ORCID Profile
0000-0001-7062-3367
Current Organisation
University of Newcastle Australia
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Publisher: Mary Ann Liebert Inc
Date: 03-2011
Abstract: Breast cancer-related lymphedema in the arm is commonly detected by bioelectrical impedance spectroscopy as an increased inter-arm impedance ratio due to the presence of excess lymph in the at-risk arm relative to that of the unaffected arm. The presence of lymphedema is determined by a value of this ratio greater than the mean ratio, plus three standard deviations observed in a comparable healthy population. This threshold value has not been established using the measurement protocols in current practice. The aim of the present study was to determine the reference range of the inter-arm impedance ratio to allow a cut-off value to be established as a criterion for the detection of breast cancer-related lymphedema. The mean and variation (3 SD) of the inter-arm impedance ratio for the arms of 172 healthy female control participants were determined from an accumulated database of impedance data obtained using present generation impedance instrumentation and methodology. This reference range and threshold value was compared to the original threshold ratio determined a decade ago but still in current use. The presence of lymphedema is indicated when the impedance ratio exceeded 1.106 when the nondominant limb is at risk, and 1.134 when the dominant limb is at risk compared with the currently used values of 1.066 and 1.139, respectively. Although the difference in these values was statistically significant, this difference was determined to be of minor importance to clinical practice. The impedance ratio thresholds for early detection of lymphedema remain suitable for clinical use with present day bioimpedance spectroscopy analyzers and measurement protocols.
Publisher: Mary Ann Liebert Inc
Date: 08-2018
Abstract: Breast cancer-related lymphedema (BCRL) is a chronic condition characterized by accumulation of lymph fluid that may subsequently become fibrotic with infiltration of adipose tissue. Bioimpedance spectroscopy (BIS) is the preferred method for early detection of lymphedema as it can estimate extracellular lymph fluid. This study developed a modified impedance technique that concurrently estimates both lymph accumulation and increases in adipose tissue. BIS was used to estimate the adipose tissue volume in a cohort of healthy women (n = 171), which was found to be highly correlated (r > 0.87) with measurements of adipose tissue obtained using the reference method of dual-energy X-ray absorptiometry (DXA). In a separate cohort of women with BCRL (n = 16), adipose volumes measured by BIS and reference method, respectively, were 2452.9 ± 933.3 mL and 2109.1 ± 824 6 mL for affected arms 1770.9 ± 747.8 mL and 1801.4 ± 775.7 mL for unaffected arms and comparable values for a group of age-matched controls were 1862.5 ± 661.6 mL and 1657.0 ± 641.1 mL for age-matched control arms. The increase in adipose tissue in affected arms was significant irrespective of the method of measurement, p < 0.02 and p < 0.001 for BIS and DXA, respectively. An impedance method is described that can estimate increase both in lymph accumulation and adipose tissue in breast cancer-related lymphedema.
Publisher: Mary Ann Liebert Inc
Date: 02-2018
Abstract: Lymphedema can have a negative impact on the function and quality of life (QOL) of patients, but most studies have examined lymphedema as a binary variable, rather than a multidimensional disease that ranges in severity. This study explored the potential impact of lymphedema severity on function and overall QOL. Of the 54 lymphedema patients recruited, 40 reported their most severe swelling to be in a limb. These participants underwent bioimpedance measurement (L-Dex Lymphedema severity did not appear to impact QOL. ISL staging may not be used alone to describe lymphedema severity. Other methods such as bioimpedance, imaging, and self-report of symptoms are required to fully evaluate the impact of lymphedema severity on function and QOL.
Publisher: Mary Ann Liebert Inc
Date: 03-2011
Abstract: 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. 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). 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. 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.
