Beyond the Limb

Using BIS in Breast Oedema Assessment and Clinical Decision-Making

With Maureen McBeth, Sr. Manager Clinical Research Education – Impedimed

Breast and chest wall oedema following cancer treatment can present challenges for assessment and ongoing management, particularly when clinical symptoms do not align with bioimpedance spectroscopy (BIS) measurements.

In this three-part presentation, Maureen McBeth explores how clinicians can use BIS alongside clinical assessment to better understand changes in breast and arm oedema, interpret measurement trends and support informed clinical decisions.

Using practical case examples and SOZO® reports, Maureen highlights the importance of recognising what BIS can and cannot measure, looking beyond a single L-Dex® score and considering the broader clinical picture. The presentation also introduces the role of body composition assessment in identifying changes in fluid and muscle mass during and after cancer treatment.

Watch the three-part presentation

Part 1: Understanding BIS in Breast and Arm Oedema

Why a normal L-Dex score does not necessarily mean an absence of oedema. Maureen examines the differences between breast and limb oedema, the importance of clinical assessment, and four case patterns demonstrating how BIS findings can inform surveillance and management.

Part 2: A Practical Five-Question Assessment Framework,

A practical five-step approach to assessment: clinical presentation, baseline, trend, asymmetry and context. Through patient examples, Maureen demonstrates how to interpret serial measurements and segmental data, and why clinical findings must guide the interpretation of BIS results.

Part 3: Beyond Fluid: Body Composition and Sarcopenia Risk

Expanding assessment beyond limb fluid measurements. Maureen introduces body composition metrics, including skeletal muscle mass, and explores how these measurements may help identify patients at risk of sarcopenia and support timely nutrition, exercise and multidisciplinary interventions.

Clinical Takeaways: Applying BIS in Practice

he following points bring together the key clinical messages from Maureen’s presentation. 

  1. A normal L-Dex score does not exclude breast oedema: Isolated breast oedema may occur without measurable limb asymmetry. Assess the breast, chest wall and arm independently, rather than relying on the L-Dex score alone.
  2. Begin with the clinical presentation: Consider tissue appearance, texture, pitting, firmness, warmth and the patient’s reported symptoms. Document changes in heaviness, fullness, discomfort and garment fit.
  3. Look for trends, not just individual measurements: Establish a pretreatment baseline where possible and review changes over time. Consider L-Dex trends, segmental asymmetry and extracellular fluid measurements alongside clinical findings.
  4. Distinguish fluid changes from tissue changes: Breast firmness or warmth following radiation may reflect tissue responses rather than fluid accumulation. Clinical examination helps determine appropriate management and monitoring.
  5. Consider the whole-body picture: Body composition measurements can provide additional information about fluid distribution and muscle mass. Changes in skeletal muscle may warrant further assessment and referral for nutrition or exercise support.

Key message: BIS provides valuable objective information, but it does not replace clinical assessment. Meaningful interpretation requires consideration of the patient’s symptoms, examination findings, measurement trends and broader health status.

Thank you

Thank you to Impedimed and Regional Health Care Group for supporting the development of this resource and ongoing clinical learning. Inclusion does not imply endorsement, and clinicians are encouraged to apply their own professional judgement in all aspects of patient care.