Assessment of bilateral limb lymphedema by bioelectrical impedance spectroscopy

Leigh Ward, Ann Winall, Elizabeth Isenring, Andrew Hills, Sharon Czerniec, Elizabeth Dylke, Sharon Kilbreath

Research output: Contribution to journalArticleResearchpeer-review

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Abstract

OBJECTIVE: The aim of the present study was to determine if the ratio of extracellular fluid (ECF), including the lymph, to that of intracellular fluid (ICF), as measured by bioimpedance spectroscopy (BIS), could be used to assess bilateral lymphedema (LE).

BACKGROUND: The presence of LE is commonly determined as an increase in tissue volume due to the presence of excess lymph relative to the volume of a comparable unaffected body region or to comparative normative data. However, in bilateral LE of the limbs, a comparable body region, the contralateral limb, is also affected, precluding normalization. An alternative is to normalize the increase in lymph volume, as ECF, to that of ICF volume.

METHODS: Extracellular/intracellular fluid ratios, expressed as the ratio of intracellular impedance (Ri) to extracellular impedance (R0), for the limbs of 277 female and 224 male controls were determined from an accumulated database of impedance data. Equivalent data were obtained for an opportunistic cross-sectional sample of 37 female and 5 male participants with bilateral LE of the legs. The ratios of Ri/R0 in the lymphedematous legs of the affected participants were compared with the equivalent ratios in the unaffected arms of the same participants and with those of the controls using box plots and visualized as bivariate data using tolerance ellipses.

RESULTS: Despite Ri/R0 ratios varying with age, sex, and limb dominance, comparison of the ratio for affected legs (normalized to the ratio in the unaffected arms) with equivalent ratios observed in a control population (as bivariate tolerance plots) was capable of discriminating between 70% and 89% of the participants with LE.

CONCLUSIONS: Bioelectrical impedance spectroscopy and determination of Ri/R0 ratios as indices of ECF/ICF ratios holds promise for the semiquantitative assessment of bilateral LE.

Original languageEnglish
Pages (from-to)409-18
Number of pages10
JournalInternational Journal of Gynecological Cancer
Volume21
Issue number2
DOIs
Publication statusPublished - Feb 2011
Externally publishedYes

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Dielectric Spectroscopy
Lymphedema
Electric Impedance
Intracellular Fluid
Extremities
Extracellular Fluid
Lymph
Leg
Body Regions
Arm
Spectrum Analysis
Databases
Population

Cite this

Ward, Leigh ; Winall, Ann ; Isenring, Elizabeth ; Hills, Andrew ; Czerniec, Sharon ; Dylke, Elizabeth ; Kilbreath, Sharon. / Assessment of bilateral limb lymphedema by bioelectrical impedance spectroscopy. In: International Journal of Gynecological Cancer. 2011 ; Vol. 21, No. 2. pp. 409-18.
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abstract = "OBJECTIVE: The aim of the present study was to determine if the ratio of extracellular fluid (ECF), including the lymph, to that of intracellular fluid (ICF), as measured by bioimpedance spectroscopy (BIS), could be used to assess bilateral lymphedema (LE).BACKGROUND: The presence of LE is commonly determined as an increase in tissue volume due to the presence of excess lymph relative to the volume of a comparable unaffected body region or to comparative normative data. However, in bilateral LE of the limbs, a comparable body region, the contralateral limb, is also affected, precluding normalization. An alternative is to normalize the increase in lymph volume, as ECF, to that of ICF volume.METHODS: Extracellular/intracellular fluid ratios, expressed as the ratio of intracellular impedance (Ri) to extracellular impedance (R0), for the limbs of 277 female and 224 male controls were determined from an accumulated database of impedance data. Equivalent data were obtained for an opportunistic cross-sectional sample of 37 female and 5 male participants with bilateral LE of the legs. The ratios of Ri/R0 in the lymphedematous legs of the affected participants were compared with the equivalent ratios in the unaffected arms of the same participants and with those of the controls using box plots and visualized as bivariate data using tolerance ellipses.RESULTS: Despite Ri/R0 ratios varying with age, sex, and limb dominance, comparison of the ratio for affected legs (normalized to the ratio in the unaffected arms) with equivalent ratios observed in a control population (as bivariate tolerance plots) was capable of discriminating between 70{\%} and 89{\%} of the participants with LE.CONCLUSIONS: Bioelectrical impedance spectroscopy and determination of Ri/R0 ratios as indices of ECF/ICF ratios holds promise for the semiquantitative assessment of bilateral LE.",
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Assessment of bilateral limb lymphedema by bioelectrical impedance spectroscopy. / Ward, Leigh; Winall, Ann; Isenring, Elizabeth; Hills, Andrew; Czerniec, Sharon; Dylke, Elizabeth; Kilbreath, Sharon.

