Bioelectrical Impedance for Detecting Upper Limb Lymphedema in Nonlaboratory Settings

Abstract

Background Single-frequency bioelectrical impedance has been used in clinical and research settings to measure extracellular fluid in arms. Its ease of use and low risk of user error suggests this measurement method may have advantages for use in nonlaboratory (community-based) environments when compared to other measurement methods. The purpose of this study was to evaluate the feasibility of using single-frequency bioelectrical impedance to detect upper limb lymphedema in nonlaboratory settings. Methods and Results Using a standardized protocol, impedance ratios among healthy normal women, breast cancer survivors with lymphedema, and breast cancer survivors without lymphedema were compared with participants seated in an upright position conducive for use outside laboratory settings (community-based environments). Ratios of healthy normal controls and breast cancer survivor groups without lymphedema were very similar, with almost complete overlap in confidence intervals. However, those values were markedly different from the values assessed in the survivor group with lymphedema (p < 0.001). Conclusions These findings suggest impedance ratios determined by single-frequency bioelectrical impedance can be used as markers for lymphedema in nonlaboratory settings when a standardized protocol is used.

Bioelectrical Impedance Self-Measurement Protocol Development and Daily Variation Between Healthy Volunteers and Breast Cancer Survivors with Lymphedema

“…A SFBIA device manufactured by Impedimed (Mansfield, Australia) was used to measure extracellular fluid and provide L-Dex readings. 28 Protocol observation checklist and measurement log (lab and home versions). A checklist to guide evaluation of protocol understanding and volunteer adherence was used by staff.…”

“…27 The first author has used SFBIA in studies since 2002, and volunteers with breast cancer-related lymphedema have repeatedly asked to use these devices at home to monitor their arms. 28 Additionally, direct testing of the ability to selfmeasure using SFBIA was demonstrated by members of this research team in our laboratory. Therefore, due to participant requests to use the device for self-measurement, its demonstrated utility as a measurement method for arm lymphedema, and its ease of use compared to other methods, SFBIA was chosen as the proposed measurement method for this study.…”

Linfedema: métodos de medición y criterios diagnósticos

“…Su disponibilidad la convierte en la forma de medición más eficiente y utilizada a nivel clínico 6 . Aunque es evidente que diversos factores (tabla 1) pueden producir errores de medida [12][13][14] , numerosos estudios consideran que esta técnica es muy fiable tanto intraobservador como interobservador 6,[15][16][17][18][19][20][21][22] . Las medidas deben tomarse siempre en las dos extremidades porque cualquier cambio de tamaño en el miembro no afecto, ya sea fisiológico, sistémico o producido por el propio tratamiento, puede producir errores de apreciación 23 .…”

“…Sin embargo, es un método caro, poco extendido y con algunas deficiencias que complican la exploración (tabla 1). La extremidad debe mantenerse en alto, apoyando la mano o el pie sobre un soporte, lo que hace difícil obtener medidas cuando existen limitaciones articulares o el paciente no puede mantener el miembro estable durante la exploración 13,33 . Además, en muchos casos el aparato puede no valorar adecuadamente el edema del brazo o del muslo ya que el marco es estrecho y el aparato solo puede medir una longitud de 40 cm 33,34 .…”

“…En general se utiliza la bioimpedancia por espectroscopia que mide la impedancia en un espectro de múltiples frecuencias. La técnica se considera muy útil para la detección precoz del linfedema 13,15,[64][65][66] o para la monitorización de los primeros estadios de este, cuando los cambios consisten predominantemente en el volumen de fluido extracelular 64 . También se ha mostrado eficaz para detectar cambios tras programas de tratamiento 67 .…”