Publisher: Mary Ann Liebert Inc
Date: 08-2020
Publisher: Oxford University Press (OUP)
Date: 04-02-2019
DOI: 10.1093/PTJ/PZZ010
Abstract: Measurements of residual limb volume often guide decisions on the type and timing of prosthetic prescription. To help inform these decisions, it is important that clinicians use measurement tools that are reliable and valid. The aim of this systematic review was to investigate the reliability and validity of measurement tools for residual limb volume in people with limb utations. A comprehensive search on MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science was performed on July 11, 2016. Studies were included if they examined the reliability or validity of measurement tools for residual limb volume, were conducted on humans, and were published in English. Data were extracted from 11 reliability and 4 validity studies and included study characteristics, volumetric estimates, and reliability and validity estimates. The quality of the studies was also rated. Data from 2 studies (38 participants) indicated good to excellent intrarater (intraclass correlation coefficient [ICC] ≥0.88) and interrater (ICC ≥0.88) reliability and high between-session reliability (coefficient of variation [CV] = 10%) for water displacement volumetry. One study (28 participants) reported excellent intrarater and interrater reliability (ICC ≥0.93) for the circumferential method, and data from 2 studies (19 participants) indicated high between-session reliability for the optical surface scanner (CV ≤9.8%). Three studies (26 participants) indicated good to excellent between-session reliability results for computed tomography (CV = 9.2%–10.9%). One study (7 participants) showed moderate within-session reliability (CV = 50%). Using water displacement volumetry as the gold standard, 2 studies (79 participants) indicated excellent validity for the circumferential method ( r ≥0.92 ICC ≥0.92). All studies reporting measures of reliability or validity were performed with people who had transtibial utations. Only studies published in English and in which water displacement volumetry was used as the gold standard were included in this review. The reliability and validity of the quality rating scale used in this review have not been tested. On the basis of a limited number of moderate- to high-quality studies with small s le sizes, circumferential and water displacement methods were found to be reliable, and the circumferential method was found to be valid in people with transtibial utations. There are inadequate data for drawing conclusions about volume measurement methods in people with other types of limb utations.
Publisher: Mary Ann Liebert Inc
Date: 03-2015
Abstract: Changes in arm soft tissue composition, especially increased adipose tissue, has been found in advanced, non-pitting breast cancer-related lymphedema (BCRL). The aim of this study was to examine whether these changes were localized to any particular region of the arm and whether they occurred in lymphedema which still pitted to pressure. Secondary aims were to explore relationships between arm segment volumes, bioimpedance spectroscopy (BIS) measurements of extracellular fluid (ECF), and dual-energy X-ray absorptiometry (DXA) measurements of tissue composition. Nine women with unilateral BCRL participated. The dominant arm was affected in 4 women, and all presented with lymphedema that pitted to pressure. Arm volume was calculated from circumferences by the truncated cone method, ECF was determined with BIS and fat and lean tissue content measured by DXA. BIS and DXA measurements for women with lymphedema were made of the whole arm and also of four 10 cm-segments measured from the ulnar styloid at the wrist. Whole arm DXA data were compared to those of 45 women of similar age and body mass index without lymphedema. All women with lymphedema had a significantly larger absolute fat mass in their affected arm compared to their unaffected arm, (median difference between arms 146.9 g). The forearm segment 10 - 20 cm proximal to the wrist had the highest median inter-limb fat difference of all four arm segments. The soft tissue composition changes associated with BCRL may occur in the presence of pitting and predominantly affect the proximal forearm.
Publisher: Mary Ann Liebert Inc
Date: 03-2015
Abstract: Tissue dielectric constant (TDC) and spot bioimpedance measurement (BIA) have a role in the assessment of tissue composition changes in breast cancer-related lymphedema (BCRL). Our aims were to determine whether TDC and spot BIA measures could detect inter-limb differences in BCRL, explore the relationship between methods, and establish the intra-rater reliability and technical error of measurement for TDC. Women with (n=20) and without (n=4) unilateral BCRL participated. Circumference, TDC, and spot BIA measures were completed on the most affected region of the arm for BCRL participants and at a standardized forearm point in women without lymphedema. All measures were compared to measurements from an identical location on the contralateral arm. The affected arm differed significantly to the unaffected arm of women with BCRL for TDC and spot BIA measures. The median (IQR) differences were: extra-small probe 5.75 (3.10-8.21), small probe 3.50 (1.16-6.89), medium probe 5.08 (0.88-10.91), and for spot BIA measurement (-35.20 Ω -59.75 to -14.85 Ω). The small and medium TDC probe measures were moderately correlated to spot bioimpedance measurements (r=-0.54 and r=-0.43, respectively). Intra-rater reliability coefficients (ICC2,1) of TDC measures ranged from 0.50 (95% CI: 0.12-0.75) to 0.92 (0.82-0.96). TDC technical error of measurement for women with lymphedema varied from 10.5% to 13.3%. Both TDC and spot bioimpedance may have a role in clinical assessment of tissue compositional change in BCRL. Their relationship with tissue composition, assessed by imaging, is now required.
