Diagnosing Male Unilateral Upper Limb Lymphedema: Determination of Normatively Determined Thresholds Using Bioimpedance Spectroscopy
Alice Zhi Ting Xie, BAppSc (Phty) Hons, Mi-Joung Lee, PhD, and Elizabeth Dylke, PhD. Lymphatic Research Biology 2019
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Diagnosing Male Unilateral Upper Limb Lymphedema: Determination of Normatively Determined Thresholds Using Bioimpedance Spectroscopy
Alice Zhi Ting Xie, BAppSc (Phty) Hons, Mi-Joung Lee, PhD, and Elizabeth Dylke, PhD. Lymphatic Research Biology 2019
Background: The use of bioimpedance spectroscopy (BIS) for the detection of unilateral upper limb lymphedema is growing. Currently, normatively determined diagnostic thresholds using bioimpedance are available for females only. It is unclear if they are suitable for males at risk of unilateral upper limb lymphedema. The aim of the present study was to determine normatively based bioimpedance thresholds for male unilateral upper limb lymphedema.
Methods and Results: Impedance values (R0) for the upper limbs of 60 healthy adult male participants were assessed using BIS. As has been found in females, dominance was found to significantly impact on R0 values (p=0.002); therefore, two diagnostic thresholds are required depending on the at-risk limb. Interlimb impedance thresholds were calculated, set at both two standard deviations (2SD) and three standard deviations (3SD) above the mean. The 3SD threshold for unilateral lymphedema in the upper limbs of males is 1.127 for the dominant at-risk limb and 1.094 for the nondominant at-risk limb. The 2SD threshold is 1.090 for the dominant at-risk limb and 1.058 for the nondominant at-risk limb. These differ from what has previously been found for females.
Conclusions: This study is the first to establish normatively determined bioimpedance thresholds for male unilateral upper limb lymphedema. These thresholds should now be used to improve early detection of male unilateral upper limb lymphedema.
Main findings
- Sixty adult male volunteers were recruited.
- This study has, for the first time, established the BIS diagnostic thresholds for the assessment of unilateral upper limb lymphedema in the male population.
- As has been found for the female and male lower limb impedance ratios,16 male impedance ratios were not influenced by participant characteristics such as age or BMI. However, limb dominance did influence the measured impedance.
- The 3SD female diagnostic thresholds are 1.136 for the dominant at-risk arm and 1.066 for the nondominant at-risk arm,8 in comparison with the male thresholds of 1.127 and 1.094, respectively. These findings have clinical implications. If female thresholds are inappropriately applied to a male, the existing female thresholds may yield false-positive results with nondominant at-risk limbs and overdiagnose the male population. Similarly, for the dominant arm, males may be underdiagnosed using the female normative threshold. This supports the need for the adoption of male-specific diagnostic thresholds. With diagnostic criteria established for both genders, this discrepancy can be avoided.
