{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T03:58:49Z","timestamp":1785729529995,"version":"3.56.0"},"reference-count":36,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Biomed Eng"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Breast cancer\u2013related lymphedema (BCRL) is a chronic complication that impairs quality of life through persistent fluid accumulation. While clinical guidelines recommend longitudinal surveillance, implementation is often limited by the logistical challenges of frequent in-clinic visits. Bioelectrical impedance analysis (BIA), specifically the segmental extracellular water\u2013to\u2013total body water (ECW\/TBW) ratio, offers a noninvasive method for tracking fluid status. However, the technical agreement between in-clinic and patient-led home-based BIA systems, as well as the feasibility of long-term self-monitoring in real-world settings, remains to be fully established.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n Our primary objective was to evaluate the agreement between in-clinic and home-based BIA systems for key body composition and fluid-related parameters. Our secondary objective was to characterize longitudinal fluid patterns and diurnal variations in ECW\/TBW ratios to assess the feasibility of home-based monitoring.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This prospective, patient-driven, 12-month observational study enrolled breast cancer survivors at risk for lymphedema. Agreement between the in-clinic BIA system (InBody 770) and the home-based device (BWA ON) was assessed using Bland-Altman analysis, intraclass correlation coefficients (ICCs), and the Lin concordance correlation coefficient (CCC). Longitudinal home-based ECW\/TBW measurements were analyzed using linear mixed-effects models to evaluate diurnal differences (before-noon vs after-noon) across groups defined by limb dominance and BCRL status (International Society of Lymphology [ISL] stage 0 vs stage 1).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Over 12 months, ECW\/TBW ratios measured by the home-based device demonstrated strong agreement with in-clinic measurements, showing minimal bias and high ICC\/CCC values. Longitudinal analysis revealed that ECW\/TBW changes did not follow uniform patterns within ISL stage categories, showing substantial physiological heterogeneity even among clinically stable groups. Diurnal analysis identified a small but statistically significant decrease in ECW\/TBW ratios in the afternoon (\n P<\/jats:italic>\n <.001). The magnitude of this decrease differed by limb dominance and BCRL status, with the most pronounced reduction observed in participants whose dominant arm was affected and who had a history of stage 1 lymphedema. ECW\/TBW variability was driven more by within-individual factors (eg, measurement timing) than by between-individual differences.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Home-based segmental bioimpedance provides reliable longitudinal data and reveals granular fluid patterns not captured by conventional ISL staging alone. The significant impact of diurnal variation, particularly in relation to limb dominance, underscores the need for standardizing measurement protocols. Standardizing home-based measurements to a fixed monitoring time can minimize physiological noise and enhance the interpretability of long-term self-monitoring strategies for breast cancer survivors.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/86624","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T14:20:06Z","timestamp":1776090006000},"page":"e86624-e86624","source":"Crossref","is-referenced-by-count":1,"title":["Remote Monitoring of Bioelectrical Impedance in Patients With Breast Cancer\u2013Related Lymphedema: 1-Year Pilot Longitudinal Study"],"prefix":"10.2196","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4132-142X","authenticated-orcid":false,"given":"Lori","family":"Bravi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7886-1191","authenticated-orcid":false,"given":"Cheri","family":"Teranishi-Hashimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1554-5439","authenticated-orcid":false,"given":"Elena A C","family":"MacDonald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4841-8515","authenticated-orcid":false,"given":"Dayna","family":"Huntley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2965-9074","authenticated-orcid":false,"given":"Samman","family":"Shahpar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0248-266X","authenticated-orcid":false,"given":"Jami","family":"Fukui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8410-3629","authenticated-orcid":false,"given":"Monica","family":"Padilla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9556-0067","authenticated-orcid":false,"given":"Yoomi","family":"Heo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6375-7719","authenticated-orcid":false,"given":"Linda