Publisher: Springer Science and Business Media LLC
Date: 15-05-2011
DOI: 10.1007/S00520-010-0896-8
Abstract: To determine if bioimpedance spectroscopy (BIS) could detect localised lymphoedema of the arm and to compare BIS measurements with equivalent measures of limb volume by perometry. Women with mild to severe upper limb lymphoedema (n = 29) and women with no history of lymphoedema (n = 11) participated. Commencing at the ulnar styloid of the wrist, 4 × 10 cm segment measurements were made of each arm using both BIS and perometry. Average BIS inter-limb ratios for the total arm and each arm segment were higher than comparable perometry measures in women with lymphoedema, but similar to perometry measures for women without lymphoedema. Limits of agreement analysis showed that the mean difference between methods varied according to segment measured, ranging from 8.5% for the uppermost segment of the arm to 16.6% for the forearm segment just below the elbow. For all limb segments, there was a positive bias towards BIS measurements, which increased as lymphoedema severity increased. BIS can be used for localised measurement of lymphoedema. Because it is specific to extracellular fluid, BIS is more sensitive to localised lymphoedema than perometry.
Publisher: BMJ
Date: 2011
DOI: 10.1097/IGC.0B013E31820866E1
Abstract: The aim of the present study was to determine if the ratio of extracellular fluid (ECF), including the lymph, to that of intracellular fluid (ICF), as measured by bioimpedance spectroscopy (BIS), could be used to assess bilateral lymphedema (LE). The presence of LE is commonly determined as an increase in tissue volume due to the presence of excess lymph relative to the volume of a comparable unaffected body region or to comparative normative data. However, in bilateral LE of the limbs, a comparable body region, the contralateral limb, is also affected, precluding normalization. An alternative is to normalize the increase in lymph volume, as ECF, to that of ICF volume. Extracellular/intracellular fluid ratios, expressed as the ratio of intracellular impedance ( R i ) to extracellular impedance ( R 0 ), for the limbs of 277 female and 224 male controls were determined from an accumulated database of impedance data. Equivalent data were obtained for an opportunistic cross-sectional s le of 37 female and 5 male participants with bilateral LE of the legs. The ratios of R i / R 0 in the lymphedematous legs of the affected participants were compared with the equivalent ratios in the unaffected arms of the same participants and with those of the controls using box plots and visualized as bivariate data using tolerance ellipses. Despite R i / R 0 ratios varying with age, sex, and limb dominance, comparison of the ratio for affected legs (normalized to the ratio in the unaffected arms) with equivalent ratios observed in a control population (as bivariate tolerance plots) was capable of discriminating between 70% and 89% of the participants with LE. Bioelectrical impedance spectroscopy and determination of R i /R 0 ratios as indices of ECF/ICF ratios holds promise for the semiquantitative assessment of bilateral LE.
Publisher: IOP Publishing
Date: 18-04-2013
Publisher: Springer Science and Business Media LLC
Date: 22-10-2019
DOI: 10.1186/S12885-019-6192-1
Abstract: Breast cancer related lymphoedema (BCRL) is a common side effect of cancer treatment. Recently indocyanine green (ICG) fluorescent lymphography has become a popular method for imaging the lymphatics, however there are no standard protocols nor imaging criteria. We have developed a prospective protocol to aid in the diagnosis and therapeutic management of BCRL. Lymphatic imaging procedures were conducted in three phases. Following initial observation of spontaneous movement of ICG in phase one, manual lymphatic drainage (MLD) massage was applied to facilitate ICG transit via the lymphatics in phase two. All imaging data was collected in phase three. Continuous lymphatic imaging of the upper limb was conducted for approximately an hour and lymphatic drainage pathways were determined. Correlations between the drainage pathway and MD Anderson Cancer Centre (MDACC) ICG lymphoedema stage were investigated. One hundred and three upper limbs with BCRL were assessed with this new protocol. Despite most of the patients having undergone axillary node dissection, the ipsilateral axilla drainage pathway was the most common (67% of upper limbs). We found drainage to the ipsilateral axilla decreased as MDACC stage increased. Our results suggest that the axillary pathway remained patent for over two-thirds of patients, rather than completely obstructed as conventionally thought to be the case for BCRL. We developed a new ICG lymphography protocol for diagnosing BCRL focusing on identification of an in idual patient’s lymphatic drainage pathway after lymph node surgery. The new ICG lymphography protocol will allow a personalised approach to manual lymphatic drainage massage and potentially surgery.
