title: Reference ranges for assessment of unilateral lymphedema in legs by bioelectrical impedance spectroscopy.
abstract: BACKGROUND
  Secondary unilateral lymphedema in the leg may occur as a consequence of pelvic surgery and/or radiation therapy, which causes damage to the pelvic lymphatic system. To date, assessment has been typically by manual measurement of the volume excess of the affected leg compared to the contralateral leg. In contrast, the assessment of unilateral arm lymphedema is readily accomplished by the use of bioelectrical impedance spectroscopy (BIS) as an increased inter-arm impedance ratio due to the presence of excess lymph in the affected arm relative to that of the unaffected arm. The presence of lymphedema is defined by a value of this ratio greater than the mean ratio plus three standard deviations (SD) observed in a comparable healthy population. The aim of the present study was to determine the equivalent reference range of the impedance ratio for the legs. This would allow a cut-off value to be established as a criterion for the detection and assessment of lower limb lymphedema.
  
  
  METHODS
  The impedances of the legs of 172 healthy females and 150 healthy males, measured by BIS, were extracted from an accumulated database of impedance data. These data were used to determine the normal distribution of inter-leg impedance ratios and the reference range and threshold value (mean + 3 SD).
  
  
  RESULTS
  The presence of lymphedema is indicated when the impedance ratio exceeds 1.167 in males and 1.136 in females. Unlike in the arms, the effect of limb dominance in the legs is minimal and it is suggested that no correction for limb dominance is warranted.
  
  
  CONCLUSIONS
  The impedance ratio thresholds for lymphedema of the legs have been established, opening the way for BIS to become established clinically for the early detection and assessment of lower limb lymphedema.
authors.affiliation: School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Brisbane, Australia. l.ward@uq.edu.au
authors.forename: L C
authors.initials: LC
authors.lastname: Ward
authors.forename: E
authors.initials: E
authors.lastname: Dylke
authors.forename: S
authors.initials: S
authors.lastname: Czerniec
authors.forename: E
authors.initials: E
authors.lastname: Isenring
authors.forename: S L
authors.initials: SL
authors.lastname: Kilbreath
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D058266:Dielectric Spectroscopy; D017097:Electric Impedance; D005260:Female; D006801:Humans; D007866:Leg / Q000503:physiopathology*; D008209:Lymphedema / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D055815:Young Adult