Project: Utilizing indocyanine green lymphography (ICG) and bioimpedance spectroscopy (BIS) to understand lipedema diagnosis in comparison to lymphedema and obesity

Principal Investigator: Louise Koelmeyer, BAppSc(OT), PhD, Ms
Australian Lymphoedema Education Research and Treatment (ALERT) Program
Department of Health Sciences
Faculty of Medicine, Health and Human Sciences
Macquarie University
Macquarie Park, Australia

Co-Principal Investigator: Helen Mackie, MD
Australian Lymphoedema Education Research and Treatment (ALERT) Program
Department of Health Sciences
Faculty of Medicine, Health and Human Sciences
Macquarie University
Macquarie Park, Australia

Co-Principal Investigator: Belinda Thompson, PhD, MS
Australian Lymphoedema Education Research and Treatment (ALERT) Program
Department of Health Sciences
Faculty of Medicine, Health and Human Sciences
Macquarie University
Macquarie Park, Australia

Co-Principal Investigator: Hiroo Suami, MD, PhD
Australian Lymphoedema Education Research and Treatment (ALERT) Program
Department of Health Sciences
Faculty of Medicine, Health and Human Sciences
Macquarie University
Macquarie Park, Australia

Co-Principal Investigator: Leigh Ward, PhD
Australian Lymphoedema Education Research and Treatment (ALERT) Program
Department of Health Sciences
Faculty of Medicine, Health and Human Sciences
Macquarie University
Macquarie Park, Australia

Summary

This study aims to use bioimpedance spectroscopy (BIS), Indocyanine Green (ICG) lymphography and patient reported outcome measures (PROMs) to investigate differences between women with lipedema, women with bilateral lower limb lymphedema, and control participants.

Background

Lipedema is a condition characterized by a disproportion of adipose tissue, usually in the lower body, and almost exclusively experienced by women. Due to a current lack in diagnostic clarity, it is often misdiagnosed as lymphedema or obesity. This misdiagnosis leads to considerable patient distress, due to incorrect treatments failing to provide adequate medical care.

Methodology

This is an observational study of clinical data that has been collected from the ALERT multidisciplinary clinics and stored in the secure ALERT Databank (registry) for the purpose of future retrospective analysis. Women aged 18 years and over who presented for assessment of the lower limbs will be included in this study and divided into three groups based on their clinical presentation: lipedema, bilateral lower limb lymphoedema and control participants with no history of lipedema nor lymphoedema. Both the lymphedema and control group will be matched for age and BMI to participants in the lipedema group. 

ICG lymphography will be used to confirm the presence or absence of lymphedema in all three groups. BIS fluid and body composition measures, and PROMs will be compared between the groups with the aim of developing potential diagnostic thresholds that are indicative of lipedema or lymphedema compared with the control participants. 

Expected outcomes

This research has been designed to pave the way for an exciting new phase in the understanding, diagnosis and treatment of lipedema. It is hypothesized that women with lipedema will show differences in BIS measures and PROMs compared with women in the lymphedema and control groups. The identification of thresholds indicative of lipedema compared with women with lymphedema may help differentiate between the two conditions and guide therapeutic management, ultimately improving patient outcomes.

Practical implementations of results

This study provides the opportunity to assess the diagnostic power of combining ICG with BIS, together with the potential of PROMs to differentiate between lipedema and lymphoedema, paving the way for further research to improve lipedema diagnosis. Translating these results to clinical education will reduce the risk of misdiagnosing women with lipedema for lymphedema or obesity. This will positively affect women with lipedema, ensuring appropriate therapies are prescribed to improve outcomes.

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