Publisher: Mary Ann Liebert Inc
Date: 06-2009
Abstract: The aim was to assess the agreement between bioimpedance indices and inter-limb volume differences, as assessed by perometry, for assessment of unilateral arm lymphedema. Impedance was measured in the arms of 45 women with lymphedema and a separate control group without lymphedema (n = 21). Arm volume was measured at the same time by perometry. The impedance indices, (ratio of impedances between limbs and the L-dex scores) were compared to the inter-limb volume differences using concordance correlation analysis. Impedance indices were highly correlated (r = 0.926) with the difference in arm volume measured by perometry. Bioelectrical impedance analysis, although not providing a quantitative volume measurement of lymphedema, provides a measurement index that is highly correlated with quantitative measurements of the volume increase in limb size seen in lymphedema. The speed and ease of the impedance technique renders it a suitable alternative to perometry for the assessment of lymphedema.
Publisher: Mary Ann Liebert Inc
Date: 03-2011
Abstract: Lymphedema of hand after breast cancer treatment causes significant loss of hand function. Although there are several ways of assessing limb volume, measuring hand volume has been problematic due to technical difficulties associated with assessment of finger volumes. The aim of this study was to investigate the criterion validity and reliability of Perometer™ for measuring hand volume in woman with and without lymphedema. Hand volume of forty women with (n = 20) and without lymphedema (n = 20) was assessed twice by one rater and once by another rater using the Perometer, and once by one rater using the water volumetry method. Intra- and inter-rater reliability was determined from the intraclass correlation coefficients and Percent Close Agreement. Agreement between the Perometer and water volumetry was determined using a limit of agreement and Lin's concordance correlation. The Perometer had high intra [ICC(2,1) = 0.989 (95% CI: 0.98-0.99)] and inter-rater reliability [ICC(2,1) = 0.993 (95% CI: 0.99-1.0)]. Percent close agreement revealed that 80% of the measures were within 9 ml for inter-rater reliability and within 15 ml for intra-rater reliability. In addition, there was high concordance between hand volumes obtained with the Perometer and water volumetry method (R(c) = 0.88). However, the Perometer overestimated the volume of hand compared to water volumetry method (bias: 7.5%). The Perometer can be used with high reliability to measure hand volume but caution should be exercised when data are compared with measures derived from the water volumetry method.
Publisher: Mary Ann Liebert Inc
Date: 09-2016
Abstract: An understanding of normal fluctuation of lymphedema over time is important to identify real change, whether it is from response to treatment or worsening of the condition. The weather is another factor that possibly influences lymphedema but has had minimal investigation to date. The purpose of this study was to determine the extent to which breast cancer-related lymphedema (BCRL) fluctuated over a 6-month period and the influence of temperature, humidity, and barometric pressure. Women with unilateral BCRL (n = 26) and without BCRL (n = 17) were measured on nine occasions over 6 months using a standardized protocol. Measures included self-reported arm swelling, arm volume, and extracellular fluid with bioimpedance. Daily weather data were obtained for analysis of effects on lymphedema. Neither arm volume nor extracellular fluid varied significantly for women with lymphedema coefficients of variation were 2.3% and 3.7%, respectively. Women without lymphedema had even less fluctuation, with coefficient of variation of 1.9% for arm volume and 2.9% for ECF. Correlation of weather and lymphedema data showed that temperature was the only aspect of the weather to have any effect on BCRL, with the maximum temperature on the day before measurement slightly affecting ECF (r = 0.27, p < 0.001), arm volume (r = 0.23, p < 0.001), and self-reported swelling (r = 0.26, p < 0.001). For women without lymphedema, the weather did not affect any measure. Established BCRL is relatively stable over a 6-month period. Temperature was the only aspect of the weather found to impact lymphedema.
