A Bioimpedance Spectroscopy-Based Method for Diagnosis of Lower-Limb Lymphedema

Megan L. Steele, Monika Janda, Dimitrios Vagenas, Leigh Ward, Bruce H. Cornish, Robyn Box, Susan Gordon, Melanie Matthews, Sally Poppitt, Lindsay D. Plank, Wilson Yip, Angela Rowan, Hildegard Reul-Hirche, Andreas Obermair, Sandra Hayes

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


Background: This study aimed at testing whether arm-to-leg ratios of extracellular water (ECW) and ECW normalized to intracellular water (ICW), measured by bioimpedance spectroscopy (BIS), can accurately detect bilateral, lower-limb lymphedema, and whether accounting for sex, age, and body mass index (BMI) improves the diagnostic performance of cut-offs. Methods and Results: We conducted a dual-approach, case-control study consisting of cases of bilateral, lower-limb lymphedema and healthy controls who self-reported absence of lymphedema. The diagnostic performance using normative data-derived cut-offs (i.e., mean + 0.5 standard deviation [SD] to mean + 3 SD; n = 136, 66% controls) and receiver operating characteristic (ROC) curve-derived cut-offs (n = 746, 94% controls) was assessed. The impact of sex, age, and BMI was investigated by comparing stratified and nonstratified normative data-derived cut-offs, and ROC curves generated from adjusted and unadjusted logistic regression models. Arm-to-leg ratios of ECW between mean + 0.5 SD and mean + 1 SD showed fair to good sensitivity (0.73-0.84) and poor to good specificity (0.64 to 0.84). Arm-to-leg ratios of ECW/ICW failed to detect lymphedema (sensitivity <0.5). Stratification by sex, or by sex and age, yielded similar results to nonstratified cut-offs. Cut-offs derived from adjusted ROC curves showed both good sensitivity (0.83-0.89) and specificity (0.8-0.84). Conclusion: These findings represent new BIS criteria for diagnosing lower-limb lymphedema that do not rely on comparison to baseline measures or the presence of a nonaffected, contralateral limb.

Original languageEnglish
Pages (from-to)101-109
Number of pages9
JournalLymphatic Research and Biology
Issue number2
Early online date5 Sept 2019
Publication statusPublished - Apr 2020


  • bilateral
  • diagnosis
  • lower-limb
  • lymphedema
  • unilateral
  • upper-limb


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