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Shear wave elastography detects novel imaging biomarkers of aromatase inhibitor–induced joint pain: a pilot study

Jessica A. Martinez1,2, Mihra S. Taljanovic3,4, Russell S. Witte1,5, Andres A. Nuncio Zuniga5, Betsy C. Wertheim1, C. Kent Kwoh3,6,7, Brian A. Goldstein5, Denise J. Roe1,8, Pavani Chalasani1,7

Affiliation and address for correspondence
J Ultrason 2021; 21: e1–e6
DOI: 10.15557/JoU.2021.0001
Abstract

Aim: To determine whether differences in joint and tendon stiffness as measured by ultrasound shear wave elastography are present in breast cancer patients with aromatase inhibitor- associated arthralgias compared to age-comparable healthy control women. Methods: Postmenopausal women with stage I–III breast cancer who were taking adjuvant aromatase inhibitors and complained of joint pain were enrolled (n = 6). Postmenopausal women with no history of breast cancer, hormone treatment, or joint pain served as controls (n = 7). All subjects had bilateral hands and wrists evaluated by gray-scale and power Doppler ultrasound, and shear wave elastography ultrasound. Results: Patients with AI-associated arthralgias had significantly stiffer tendons than controls in the 1st extensor compartment (long axis; p = 0.001), 4th extensor compartment (long axis; p = 0.014), 3rd metacarpophalangeal joint (p = 0.002), the pooled values of the extensor compartments, both long (p = 0.044) and short axes (p = 0.035), and the pooled values for the metacarpophalangeal joints (p = 0.002). On ultrasound, the patients (but not controls) presented with hyperemia and increased tenosynovial fluid in the flexor and extensor tendon sheaths, and the median nerves were symptomatic and bifid; however, these differences were not statistically significant. Conclusions: This is the first study to identify increased tendon stiffness as a putative physiological characteristic of aromatase inhibitor–associated arthralgias. Future studies should determine whether increased tendon stiffness is a risk factor for the development of aromatase inhibitor–associated arthralgias, or a result of aromatase inhibitor treatment.

Keywords
aromatase inhibitors, breast cancer, arthralgia, Doppler ultrasound, shear wave elastography