Publisher: Springer Science and Business Media LLC
Date: 18-06-2009
DOI: 10.1007/S10549-008-0090-6
Abstract: The aims were to determine (i) whether single frequency bioimpedance analysis (SFBIA) is as accurate as bioimpedance spectroscopy (BIS) in measurement of extracellular fluid and (ii) whether change in extracellular fluid was specific to only the limb directly affected by surgery. Arms of the control (n = 28) and arm lymphedema group (n = 28) and legs of the leg lymphedema group (n = 16) were assessed with SFBIA. All four limbs in all participants were assessed with BIS. All measurements occurred in a single session. BIS-measured ratios were highly concordant with those obtained with SFBIA (r (c) = 0.99, P < 0.001). Repeated measures ANOVA revealed that the ratio involving the lymphedema limb was different to the ratio of the non-oedematous limbs which was not significantly different to the arm or leg ratios of the control group. SFBIA is a simple accurate alternative to BIS for the clinical assessment of unilateral lymphedema. BIS discriminates those with clinical diagnosis of unilateral lymhoedema from those without the diagnosis.
Publisher: Informa UK Limited
Date: 16-11-2010
DOI: 10.3109/07357900902918494
Abstract: To determine the relationship between physical methods of measuring lymphedema and self-reported swelling, their reliability, and standard error of measurement. Lymphedema in each arm of women with (n = 33) and without (n = 18) unilateral arm lymphedema, secondary to breast cancer was measured by self-report, bioimpedance spectroscopy (BIS), perometer, and the truncated cone method. The physical measurement tools were highly reliable (ICC((2,1)): 0.94 to 1.00) with high concordance (r(c): 0.89 to 0.99). Self-report correlated moderately with physical measurements (r = 0.65 to 0.71) and was moderately reliable (ICC((2,1)): 0.70). Lymphedema assessment methods are concordant and reliable but not interchangeable.
Publisher: Oxford University Press (OUP)
Date: 06-11-2020
DOI: 10.1002/BJS.11368
Abstract: This study documents the development and evaluation of a comprehensive multidisciplinary model for the assessment and personalized care of patients with lymphoedema. The Australian Lymphoedema Education Research and Treatment (ALERT) programme originated as an advanced clinic for patients considering surgery for lymphoedema. The programme commenced liposuction surgery in May 2012 and then introduced lymph node transfer in 2013 and lymphovenous anastomosis (LVA) in 2016. An outpatient conservative treatment clinic was established in 2016. ALERT commenced investigations with indocyanine green (ICG) lymphography in late 2015, leading to the creation of a diagnostic assessment clinic offering ICG in 2017. Since 2012, 1200 new patients have been referred to ALERT for assessment of lymphoedema for a total of 5043 episodes of care. The introduction of ICG lymphography in 2015 initially allowed better screening for LVA, but is now used not only to guide surgical options, but also as a diagnostic tool and to guide manual lymphatic drainage massage. The total number of new patients who attended the surgical assessment clinic to December 2018 was 477, with 162 patients (34·0 per cent) undergoing surgery. The ALERT programme has developed a multidisciplinary model of care for personalized lymphoedema treatment options based on clinical, imaging and ICG lymphography. Patients are selected for surgery based on several in idual factors.
Publisher: Springer Science and Business Media LLC
Date: 11-12-2009
DOI: 10.1007/S10549-008-0258-0
Abstract: The aim was to make bioimpedance spectroscopy (BIS) quantitative for assessment of lymphoedema. Apparent resistivity coefficients were determined for the intra- and extracellular water of arms in a control cohort of women (n = 66). These coefficients were used to predict water volumes in the arms of women with lymphoedema (n = 23) and a separate control group without lymphoedema (n = 13) and to compare these with total arm size measured by perometry. Total arm volume was highly correlated (r = 0.80-0.90) with arm fluid volumes predicted by BIS and the proportional increase in arm size predicted by BIS was not significantly different to that measured by perometry. BIS predicted that the increased volume in the women with lymphoedema was predominantly (60%) due to increase in extracellular fluid. BIS is capable of quantifying the volume increase in limb size seen in lymphoedema.
No related grants have been discovered for Sharon Czerniec.