The L-Dex XCA is a bioimpedance analyzer designed to assist in the clinical assessment of unilateral lymphedema of the arm. The L-Dex XCA utilizes a simple linear scale called the L-Dex (lymphedema index). The L-Dex ranges from -10 to +10 and defines the normal range of L-Dex values for a patient without lymphedema. The presence or absence of lymphedema is assessed by comparing the patient’s L-Dex to this range.

The National Lymphedema Network position statement, Screening and Measurement for Early Detection of Breast Cancer Related Lymphedema, updated April 2011, states that circumferential tape measurements are acceptable means of measuring limb volume. The current position statement states “bioelectrical spectroscopy (BIS) or infrared perometry are suggested as alternative or adjunctive methods to circumferential measurement.” A technology assessment of the diagnosis and management of secondary lymphedema prepared for the Agency for Healthcare Research and Quality (Oremus et al, 2010) concluded: “There is consistent evidence to indicate that lymphedema can be reliably measured using circumferential measures or volume displacement … There is too little evidence to draw conclusions about the reliability of other tests such as tonometry, ultrasound, lymphoscintigraphy, or bioimpedance.” The Northern Ireland CREST Committee guidelines for lymphedema (2008) recommend circumferential limb volume measurement for assessing limb volume. Bioimpedance measurement is described as promising, noting that it should be considered over the next 5 years. Presumably, an updates statemetns will soon be issued.
by Shah et al says that However the most recent guideline says that Bioimpedance spectroscopy represents a standard diagnostic approach to assess for breast cancer-related lymphedema, allowing for early detection and treatment. BIS should be used as part of routine clinical care starting with measurement prior to treatment; however, BCRL surveillance can be utilized without a pre-treatment assessment. The updated clinical practice guidelines are supported by evidence from a randomized controlled trial and other real-world data.

Torgbenu E, Luckett T, Buhagiar MA, Phillips JL. Guidelines Relevant to Diagnosis, Assessment, and Management of Lymphedema: A Systematic Review. Adv Wound Care (New Rochelle). 2023 Jan;12(1):15-27. doi: 10.1089/wound.2021.0149.

The National Cancer Institute Physician Data Query (PDQ) on lymphedema (NCI, 2011) states that circumferential upper-extremity measurement is the most widely used method to diagnose upper-extremity lymphedema. Bioimpedance is listed among several other options for evaluating limb volume. The PDQ also stated that a study comparing various methods of assessing upper-limb lymphedema did not show any superiority of any one method; for support, the PDQ cited a study by Ridner, et al. (2007) comparing circumferential limb measurements to bioimpedance and perometry.
n the balance, there is some support in guideliens for the concept of testing for the risk of lymphedema over time, but specifically bioimpedance appears not to be well supported.

Torgbenu E, Luckett T, Buhagiar MA, Phillips JL. Guidelines Relevant to Diagnosis, Assessment, and Management of Lymphedema: A Systematic Review. Adv Wound Care (New Rochelle). 2023 Jan;12(1):15-27. doi: 10.1089/wound.2021.0149.

Shah C, Whitworth P, Valente S, Schwarz GS, Kruse M, Kohli M, Brownson K, Lawson L, Dupree B, Vicini FA. Bioimpedance spectroscopy for breast cancer-related lymphedema assessment: clinical practice guidelines. Breast Cancer Res Treat. 2023 Feb;198(1):1-9.

The ReidSleeve® (Peninsula Medical, Inc., Scotts Valley, CA) is a custom-fitted, non-elastic sleeve that provides compression to assist in flow of lymphatic fluid. According to the manufacturer’s website, the  sleeve contains a foam insert and works by applying high and low pressure to different parts of the affected area. The high-pressure zones force excess fluid into the areas under lower pressure, forming channels by which the lymphatic fluid can be removed through the lymphatic and venous system. The Contour® and Optiflow® sleeves are made by the same manufacturer as the ReidSleeve and use the same technology but are lighter sleeves that are intended for patients with mild to moderate lymphedema. ArmAssist® and LegAssist® (MedAssist Group, Tampa, FL) are other custom-fabricated, non-elastic compression sleeves. CircAid® (CircAid Medical Products Inc., San Diego, CA) is a non-elastic compression sleeve that is available prefabricated and custom-fitted. THe FDA approval was based on the original study that demonstrated that  edema in the hands of affected patients was reduced by an average of 80%. U.S. Food and Drug Administration (FDA): The FDA has classified compression sleeves as Class I devices, therapeutic medical binders. They are exempt from the premarket notification procedure. Such devices meet a much lower burden of proof to be considered medically necessary.

Read the Professional version here.

Read the Professional version here.