Multimodal Assessment of Breast Cancer-Related Lymphedema Using Bioimpedance Analysis, Ultrasound Tissue Thickness, and Shear Wave Elastography

Background/Objectives: Lymphedema is a chronic condition caused by impaired lymphatic function that is characterized by fluid accumulation with progression to tissue thickening and fibrosis. Although various noninvasive assessment methods have been proposed, studies that have integrated fluid, structural, and stiffness-related changes are limited. To address this gap, we conducted an integrated multimodal assessment combining multiple-frequency bioelectrical impedance analysis (MFBIA), ultrasound tissue thickness measurements, and shear wave elastography (SWE) to characterize stage-specific changes in breast cancer-related lymphedema. Methods: This prospective cross-sectional study included patients who had undergone breast cancer surgery. Participants were classified into the clinical and subclinical lymphedema groups based on MFBIA criteria. Dermal thickness, subcutaneous thickness, and tissue stiffness measurements in both upper limbs were obtained using SWE on the same day. MFBIA parameters including extracellular water ratio, 5 kHz impedance ratio, and phase angle were assessed. Ipsilateral and contralateral limbs were compared, and correlation analyses of variables were performed. Results: Dermal thickness and subcutaneous thickness in the ipsilateral limb were greater than those in the contralateral limb in the overall cohort and subclinical group. Increased tissue stiffness measured using SWE was observed only in the clinical lymphedema group. MFBIA parameters in the clinical group were higher than those in the subclinical group. According to the correlation analysis, MFBIA parameters were associated with tissue thickness and SWE parameters were not correlated with other variables. Conclusions: These findings support the clinical utility of a multimodal approach for the stage-specific evaluation of breast cancer-related lymphedema, thereby facilitating stage-based and individualized management.