In: International Journal of Gynecological Cancer, Vol. 21, No. 2, 02.2011, p. 409-18.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Assessment of bilateral limb lymphedema by bioelectrical impedance spectroscopy

AU - Ward, Leigh

AU - Winall, Ann

AU - Isenring, Elizabeth

AU - Hills, Andrew

AU - Czerniec, Sharon

AU - Dylke, Elizabeth

AU - Kilbreath, Sharon

PY - 2011/2

Y1 - 2011/2

N2 - OBJECTIVE: The aim of the present study was to determine if the ratio of extracellular fluid (ECF), including the lymph, to that of intracellular fluid (ICF), as measured by bioimpedance spectroscopy (BIS), could be used to assess bilateral lymphedema (LE).BACKGROUND: The presence of LE is commonly determined as an increase in tissue volume due to the presence of excess lymph relative to the volume of a comparable unaffected body region or to comparative normative data. However, in bilateral LE of the limbs, a comparable body region, the contralateral limb, is also affected, precluding normalization. An alternative is to normalize the increase in lymph volume, as ECF, to that of ICF volume.METHODS: Extracellular/intracellular fluid ratios, expressed as the ratio of intracellular impedance (Ri) to extracellular impedance (R0), for the limbs of 277 female and 224 male controls were determined from an accumulated database of impedance data. Equivalent data were obtained for an opportunistic cross-sectional sample of 37 female and 5 male participants with bilateral LE of the legs. The ratios of Ri/R0 in the lymphedematous legs of the affected participants were compared with the equivalent ratios in the unaffected arms of the same participants and with those of the controls using box plots and visualized as bivariate data using tolerance ellipses.RESULTS: Despite Ri/R0 ratios varying with age, sex, and limb dominance, comparison of the ratio for affected legs (normalized to the ratio in the unaffected arms) with equivalent ratios observed in a control population (as bivariate tolerance plots) was capable of discriminating between 70% and 89% of the participants with LE.CONCLUSIONS: Bioelectrical impedance spectroscopy and determination of Ri/R0 ratios as indices of ECF/ICF ratios holds promise for the semiquantitative assessment of bilateral LE.

AB - OBJECTIVE: The aim of the present study was to determine if the ratio of extracellular fluid (ECF), including the lymph, to that of intracellular fluid (ICF), as measured by bioimpedance spectroscopy (BIS), could be used to assess bilateral lymphedema (LE).BACKGROUND: The presence of LE is commonly determined as an increase in tissue volume due to the presence of excess lymph relative to the volume of a comparable unaffected body region or to comparative normative data. However, in bilateral LE of the limbs, a comparable body region, the contralateral limb, is also affected, precluding normalization. An alternative is to normalize the increase in lymph volume, as ECF, to that of ICF volume.METHODS: Extracellular/intracellular fluid ratios, expressed as the ratio of intracellular impedance (Ri) to extracellular impedance (R0), for the limbs of 277 female and 224 male controls were determined from an accumulated database of impedance data. Equivalent data were obtained for an opportunistic cross-sectional sample of 37 female and 5 male participants with bilateral LE of the legs. The ratios of Ri/R0 in the lymphedematous legs of the affected participants were compared with the equivalent ratios in the unaffected arms of the same participants and with those of the controls using box plots and visualized as bivariate data using tolerance ellipses.RESULTS: Despite Ri/R0 ratios varying with age, sex, and limb dominance, comparison of the ratio for affected legs (normalized to the ratio in the unaffected arms) with equivalent ratios observed in a control population (as bivariate tolerance plots) was capable of discriminating between 70% and 89% of the participants with LE.CONCLUSIONS: Bioelectrical impedance spectroscopy and determination of Ri/R0 ratios as indices of ECF/ICF ratios holds promise for the semiquantitative assessment of bilateral LE.

U2 - 10.1097/IGC.0b013e31820866e1

DO - 10.1097/IGC.0b013e31820866e1

M3 - Article

VL - 21

SP - 409

EP - 418

JO - International Journal of Gynecological Cancer

JF - International Journal of Gynecological Cancer

SN - 1048-891X

IS - 2

ER -