A","family":"Koehler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.21654","article-title":"Cancer statistics, 2021","volume":"71","author":"Siegel","journal-title":"CA Cancer J Clin"},{"issue":"44","key":"R2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000012945","article-title":"Reference values of bioelectrical impedance analysis for detecting breast cancer-related lymphedema","volume":"97","author":"Jung","journal-title":"Medicine (Baltimore)"},{"issue":"2","key":"R3","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1016\/j.jvsv.2022.10.006","article-title":"Bioelectrical impedance analysis in patients with breast cancer-related lymphedema before and after lymphaticovenular anastomosis","volume":"11","author":"Roh","journal-title":"J Vasc Surg Venous Lymphat Disord"},{"issue":"2","key":"R4","doi-asserted-by":"publisher","first-page":"51","DOI":"10.5152\/turkjsurg.2017.3870","article-title":"Lymphedema: From diagnosis to treatment","volume":"33","author":"Kay\u0131ran","journal-title":"Turk J Surg"},{"issue":"4","key":"R5","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1097\/PRS.0000000000000010","article-title":"Operative treatment of peripheral lymphedema: A systematic meta-analysis of the efficacy and safety of lymphovenous microsurgery and tissue transplantation","volume":"133","author":"Basta","journal-title":"Plast Reconstr Surg"},{"issue":"4","key":"R6","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1111\/j.1524-4741.2012.01252.x","article-title":"Breast-cancer related lymphedema: A review of procedure-specific incidence rates, clinical assessment AIDS, treatment paradigms, and risk reduction","volume":"18","author":"Shah","journal-title":"Breast J"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.1062472","article-title":"The prevention and treatment of breast cancer- related lymphedema: A review","volume":"12","author":"McEvoy","journal-title":"Front Oncol"},{"issue":"2","key":"R8","doi-asserted-by":"publisher","first-page":"187","DOI":"10.3978\/j.issn.2227-684X.2015.11.06","article-title":"Lymphatic mapping and preoperative imaging in the management of post-mastectomy lymphoedema","volume":"5","author":"Chowdhry","journal-title":"Gland Surg"},{"issue":"2","key":"R9","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.clbc.2021.02.009","article-title":"Prevention of breast cancer-related lymphedema","volume":"21","author":"McEvoy","journal-title":"Clin Breast Cancer"},{"issue":"6","key":"R10","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1056\/NEJMoa012782","article-title":"A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer","volume":"349","author":"Veronesi","journal-title":"N Engl J Med"},{"issue":"32","key":"R11","doi-asserted-by":"publisher","first-page":"5213","DOI":"10.1200\/JCO.2008.16.3725","article-title":"Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: Objective measurements","volume":"26","author":"McLaughlin","journal-title":"J Clin Oncol"},{"key":"R12","unstructured":"Thorne CH , editor. Grabb and Smith\u2019s Plastic Surgery. In: Lymphedema: Diagnosis and Treatment. Vol 2013. 7th ed. Wolters Kluwer Health; :980-988."},{"key":"R13","unstructured":"Defining best practices in lymphatic health. National Lymphedema Network. URL: https:\/\/lymphnet.org\/page\/position-papers [Accessed 19-01-2026]"},{"issue":"4","key":"R14","first-page":"170","volume":"49","author":"Executive Committee","journal-title":"Lymphology"},{"issue":"2","key":"R15","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1007\/s12609-013-0105-0","article-title":"Best practice guidelines in assessment, risk reduction, management, and surveillance for post-breast cancer lymphedema","volume":"5","author":"Armer","journal-title":"Curr Breast Cancer Rep"},{"issue":"3","key":"R16","doi-asserted-by":"publisher","first-page":"424","DOI":"10.3390\/jpm4030424","article-title":"Surveillance recommendations in reducing risk of and optimally managing breast cancer-related lymphedema","volume":"4","author":"Ostby","journal-title":"J Pers Med"},{"issue":"1","key":"R17","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/01893697-201432010-00004","volume":"32","author":"Harrington","journal-title":"Rehabil Oncol"},{"issue":"3","key":"R18","doi-asserted-by":"publisher","first-page":"311","DOI":"10.3390\/jpm5030311","article-title":"Prospective lymphedema surveillance in a clinic setting","volume":"5","author":"Chance-Hetzler","journal-title":"J Pers Med"},{"issue":"3","key":"R19","doi-asserted-by":"publisher","first-page":"241","DOI":"10.5306\/wjco.v5.i3.241","article-title":"Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management","volume":"5","author":"Fu","journal-title":"World J Clin Oncol"},{"issue":"17","key":"R20","doi-asserted-by":"publisher","first-page":"9810","DOI":"10.3390\/app13179810","article-title":"Quantitative assessment of upper-limb volume: Implications for lymphedema rehabilitation?","volume":"13","author":"Lippi","journal-title":"Appl Sci (Basel)"},{"issue":"10","key":"R21","doi-asserted-by":"publisher","DOI":"10.1007\/s12032-024-02472-9","article-title":"Current diagnostic and quantitative techniques in the field of lymphedema management: a critical review","volume":"41","author":"Vargo","journal-title":"Med Oncol"},{"issue":"4","key":"R22","doi-asserted-by":"publisher","first-page":"1330","DOI":"10.4143\/crt.2015.463","article-title":"Identification of prognostic risk factors for transient and persistent lymphedema after multimodal treatment for breast cancer","volume":"48","author":"Kim","journal-title":"Cancer Res Treat"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1007\/s12609-010-0009-1","article-title":"Lymphedema: How do we diagnose and reduce the risk of this dreaded complication of breast cancer treatment?","volume":"2","author":"Bernas","journal-title":"Curr Breast Cancer Rep"},{"issue":"4","key":"R24","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1089\/lrb.2014.0035","article-title":"The importance of detection of subclinical lymphedema for the prevention of breast cancer-related clinical lymphedema after axillary lymph node dissection; a prospective observational study","volume":"12","author":"Soran","journal-title":"Lymphat Res Biol"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2016.00192","article-title":"The impact of L-Dex(\u00ae) measurements in assessing breast cancer-related lymphedema as part of routine clinical practice","volume":"6","author":"Laidley","journal-title":"Front Oncol"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b5396","article-title":"Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: Randomised, single blinded, clinical trial","volume":"340","author":"Torres Lacomba","journal-title":"BMJ"},{"issue":"1","key":"R27","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s11764-009-0103-4","article-title":"The role of occupational upper extremity use in breast cancer related upper extremity lymphedema","volume":"4","author":"Tahan","journal-title":"J Cancer Surviv"},{"issue":"3","key":"R28","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1007\/s10549-009-0578-8","article-title":"Axillary reverse mapping for breast cancer","volume":"119","author":"Noguchi","journal-title":"Breast Cancer Res Treat"},{"issue":"10","key":"R29","doi-asserted-by":"publisher","first-page":"2948","DOI":"10.1245\/s10434-018-6601-8","article-title":"Reducing breast cancer-related lymphedema (BCRL) through prospective surveillance monitoring using bioimpedance spectroscopy (BIS) and patient directed self-interventions","volume":"25","author":"Kilgore","journal-title":"Ann Surg Oncol"},{"issue":"1","key":"R30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10549-022-06850-7","article-title":"Bioimpedance spectroscopy for breast cancer-related lymphedema assessment: Clinical practice guidelines","volume":"198","author":"Shah","journal-title":"Breast Cancer Res Treat"},{"issue":"2","key":"R31","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/j.bjps.2019.06.041","article-title":"Multi-segment bioimpedance can assess patients with bilateral lymphedema","volume":"73","author":"Qin","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"2","key":"R32","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1080\/07315724.1992.12098245","volume":"11","author":"Kushner","journal-title":"J Am Coll Nutr"},{"issue":"5","key":"R33","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1093\/ajcn\/56.5.835","article-title":"Is the impedance index (ht2\/R) significant in predicting total body water?","volume":"56","author":"Kushner","journal-title":"Am J Clin Nutr"},{"issue":"4","key":"R34","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1152\/jappl.1969.27.4.531","article-title":"Correlation of whole-body impedance with total body water volume","volume":"27","author":"Hoffer","journal-title":"J Appl Physiol"},{"issue":"4","key":"R35","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000023722","article-title":"Feasibility of segmental bioelectrical impedance analysis for mild- to moderate-degree breast cancer-related lymphedema: Correlation with circumferential volume measurement and phase angle","volume":"100","author":"Kim","journal-title":"Medicine (Baltimore)"},{"key":"R36","unstructured":"McArdle WD Katch FI Katch VL . Exercise Physiology: Energy, Nutrition, and Human Performance. 5th ed. Lippincott Williams & Wilkins; 2001."}],"container-title":["JMIR Biomedical Engineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/biomedeng.jmir.org\/2026\/1\/e86624","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:14:25Z","timestamp":1782839665000},"score":1,"resource":{"primary":{"URL":"https:\/\/biomedeng.jmir.org\/2026\/1\/e86624"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,5]]},"references-count":36,"URL":"https:\/\/doi.org\/10.2196\/86624","relation":{},"ISSN":["2561-3278"],"issn-type":[{"value":"2561-3278","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,5]]},"article-number":"v11i1e86624"}}