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Transvaginal Ultrasound Detects Endometrial Cancer Before Symptoms Arise

By MedImaging International staff writers
Posted on 11 Jan 2011

Transvaginal ultrasound screening (TVS) has good (80% - 90%) sensitivity and specificity at detecting endometrial cancer before symptoms appear in postmenopausal women, according to the first large-scale study to evaluate the performance of TVS screening for endometrial cancer. However, the findings revealed that additional research to assess acceptability, health economics, and risk are needed before routine population screening or targeted screening for endometrial cancer can be advocated.

The study's findings were published online December 2010 in the journal the Lancet Oncology. Endometrial cancer is the most common gynecologic cancer. However, because of the good prognosis of patients with endometrial cancer compared with other cancers, few studies have been done to assess the benefits of screening in asymptomatic women. However, increasing obesity, falling fertility, and an aging population suggest that incidence will continue to rise.

Up to now, no screening test to detect early stage endometrial cancer in asymptomatic women has been shown to be effective. Measuring endometrial thickness with TVS has been suggested as a potential screening method.

To investigate the performance of TVS screening on a large scale, a team led by Ian Jacobs from the University College London (UK), analyzed data from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). As part of the trial, TVS was performed on 37,038 postmenopausal women. The researchers calculated the performance characteristics of endometrial thickness (ET) and endometrial abnormalities at detecting endometrial cancer within one year of TVS screening, and examined the sensitivity and specificity of TVS for different risk groups. Modeling using epidemiologic variables was performed to assess a screening strategy for women at higher risk.

In the 133 women diagnosed with endometrial cancer or atypical endometrial hyperplasia (AEH) within one year of screening, 107 (81%) had an ET of 5 mm or greater. Most of the 36,731 women who did not have cancer had an ET of less than 5 mm. At the optimum ET cutoff of 5.15 mm, TVS would detect 80.5% of cancer cases (sensitivity) and would have a 14.3% false-positive rate (85.7% specificity). Using this threshold, if the entire population was screened, one case of endometrial cancer would be detected for every 47.7 women.

The authors pointed out that although the number of false-positives could be reduced considerably by increasing the cutoff for ET, this would result in a corresponding fall in sensitivity. An increased cutoff of 10 mm would identify 54.1% of cancer cases with 97.2% specificity, and 17 women would undergo further procedures to detect each case of endometrial cancer.

When the analysis was restricted to the 96 women with cancer who reported no symptoms of postmenopausal bleeding at the scan, an ET cutoff of 5 mm was able to detect 77.1% of women who developed cancer with a 14.2% false-positive rate.

Moreover, the modeling analysis detected 25% of the population as at high risk, and this high-risk group included 40% of endometrial cancer or AEH cases. In this group, the optimum ET cutoff of 6.75 mm would detect 84.3% of cancer cases and achieve a specificity of 89.9%. According to the researchers, "this would reduce the burden of screening to 25% of the population with detection of about 40% of the cases.”

The researchers reported, "A targeted screening approach might help reduce the overall number of false-positive findings while maintaining a high sensitivity.” They concluded, "Although the role of population screening for endometrial cancer remains uncertain, the findings are of immediate value in the management of increased endometrial thickness in postmenopausal women undergoing pelvic scans for reasons other than vaginal bleeding...Our findings provide the basis for further studies to assess the acceptability, health economics, and risk stratification.”

In a comment in the same issue, Dr. Ignace Vergote and colleagues from University Hospitals Leuven (Leuven, Belgium) cautioned that the findings do not prove "a benefit for screening for endometrial cancer because of an absence of survival data. The study...provides important ultrasonographic endometrial findings in asymptomatic postmenopausal women, but screening for endometrial cancer with ultrasonography has not been sufficiently proven to be beneficial because of the high cost, the prevalence of cancers that are not clinically relevant or hyperplasia, the number of unnecessary surgical interventions and associated morbidity, the presence of clinically detected symptoms such as bleeding that happen at an early stage in many women with endometrial cancer, and the absence of prospective randomized trial data that show a survival benefit in screened patients.”

