mm. Employing a threshold of 7 mm or 8 mm to define a positive lung cancer result in a baseline round of CT could significantly decrease unnecessary workup of nodules that are not cancerous. However, additional future research is required to determine the extent to which increasing the threshold may postpone diagnosis of cancer in some patients.

“Over the past decade, due to advancements in CT technology and our increased knowledge, the frequency of identifying a noncalcified nodule [NCN] of any size on the initial baseline CT scan has almost tripled, said Claudia I. Henschke, PhD, MD, professor of radiology at the Icahn School of Medicine at Mount Sinai and I-ELCAP principal investigator. “Using too small of a measurement to define a positive result may cause excessive diagnostic work-up and unnecessary treatment, while using too large of a measurement may delay diagnosis. We feel that nodule size, including volume, remains the most useful and reproducible metric of the most benefit to our patient population. Just as the definition of a positive result has been revised in the past to reflect updated data, we feel it is again time to use the information at our disposal to create a more restrictive definition.”

Researchers reviewed medical records for a cohort of 21,136 patients who had a baseline CT conducted between 2006 and 2010 to evaluate how using a more restrictive threshold in the baseline round of screening would affect the number of positive findings and delayed diagnoses. Of the study participants undergoing baseline screenings, 57% had at least one NCN discovered. Using the current designation of 5 mm, 16% (3,396 of the 21,136 patients) had a positive result of the baseline screening. Among those whose largest nodule was between 5–9 mm, eight were detected with lung cancer within 12 months of baseline enrollment. Increasing the threshold to 6, 7, 8, and 9 mm would have lowered the frequency to 10%, 7%, 5%, and 4%, respectively, therefore decreasing additional work-up by 36%, 56%, 68%, and 75%, respectively.

“Changing the size threshold for a positive screening could help reduce the harms associated with unnecessary work-up,” said Dr. Henschke. “I can’t say with certainty what the best definition of a positive result is, but our data provide the basis for contemplation and reevaluation.”

I-ELCAP is an international collaborative group of more than 60 participating institutes comprised of specialists on lung cancer-related disorders. Earlier studies from the group revealed that lung cancers identified through CT screening have an 80% estimated cure rate compared to a 10% cure rate for lung cancers detected in the clinical setting in the absence of screening.

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Icahn School of Medicine at Mount Sinai

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62 (797.03330993652): SELECT fid FROM jos_deeppockets WHERE id=294745166 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294745166 AND published='1' LIMIT 1

63 (111.10305786133): 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=211 ORDER BY `ordering`

64 (536.91864013672): select jos_twitters.link from jos_twitters where cat=10

65 (36.954879760742): select jos_facebook.link from jos_facebook where cat=10

66 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

67 (29.087066650391): select jos_linkedin.link from jos_linkedin where cat=10

68 (272.03559875488): SELECT fid FROM jos_deeppockets WHERE id=294745166 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294745166 AND published='1' LIMIT 1

69 (413.17939758301): 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=211 ORDER BY `ordering`

70 (822.06726074219): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294745166 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (378.84712219238): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294745166 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (58.174133300781): 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 (100.85105895996): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (118.01719665527): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (59.127807617188): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (!!!!! 2739.9063110352): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (84.877014160156): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (75.817108154297): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (121.11663818359): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (65.088272094727): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (92.029571533203): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (100.85105895996): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294745166 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (52.928924560547): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294745166 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (56.982040405273): 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 (102.99682617188): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (57.93571472168): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (59.843063354492): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (!!!!! 1452.9228210449): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (94.890594482422): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 1765.0127410889): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

105 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

106 (55.074691772461): 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=294745166 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (812.05368041992): 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=294745166 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (237.22648620605): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

109 (105.14259338379): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

110 (108.95729064941): 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=294745166 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (958.91952514648): 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=294745166 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (647.06802368164): 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 (!!!!! 2313.8523101807): 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 (115.87142944336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

115 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

116 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

117 (39.815902709961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

118 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

119 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

120 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

121 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

122 (375.98609924316): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 44342.041015625): 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 (591.03965759277): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294745166 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294745166 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 19197.940826416): ( 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 (70.095062255859): ( 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 (49.114227294922): 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 (33.855438232422): 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 (43.869018554688): 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 (36.001205444336): 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 (430.10711669922): 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 (42.915344238281): 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 (57.93571472168): 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 (35.04753112793): 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 (466.10832214355): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (372.88665771484): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (89.883804321289): SELECT name FROM jos_deeppockets WHERE id=211

138 (32.186508178711): SELECT name FROM jos_deeppockets WHERE id=211

139 (557.89947509766): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (508.06999206543): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

142 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

143 (!!!!! 13904.094696045): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 3045.0820922852): 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=294745166 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (153.0647277832): 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=294745166 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (540.97175598145): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 1555.9196472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

149 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

150 (!!!!! 1340.1508331299): 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 (!!!!! 3769.1593170166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

152 (151.15737915039): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

153 (52.928924560547): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294745166 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294745166 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (36.001205444336): 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=211 or channel_id is null)

155 (31.948089599609): 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=211 or channel_id is null)

156 (34.093856811523): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (96.797943115234): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

158 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745166 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745166 AND published='1' LIMIT 1

159 (905.03692626953): select jos_twitters.link from jos_twitters where cat=10

160 (37.908554077148): select jos_facebook.link from jos_facebook where cat=10

161 (32.901763916016): select jos_google_plus.link from jos_google_plus where cat=10

162 (28.848648071289): select jos_linkedin.link from jos_linkedin where cat=10

163 (302.79159545898): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1646.9955444336): insert into jos_banners_delta values (14615,'2025-08-19 10:35:54','216.73.216.0','view'),(14202,'2025-08-19 10:35:54','216.73.216.0','view'),(14203,'2025-08-19 10:35:54','216.73.216.0','view')

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