{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T15:56:18Z","timestamp":1781366178586,"version":"3.54.1"},"reference-count":24,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2020,4,1]],"date-time":"2020-04-01T00:00:00Z","timestamp":1585699200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lymphatic Research and Biology"],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results:<\/jats:title>\n                    <jats:p>\n                      We conducted a dual-approach, case\u2013control 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\u2009+\u20090.5 standard deviation [SD] to mean\u2009+\u20093 SD;\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009136, 66% controls) and receiver operating characteristic (ROC) curve-derived cut-offs (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009746, 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\u2009+\u20090.5 SD and mean\u2009+\u20091 SD showed fair to good sensitivity (0.73\u20130.84) and poor to good specificity (0.64 to 0.84). Arm-to-leg ratios of ECW\/ICW failed to detect lymphedema (sensitivity &lt;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\u20130.89) and specificity (0.8\u20130.84).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/lrb.2018.0078","type":"journal-article","created":{"date-parts":[[2019,9,5]],"date-time":"2019-09-05T10:11:17Z","timestamp":1567678277000},"page":"101-109","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":23,"title":["A Bioimpedance Spectroscopy-Based Method for Diagnosis of Lower-Limb Lymphedema"],"prefix":"10.1177","volume":"18","author":[{"given":"Megan L.","family":"Steele","sequence":"first","affiliation":[{"name":"Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia."},{"name":"School of Clinical Medicine, The University of Queensland, Brisbane, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Janda","sequence":"additional","affiliation":[{"name":"Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia."},{"name":"Faculty of Health, Centre for Health Services Research, The University of Queensland, Brisbane, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Vagenas","sequence":"additional","affiliation":[{"name":"Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leigh C.","family":"Ward","sequence":"additional","affiliation":[{"name":"School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce H.","family":"Cornish","sequence":"additional","affiliation":[{"name":"Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn","family":"Box","sequence":"additional","affiliation":[{"name":"Queensland Lymphedema &amp; Breast Oncology Physiotherapy, Brisbane, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Gordon","sequence":"additional","affiliation":[{"name":"College of Healthcare Sciences, James Cook University, Townsville, Australia."},{"name":"College of Nursing and Health Sciences, Flinders University, Adelaide, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Matthews","sequence":"additional","affiliation":[{"name":"College of Healthcare Sciences, James Cook University, Townsville, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally D.","family":"Poppitt","sequence":"additional","affiliation":[{"name":"Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay D.","family":"Plank","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Auckland, Auckland, New Zealand."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson","family":"Yip","sequence":"additional","affiliation":[{"name":"Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Rowan","sequence":"additional","affiliation":[{"name":"Fonterra Co-operative Group Limited, Auckland, New Zealand."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hildegard","family":"Reul-Hirche","sequence":"additional","affiliation":[{"name":"Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Obermair","sequence":"additional","affiliation":[{"name":"Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra C.","family":"Hayes","sequence":"additional","affiliation":[{"name":"Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,4,17]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms18010171"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.sap.0000257149.42922.7e"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-14493-1"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2017.09.004"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23494"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-017-4451-x"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269215518757292"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/tbj.12939"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-52423-8_16"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2010.0024"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2010.0014"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/000331970205300106"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/IGC.0b013e31820866e1"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2017.0082"},{"key":"e_1_3_4_16_2","unstructured":"Impedimed Ltd. 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