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55 (!!!!! 3659.0099334717): 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=294732890 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

56 (720.97778320312): 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=294732890 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 3992.0806884766): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

58 (!!!!! 3243.9231872559): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

59 (!!!!! 5350.8281707764): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

60 (299.93057250977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

61 (962.97264099121): 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 (997.06649780273): SELECT fid FROM jos_deeppockets WHERE id=294732890 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294732890 AND published='1' LIMIT 1

63 (56.028366088867): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

64 (!!!!! 3193.8552856445): select jos_twitters.link from jos_twitters where cat=10

65 (61.03515625): select jos_facebook.link from jos_facebook where cat=10

66 (44.107437133789): select jos_google_plus.link from jos_google_plus where cat=10

67 (41.007995605469): select jos_linkedin.link from jos_linkedin where cat=10

68 (!!!!! 4734.992980957): SELECT fid FROM jos_deeppockets WHERE id=294732890 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294732890 AND published='1' LIMIT 1

69 (474.92980957031): 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=214 ORDER BY `ordering`

70 (!!!!! 3571.9871520996): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294732890 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (573.15826416016): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294732890 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (461.81678771973): 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 (764.13154602051): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (56.028366088867): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (306.84471130371): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (202.17895507812): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (242.94853210449): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (240.08750915527): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (230.07392883301): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (616.07360839844): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294732890 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (429.15344238281): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294732890 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (247.00164794922): 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 (497.10273742676): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (82.015991210938): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (!!!!! 6336.9274139404): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (!!!!! 1288.1755828857): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (233.88862609863): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (95.844268798828): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (!!!!! 3710.9851837158): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (218.15299987793): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (98.943710327148): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (64.13459777832): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (218.86825561523): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (!!!!! 5043.0297851562): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (!!!!! 3224.8497009277): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 4645.824432373): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

105 (!!!!! 2484.0831756592): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

106 (97.990036010742): 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=294732890 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (859.02214050293): 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=294732890 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1276.0162353516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

109 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

110 (109.19570922852): 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=294732890 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (746.01173400879): 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=294732890 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (809.90791320801): 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 (!!!!! 2238.9888763428): 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 (134.94491577148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

115 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

116 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

117 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

118 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

119 (144.00482177734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

120 (169.03877258301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

121 (75.817108154297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

122 (580.78765869141): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 75227.975845337): 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 (732.1834564209): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294732890 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294732890 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 24240.970611572): ( 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 (66.995620727539): ( 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 (277.04238891602): 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 (295.16220092773): 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 (861.88316345215): 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 (61.03515625): 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 (387.19177246094): 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 (54.836273193359): 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 (452.99530029297): 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 (51.975250244141): 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 (!!!!! 7817.9836273193): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 1308.9179992676): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (66.995620727539): SELECT name FROM jos_deeppockets WHERE id=214

138 (40.054321289062): SELECT name FROM jos_deeppockets WHERE id=214

139 (890.97023010254): 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 '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (694.03648376465): 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 '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 2475.0232696533): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

142 (91.075897216797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

143 (!!!!! 15048.027038574): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 7659.912109375): 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=294732890 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 6965.160369873): 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=294732890 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 4052.8774261475): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (!!!!! 7463.9320373535): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 4235.9828948975): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

149 (!!!!! 1515.1500701904): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

150 (!!!!! 3463.0298614502): 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 (692.84439086914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

152 (368.11828613281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

153 (497.10273742676): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294732890 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294732890 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (56.028366088867): 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=214 or channel_id is null)

155 (41.007995605469): 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=214 or channel_id is null)

156 (310.89782714844): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 3753.1852722168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

158 (!!!!! 1052.8564453125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294732890 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294732890 AND published='1' LIMIT 1

159 (775.09880065918): select jos_twitters.link from jos_twitters where cat=10

160 (574.11193847656): select jos_facebook.link from jos_facebook where cat=10

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

162 (40.054321289062): select jos_linkedin.link from jos_linkedin where cat=10

163 (!!!!! 1547.09815979): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

164 (!!!!! 1472.9499816895): insert into jos_banners_delta values (14202,'2025-08-12 15:42:46','216.73.216.186','view'),(14203,'2025-08-12 15:42:46','216.73.216.186','view')

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