Abstract 3728: Imaging biomarkers of aromatase-inhibitor induced joint pain

Estrogen receptor positive (ER+) breast cancer patients undergoing treatment with aromatase inhibitors (AI) tend to discontinue the supplement when to painful side effects appear. It is believed that women with AI-induced musculoskeletal syndrome (AIMSS) have specific physiological conditions that differentiate them from women with normal aging-related inflammatory processes (e.g., rheumatoid arthritis or RA). Ultrasound shear wave elastography (USWE) provides a real-time, quantitative assessment of the elastic modulus of soft tissue, which is a potential biomarker that is altered in women with AIMSS. Because USWE is a completely noninvasive technique available on state-of-the-art clinical ultrasound scanners, it can be readily applied to study patients who undergo AI treatment and help predict adverse effects during therapy. A Siemens s3000 clinical scanner and 9 MHz linear probe were used for USWE of the hands and wrists in postmenopausal women on AI, postmenopausal women with RA and healthy postmenopausal women. The scans included an evaluation of major wrist tendons, nerve, and joints with shear wave velocities ranging from 0.5 to 15 m/s, which are directly related to the local shear modulus – an absolute measure of tissue stiffness. The ultrasound images and raw shear wave data were then analyzed in MATLAB-TM using a custom graphical user interface (GUI) to calculate the distribution of velocities (or shear moduli) in a user-defined region of interest (ROI). The results were exported to a spreadsheet in Excel for further analysis and comparison among the different groups. Initial results suggest the shear wave velocity and estimated Young’s modulus (λ) were significantly higher in AI patients (14.6 ± 0.2 m/s, λ=642 ± 17 kPa) compared to RA (6.84 ± 1.1 m/s, λ=143 ± 43 kPa) and healthy (7.58 ± 0.9 m/s, λ=174 ± 42 kPa) patients. These values suggest that the mechanical properties of tendons in the wrist may change during treatment with AI and contribute to joint pain in these subjects. It is critical that ER+ patients on AI complete their full treatment. As a potential biomarker of AIMSS and associated pain, USWE may help predict which patients are most susceptible to these side effects, promote early intervention to reduce or eliminate symptoms, and help increase adherence to AI therapy. Citation Format: Brian A. Goldstein, Mihra Taljanovic, Pavani Chalasani, C. Kent Kwoh, Amanda Hadden, Russell Witte, Jessica Martinez. Imaging biomarkers of aromatase-inhibitor induced joint pain [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3728. doi:10.1158/1538-7445.AM2017-3728